The Brain, Brain, Brain, Brain, Brain

We all have one. You might think some don’t, but we do. It helps you balance, see, process ideas, remember song lyrics, hear, recognise people and places, sleep and just about everything you do. Only a handful of reactions and functions, for example reflexes, are not controlled by your brain. Yet the brain, to me, is the easiest organ of them all to remove from a person. Apart from the pesky skull, the brain is kind of floating about with not that many connections. This week I took my first brain out and that was incredibly awesome.

As part of a post mortem the brain is examined. This could be for a number of reasons, but mainly I’ve seen the pathologist look for injury or bleeds. A brain with a bleed is often quite obvious from the moment the skull is opened as far as I’ve seen so far.

The skull is cut with an oscillating saw which is often called a bone saw or autopsy saw. It blows my mind that it can cut through bone and solid things like plaster casts but it couldn’t cut your skin or even the glove on your hand. I’ve tried to read about how this works with not much luck I’ll add! More about the saws we use here. With quite a wide section of the skull removed, mostly the top of the head, the layer between the brain and the skull can be seen. This is known as the dura and is a thickish membrane which surrounds your brain. Sometimes this can be stuck to the section of the skull removed and this needs to be peeled off in order to ascertain if there are any skull fractures. If not, the dura can be removed from the area opened to reveal the brain.

The brain is removed quite simply by scooping it out from the front and detaching it from the optic nerves, the membranes attaching it to the base of the skull and the spinal cord. In its entirety, the brain weight can be very different between people but tends to be the same colour and shape. Holding one in your hands is a very humbling experience is all I can say. Oh and they’re not bright pink like you see on tv a lot of the time, they tend to range between a grey colour and a weird shade of beige.

Hopefully with time I will learn more and more about this to share, for now my knowledge is quite limited. I started today learning more about being able to recognise certain parts for post mortem and how to tell if certain injuries or problems are present with my Manager which was brilliant.

A final note to say the HTA inspection I wrote about on Tuesday and that happened this week went very well. I felt like I discovered a lot more about what they were looking for and why. I wasn’t too fearful of them because they were very friendly and I certainly feel less afraid of any inspections going forward!

Have a great weekend and thanks, as always, for taking the time to read.

MG x

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The HTA- who, what, why & how

The Human Tissue Act 2004 was introduced off the back of a number of scandals in the UK. The main scandal that people speak of in reference to this is the Alder Hey organs scandal from 1988 to 1995 where organs and tissue of a number of children were held without permission or consent from their parents. More can be seen about the scandal here. This was alongside a number of other issues which meant something had to change in the country. It is important to note here that this act applies only to England, Wales and Northern Ireland, Scotland have a similar but different legislation of their own.

The idea behind this change in legislation was to aid the public’s confidence in the system by aiming to ‘regulate the removal, storage, use and disposal of human bodies, organs and tissue’. This also introduced a governing body known as the Human Tissue Authority (HTA). The HTA’s role is to enforce the polices and legislation by providing guidance and issuing licenses to institutions who have contact with human tissue in a number of environments.

The licenses they issue depend of what kind of institution they are licensing. It varies from mortuaries like where I work where a license will be issued to conduct post-mortem examinations, to museums like Bart’s Pathology Museum who will be licensed to display human tissue for research and study. Their work is important, and is enforced by inspections.

Such an inspection is occurring tomorrow and Thursday where I work. Representatives of the HTA will be coming to visit to ensure that we at the mortuary are compliant with their guidelines, are fit for work and have practices that fit with the manner of our license. More about the inspections can be found on their website here.

If you would like to know more about the HTA yourself, a good place to start are their guides for the public which are https://www.hta.gov.uk/guidance-public/public-guides-hta-codes-practice

I’m excited to see what they do, how they go about it and to learn more about the HTA from them. I feel like I have read a lot about them on their website but seeing it for myself will be the real learning experience. Hope you are all having a good week so far and thank you for reading!

MG x

Eye Donation with NHSBT

The first full week of the year and five day week for some time seemed to simultaneously go fast and slow if such a thing is possible. Slow in that, by the time Friday evening rolled around, I was physically and mentally completely exhausted. I couldn’t pull my brain together to write this yesterday and normally I can get this done easily! It went fast in that so much happened it feels a bit like a blur.

The capacity issues of previous weeks seem to be becoming less of a problem (I really hope I haven’t spoken too soon on that front) and we caught up on all the the post-mortems that were required as of Friday. This is great because next Wednesday the hospital is having an inspection by the Human Tissue Authority (HTA). Next week I will go into what this means and let you know how it went!

On Thursday I had a chance to watch an eye donation from a patient who had donated what looked like organs, tissue and eyes to the donation system. This was brilliant and without being too gross (I’ll try!) I’d like to explain how this process went.

https://www.nhsbt.nhs.uk

The woman who worked for NHSBT (NHS Blood and Transplant) rang the bell at the mortuary like all visitors do and identified herself. I got her to sign in and asked politely if I could watch her do what she does- she seemed more than happy for me to watch and was very friendly! Together we identified the patient who was donating, it’s important two people check together the wristbands of the individual to ensure the correct person is donating, like with any process in the mortuary and the individual is unable to identify themselves.

She then put on the protective equipment for herself and the process (hairnet, mask, gloves, apron etc.) and laid out all of her tools, paperwork and other bits to take his eyes. First she filled out some paperwork, then asked me to grab her a sharps bin and a bag for her waste.

She started by checking the individual over for signs of infection or any reasons why he should not donate. This was all clear and good to go. She then laid out a sheet over his face and cleaned his eyes of all debris. There are connective tissues and four muscles which hold your eye in its socket, plus the optic nerve at the back of the eye. I still find this incredible considering I always thought your eyes could pop out if you sneezed with your eyes open. Apparently not. To remove the eye all of these tissues and nerve need to be disconnected. I won’t go into detail how! Once this is done, the eye is placed in a holder which is placed into a pot. She kept them on the left and right side of his body in order to know which side they came from. She then cleaned him up, placed cotton wool and a cap into the socket and reconstructed his eyes. They seriously looked like nothing had happened with his eyes closed. You would never know there weren’t eyes under his eyelids!

The eyes themselves can be kept for up to four weeks by the service awaiting use, but the woman assured me that they are rarely there for long once they have been tested to make sure they are okay for transplant. Eyes must be taken within 24 hours of death so they are okay for transplant too. The teams taking Tissue for transplant work around the clock to take these donations within the time limits and keep it running. I think it’s incredible and so should you because one day you might require a transplant such as this.

Other things this week, I started helping out in the post mortem took a lot more. My stitching is getting better, smoother and faster. I also encountered my first problem with this and overcame it quite well (think skin that doesn’t stitch back together so well…) so I’m proud of that!

Very important and busy week next week as mentioned previously. I’ll be sure to post about this next time. Hope you all have a great weekend and enjoyed this post.

MG x

One Year On…

A year ago yesterday exactly, I had a rotten cold. The kind where your head weighs much more than it should and you ache furiously. I was at work in my office job, which I liked only because of the lovely people I worked with, when I received an email. My Manager noticed that I had been unwell and came over to ask if I was okay. Unfortunately a combination of the lurgy and that email made me burst into tears. After a long talk in a small room away from the open office I felt spurred on to sort things out, but firstly to go home and feel better in myself.

The email itself stated that I had not been selected to interview for a Trainee Anatomical Pathology Technologist position at the local hospital. While deep down I knew that it was a long shot, I stupidly had a lot of hope riding on the role.

Yesterday, I received the news that I had been given a Trainee APT role where I work now at that local hospital! With that news came the first time of holding a PM40 blade and using it. I had only ever held them before to change them for the APTs or Pathologists. For those who don’t know, a PM40 is a blade used for post-mortem work. It’s bigger than a scalpel and with a chunkier handle. Some APTs use a PM40 for everything, some use a scalpel and some use a combination of the two. For the first time I felt like the scalpel was easier to use and more tactile but that was just the first go!

These items are made by a company called Swann-Morton and can be found here if you’re interested-

https://www.swann-morton.com/

The other APTs are highly skilled and make the evisceration look so easy. Having a little go at some of the bits myself yesterday, I managed to slice through the aorta and not do so great all in all. However for a first go I’m okay with that, we all have to start somewhere. Plus, I have cheekily had a couple of goes at stitching previously so now my stitching is still slower than the other APTs, but it looks nice and holds well. If I can get quicker I’ll be chuffed to bits!

So that’s my good news of the week. I finally made it after a year of working so hard to get here. The lack of interview spurred me on to contact the mortuary manager, who agreed to meet face to face, who then offered a work

placement, which then led to applying furiously for NHS jobs, which led to my position at Guy’s in the office which all put me in good stead for the Mortuary Assistant job and now I’m here.

I’d like to say thank you to those who have believed in me, put up with my moaning or crying or mood swings and to those who have supported me. You all know who you are and what part you played and I’m so very grateful. Bring on the coming years and all the training, I’m so excited to learn it all!

MG x

January is the Monday of the Year

I remember seeing that on Twitter at some point and finding it funny because it’s true. I always find January a particularly tough time with my brain. It feels like starting over to me. Like everything seems scary and bleak. I have no idea why this is the case, it’s not at all. I have some excellent things to look forward to and some brilliant people in my life. Just can never shift the gloom I feel around the particular month.

Recently my own mental health and generally the topic of mental health has been at the forefront of my mind. My little side project with my friend Adam, our podcast This Little Island, last month discussed mental health in the UK and I’m a huge advocate of talking about these things.

So, here it goes. I have depression. I have a clinical diagnosis as such, and although not currently on any medication, in the past I have been, and I have also undergone counselling. I’ve been at incredibly low places where I’d not seen a way out. I’ve also, very recently, battled against my brain which tells me that although things are good right now, this can only mean that terrible things are coming because apparently that’s how life works. The good and the bad. Too much good and expect the bad.

Ironically, my brain would never tell me that too much bad meant the good was coming. I am very good at over analysing, breaking down things into very minute details. This is useful in some scenarios but not when you’re trying to convince yourself that everything is fine and to stop worrying. For a long time my head has believed that worrying to the point of feeling unwell was all part of the preparatory process. I simply would not feel ready for something to happen had I not thought about it until I had an upset stomach or not slept for three nights.

While I know my own mental health problems are not as serious as others, by talking about them I hope it brings others forward to discuss their own experiences. I want to help smash up the taboo that exists around talking about our mental health issues.

I felt particularly low yesterday and I have no idea why. I was at work and felt like I was coping fine and hiding it well to some extent. Then at around 3pm my colleague came over to me when I was on my own and asked something very simple.

Would you like a hug?

Seems silly but it meant the absolute world, partly because she gives the best hugs you could ever imagine, but also because someone hadn’t asked me if I was alright, or ignored me or anything else. They had seen someone feeling low and knew how to fix the problem, if only for a few minutes. But that’s a few minutes I needed!

On that note, I came to work today feeling much brighter. I tend to take a day at a time and today felt much more positive. I even met some relatives visiting their family member on my own for the first time. I was incredibly nervous but they were so nice and friendly I felt very stupid for getting so worked up about it. I then had a great conversation with Laura D about it all this evening and, hugely significantly, I don’t feel alone in it all.

Importantly, here’s some links you should check out in regards to this post:

Mind

Samaritans and can be called on 116 123 from any phone

Check out This Little Island podcast on iTunes or podbean- links can be found on our twitter @tlipodcast

And most importantly, if you are suffering yourself with mental health problems then seek help. Even if you just want to have a chat, please email me or message me on my social media either @gemmanorbs or the same on Instagram

Take care everyone!

MG x

Blood, the Polish and a Shock to the Heart

Seems highly appropriate to write a blog article while I’m having blood siphoned out of my arm. Don’t worry I’ve not gone mental, I am festively giving blood and doing my bit for NHS Blood and Transplant. I’m a huge advocate of giving back what you can and blood is a hugely important aspect of this if you can! I understand that either people physically can’t or the idea makes them shudder, but if not then you have no excuse. Get yourself signed up and do your bit!

Sorry-not-sorry for the slightly gross photo…

It was a short week in the mortuary for me as I am not doing on call shifts yet. Therefore I had only 3 days there to catch up on the people who had been brought in from the weekend and also other work that needed doing. I saw two things this week that I wanted to talk about that I found fascinating.

We had a Polish lady who was going back to Poland for her funeral. I have seen a few cases where foreign nationals are picked up by different companies to be taken back to their country of origin however this Polish example was slightly different. My manager said to me to watch what they did because it would follow a particular set of practices which he described. He wasn’t wrong, and it was very interesting.

First they dressed her in simple black clothing which was carried out in a very respectful manner. They then moved her into her coffin (its unusual for funeral directors to bring coffins into the mortuary so it is rare to see one like this), and positioned her with her hands entwined over her stomach and a cross underneath them. A plaque was placed above her head and then they took several photos of her laying there. It was so unusual to see, and seemed so intimate that I felt privileged to be able to see this. Once the photos were taken, the plaque and cross were fixed to the lid of the coffin and the lid was screwed down.

After this occurred, I was intrigued by Polish funeral practices- I mean that’s just how I roll. So I had a quick look at Google and a range of different websites. I found it particularly interesting that it’s considered strange to try and be happy when mourning. Thinking of happy memories of loved ones and looking back with thoughts like this is just not considered the done thing. It made me think of how often we forget that there are so many different cultures out there with different ideas around what you should and shouldn’t do. Especially in our line of work we need to be mindful of this.

The other cool thing that happened today was that I was witness to an ICD (implantable cardioverter defibrillator) being deactivated on a patient. It’s all very clever these ICDs, they sit inside your chest and monitor your heart. They can shock you when you need it too, and let the hospital know when you have difficulties. I’ve often thought that it would be annoying to have this metal box under your skin all the time just hanging out but actually I think I’d be quite happy and feel in safe hands! The device is deactivated by placing a computer mouse like piece over the top (while still inside the patient) and then the machine reads it and the Cardiologist turns off all the functions. This machine can also tell them if the device has gone off and how the heart functioned while the patient was alive. It simply blows my mind. These are deactivated so they can be removed, because if not they could shock whoever cuts through the wire.

Well that’s all from me for now, I hope you had a brilliant Christmas like myself and have a very jolly New Years however you are celebrating (or not)!

If you are interested in any of the things I have spoken about please see he following links to start:

Polish Death & Burial Customs

Polish Commemoration of the Dead

BHF ICD page

heart.org ICD page

And register to give blood here

Thank you so much for reading; if you have any questions or want to discuss anything then let me know.

MG x

Merry Christmas Everyone!

A quiet evening in on Christmas Eve-Eve seemed like a good time to post a short update and wish you all a very merry festive season and all the best for 2018 as I am not sure how or when I will be able to post again.

The mortuary got busier of course and so much happened in the past week I can’t even think where to start. I have been cracking on with everything considering having a fairly horrid cold including a nasty cough and regular nose bleeds. Trying to be social while feeling like death warmed up is never fun but I’ve tried very hard!

I feel very privileged to be included in a team that has received many gifts and cards from all the funeral directors we see each day. I have never seen so many boxes of biscuits outside of a supermarket and luckily had two bottles of red wine to bring home (one of which I am sampling while writing this article).

One aspect of the week I found particularly fascinating and wanted to mention was a case of a patient who had a prosthetic nose. I had never seen such a thing before and found it completely intriguing so (of course) I researched them and found some articles I’d like to share. Some forms of cancer can cause loss of the nose and there is the possibility of having a prosthetic nose made, even 3D printed, and then attached using a magnet system built into your nasal area. I found two news articles where people had come forward with such noses, one in the Mirror and one in the Daily Mail. Isn’t technology wonderful! I’ve found cases where people have had ears attached in the same way and even whole parts of their face. I think this is incredible.

December 17th 2017: The Sunday Times

Another thing I noticed this week was that Alkaline Hydrolysis (see my previous discussion) reared it’s head in the news again. I saw a lot of talk on Twitter and my Dad passed me the above article from The Times with a fairly distasteful headline where it was talked about. Generally I am getting the impression that the public was not in favour because moving forward with such a thing would mean the human remains in the water of the process would be flushed away in the normal waste process of water. I have particularly strong feelings about this.

@ChickAndTheDead and @VonSvs discuss Alkaline Hydrolysis on Twitter

As you can see from this snapshot of Twitter, it has been pointed out that the process of post mortem actually washes an amount of human products away into the same system. I’m also not sure how different it is for the smoke of cremation to be pumped into the air compared to certain fluids being pumped into the water system, other than the fact we have a lot of hygienic and sanitary processes in place in our water system unlike the air that we breathe. If anyone has any thoughts on this I would be very interested to hear them.

I will now leave you with that thought, and once again wish you a Merry Christmas and will hopefully update you again soon. We spent a lot of time making enough fridge capacity space (hopefully) for the festive four day weekend but this does mean I will most likely be having a very busy day on Wednesday when I go back! Oh and please take a minute to think of those who work in the NHS or are on call over the four days. These people do not get thanked enough!

Take care and enjoy yourselves,

MG x

Return to The Gordon Museum of Pathology

Thursday evening this week something very exciting happened. I had the absolute pleasure of being invited along to the Cellular Pathology Discussion Group December 2017 Meeting at The Gordon Museum thanks to my friend Simon pulling a lot of strings.

I turned up at the Gordon Museum ten minutes before the allocated start time, particularly because I had been told there were nibbles and drinks to be had. I was told upon arrival to get down to the room where they were soon ‘before they ran out’. I’m not one to move slowly when food is at stake and I was even told to slow down on the old stone spiral staircase that is in the middle of the museum. I helped myself to two sandwiches and, of course, a mince pie. I found my friend Simon who seemed very tied up in organising so I left him with some encouraging words I hoped would help and began to explore.

A very friendly group had gathered in the room at the bottom of the museum, but socially awkward me hid in plain sight at a table and began forming a plan of how to spend the next hour before the talks began. I decided to have a little look around the museum as I’m not one to waste time or food it would seem. In case you haven’t read my previous article on this museum I will highlight my favourite items once again. I adore the the Joseph Towne wax models with all of my heart. This love has grown ever since I attended a talk at The Florence Nightingale Museum by Bill Edwards regarding them and since I last came here and saw them for myself. Luckily I could spend an age admiring them so I used up the spare time I had taking them in once again. They’re the kind of object you could stare at for hours and notice something new or different every five minutes.

I finally took my seat, hiding right at the back but early enough to actually get a seat. I had heard that they had enough seating room for around 50 but over 70 people in attendance. It’s very pleasing to see such a high turnout for events like this! Once in my seat I pulled out a notebook my friend Corinna had bought me when I left my previous job at Guy’s hospital- it seemed appropriate to use this as the last time I was here I still worked with her and the career I had left for had brought me right back.

Bill Edwards had the first talk which was title Forty Years of Murder. Having joyfully experienced one of Bill’s talks previously, I knew this would be a treat and it did not disappoint. The subject of this talk was an introduction to Professor Keith Simpson who was the first Forensic Pathologist. It was fascinating to learn all about how his career developed into the origins of what we now know as forensic pathology and how he carved this path himself through his ideals of what needed to happen for it to be effective. Simpson began his career in 1932, and through a lot of self teaching and learning in his role, he became a leading figure in the Forensic world.

Bill Edwards talked us through some examples of cases that Simpson had worked on and what he had done which was considered revolutionary at the time (and we now think of as basic Forensic work) like examining the scene before it is touched by anybody and photographing the scene for evidence. He decided it was important to examine under the fingernails of victims, and became interested in looking closer at ligatures and the knots used.

We mustn’t forget that he worked in a world where this kind of work was not taken seriously and considered to almost be ‘magic’ because it was not understood. At the end of the talk we were given two videos of Simpson talking that were lovely and a perfect way to seal the talk. My favourite happened to be him being asked why he had not become a clinical doctor, upon which he replied that he had a terrible bed-side manner but a great slab-side one. I can’t help but completely understand what he means when he said that!

The second talk was by Dr Elena Pollina and titled A Stowaway with your Baby- The hidden burden of Malaria in Pregnancy. This was a fascinating, in-depth discussion of malaria and how it impacts people through their life. Dr Pollina delivered the presentation in a very effective and thought-provoking way, with parts of humour thrown in which made it easy to follow. I was especially nervous of a lot going over my head as I do not have the scientific background of everyone else in that room! However, I learnt a lot about malaria and although I had a huge coughing fit in the middle of the really scientific part (for those who don’t know, I’m in the middle of a nasty chest infection) the end really stuck with me.

It was fascinating to learn that the WHO had intended malaria to be eradicated by 1950 and this was thought to be the case. However, cases of malaria have increased significantly and with the raising global temperatures it is thought that malaria will come back to Europe and in particular the UK in years to come. I think the most gutting part of this talk was being told that although drinking gin and tonics are considered to prevent malaria because of the quinine- too much quinine will ultimately give you terrible tinnitus and make you deaf. Here was me hoping that one of my favourite tipples would help me!

The night ended and I had a little wander about the museum taking full advantage of my time there. I had a little stroll around the kidneys and livers before calling it a night. What a fabulous evening and I’m so glad I could attend. Huge thanks to the Cellular Pathology Discussions Group Committee for organising (& Simon for getting me a ticket!). Also, thank you to Bill Edwards and Dr Elena Pollina for taking the time to present their talks.

I have tried to include links to sources throughout if you would like to know more, but if you have any questions or would like to discuss anything please get in contact! Also, doesn’t The Shard look lovely at night? Took the above photo as I was walking out of the university.

MG x

Christmas is a very busy time for us, Mr. Cratchit

With Christmas fast approaching, my social life gets hectic while my waistline increases as I shove mince pies in my face like there’s no tomorrow. In the meantime, the mortuary is noticeably busier and it’s becoming more important to look at what spaces we have- especially at weekends.

The mystery of why more people die in winter has been under debate for a long time. This news report from 2014 here as much as decides there is no reason for this phenomena because there are no distinguishable factors determining why a higher number of people die in the winter months. Interestingly, the ‘excess winter deaths’ are higher in warmer countries and lower in colder ones, however the reason for this is unknown and life expectancy can be similar between them. Also, the actual increase in deaths is unpredictable and can vary hugely year to year. While this could be put down to prevalent illnesses at these times, it’s not believed there is a correlation between, for example, flu outbreaks and the number of deaths.

There is a belief that people quite often ‘hold out’ for things like Christmas or important dates and essentially give up afterwards. The fact that a lot of the deaths around this time are due to terminal illnesses would imply that this could be the case. Mental illness is often thought to be a big issue around the festive season too, with social, financial and other pressures impacting people’s lives. There is a lot of support available to anyone experiencing mental health problems- I found this link where tips are given for coping through Christmas and charities like The Samaritans are always available to those that need help.

The care received in hospitals has also been thought to affect the death rate rise. Statistically, less experienced Doctors are not always available at weekends and during the holiday season such as reported here. However I wonder at how much these factors are looked at together rather than seen as failings of the NHS in the UK to provide care as is the case with a lot of the news articles I have seen. This did also seem to be a political issue of recent time so I will keep an eye out for anything published this year in regards to it. If you have any thoughts on this please do get in touch!

The past week’s activities to note included attending a meeting for the implementation of our new computer system. We met with the developers and discussed what our requirements were. You might think it strange that a newbie assistant gets to attend this kind of meeting, however I think they are using my skills from my previous job of being a change implementation technical expert in my financial sector role!

We were very busy with post-mortems this week and the APTs were kind as always to call me in if there was anything interesting to be seen. There was a skull which had previously been operated on and had two metal screw-like attachments which was fascinating to see.

We also had a moment where a visitor to the family room, where members of the public can visit their relatives, had lit up a cigarette. My manager had to rush in to remind them that it is a no smoking hospital before the smoke alarms went off. We experience all levels of grief and obviously are conscious that people grieve in their own ways so no animosity was present here. It was more the sheer panic of trying to not have to explain to the fire team that someone was smoking in the mortuary!

Next week I am only in work for three days because I’m cheekily taking two days off. More about this later as some exciting things are happening. Take care everyone, and have a great weekend!

MG x

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