What killed her? A witness account of the search for clues into a woman’s ‘suicide’

The “client” was placed on the flat morgue trolley. She was medium in height, weight, skin tone... everything. Her long gray-brown hair surrounded her face and feathered over her ears, and her long nose projected out like a weathered crag from her very supple cheeks.

She had been remarkably beautiful in life, and death had done nothing to impair her looks, though wan and haggard from the purported suicide. The insulated braided rope that had hours earlier looped her to death was still on her neck, competing for attention with a silver necklace from which dangled a bluish gemstone amulet that matched a bracelet on her left wrist.

ORGANS REMOVED

As we — the investigating officer, two morticians, two pathologists, a morgue attendant and I — surrounded the body on Thursday last week, I could not help but wonder why such a woman would choose to end her life. Death is ugly, violent and nasty, I thought to myself.

Two weeks earlier, I had called chief government pathologist Johansen Oduor and asked him to allow me to join him for an autopsy on a day he was comfortable with. I wanted to see a pathologist at work, see what happens to a cadaver a few hours after death, ask questions about why some organs are removed, and take you, through the whole process. He agreed.

After taking me through a short counselling session and preparing me for what to expect, he told me that autopsies are not mandatory, and that they are conducted to ascertain the cause of death.

LEGAL PROCESS

“They are, however, very necessary for investigations into sudden deaths, homicide, suicide, and those that occur during surgical procedures. Some families just need closure,” Dr Oduor said, adding that some doctors also request postmortems on patients they have treated for long, or when death is a puzzle to them. In this case, the next of kin must be made aware.

In Kenya, autopsies are mostly required for the purpose of aiding a legal process, and also for planning purposes as the government needs them for a database that helps in policy formulation. Section 80 of the Health Act, 2017 permits the pathologist to conduct a postmortem on a person if the person, when alive, gave consent, if the kin give consent, or the examination is necessary for determining the cause of death.

For the procedure I was witnessing, Dr Oduor was joined by another forensic doctor — Andrew Gachie — who represented the family of the deceased. The woman, the wife of one of the city’s richest men, had died two weeks shy of her birthday, and a police report — formally referred to as Form 23A — brought in by police constable John Mark Mwanzia indicated she had committed suicide by hanging herself.

ASCERTAIN IDENTITY

The police report is a requirement under Section 380 of the Criminal Procedure Code, and details the name of the deceased, the history and circumstance of death, the date and place of death, the name and signature of the person who identified the body, and also the name and signature of the investigating officer.

Apart from the form, statements taken from the witness and identifier of the body have to be presented to the pathologist, who checks a tag on the corpse to ascertain its identity.

The room we have gathered in looks more like a butchery than your ordinary theatre, with forceps, shears, scalpel handles, a double-bladed spine saw, and other unpleasant metals. There also are several taps with running water and containers filled with chemicals. Protective clothes and gloves are hung near the entrance and everyone has to wear them before making their way in.

On one of the walls of the small room is a short quote from Napoleon Bonaparte: “Death is nothing, but to live defeated and inglorious is to die daily.”

TAKE PICTURES

“We have to match the documented identity of the woman with the body we are about to conduct the procedure on,” Dr Oduor says as he hunkers over the body to observe it closely. He checks the eyes, skin, teeth, ears, neck, legs, hands, and the head.

The police officers and pathologists take pictures of the body, saying the findings at every step of the procedure will, in most cases, be needed in a court of law and, sometimes, by insurance companies.

“We have to pay attention to all unusual features; every death report is treated with skepticism, and so we have to ask the questions: Does she have bruises or swellings on the body? Did she struggle with someone? Does she have defensive wounds on the hands? Did she get hurt by a hard object? Is there haemorrhage on the head suggesting she was hit? Do her chest and rib cage have bruises?”

Every unusual feature and changes in the colour, shape and position of the organs provide a clue. We notice a dark pooling of blood on the back of the deceased’s body, which lies face up. The tips of her toes and fingers also appear dark. Dr Oduor says the phenomenon is called lividity, the term derived from the Latin phrase Livor mortis (livor for ‘bluish colour’, and mortis for ‘of death’). This, Dr Oduor says, is caused by the fact that when the heart stops beating, blood moves with gravity to the lowermost part of the body, depending on its position. Again, this gives a clue on the person’s posture at the time of death.

ESTIMATED TIME

“In this case, the blood is concentrated on the feet, and the back. The body’s limbs and muscles have become stiff because death occurred more than 24 hours ago. The stiffness is referred to as rigor mortis,” Dr Gachie says. This clue gives the estimated time of death.

The body has small capillaries in its eyes’ inner iris, the neck bears the mark of an inverted V inflicted by the rope, her tongue base is extended out, and she has a bluish cast on both her hands, which the team says points to death by hanging.

The examination and police process lasts one hour and 18 minutes, and at exactly 5.18pm Dr Oduor indicates he is ready to dissect the body to examine the internal organs. The morticians make a Y-shaped incision on the chest. Each incision begins from either shoulder, and the two meet at the centre of the chest, where they are extended to the centre of the abdomen.

HISTOLOGY

The internal organs are removed and placed on a white board on the table and examined one by one. “We have to observe the sizes of the organs, the colour and any other unusual features,” Dr Oduor says, adding that, sometimes, even the smell emanating from the organs can give clues to the cause of death, especially when drugs and alcohol were culprits.

“We will collect samples of each of the organs and take them for histology and toxicology,” he says. In histology, the tissues from the organs are studied using a microscope, while toxicology helps detect, identify and evaluate toxic substances, if any, in the organs.

The tests are done at the Government Chemist, located near Kenyatta National Hospital. Kenya has only three such facilities — in Kisumu, Mombasa and Nairobi — which often leads to delays in getting results.

REFRIGERATED

“The delays sometimes last up to two years and cause the samples to be compromised because of improper storage, decomposition and other factors,” Dr Gachie says. Samples taken for toxicological analysis are not preserved in any chemicals because reactions could occur. They are just kept in sterile containers and refrigerated.

Section 3 of the Human Tissue Act (Cap 252) permits pathologists to retain body tissues for the purpose of inquest, while Section 80 of the Health Act, 2017 prohibits the removal of such organs for transplantation in another human being.

One can, however, write a Will in the presence of at least two witnesses to donate one’s body or any specified tissue to be used after one’s death for the purposes of health research, among others.

After examining the vessels, arteries and veins of the deceased, Dr Gachie and Dr Oduor ask the morticians to open the skull and extract the brain for examination too, after which all organs are weighed to establish whether they are normal, before being washed and placed in a container filled with formalin. They will, according to the pathologists, be kept in the chemicals for some time before being returned to the body of the deceased, which is embalmed and reconstructed after the postmortem procedure.

BELIEFS

The two doctors say that, even though their job pays their bills and puts food on the table, it is a challenging one, especially when they have to work on the body of a person they know. Often, when faced with these situations, they request other pathologists to take up the job.

Pathologists in Kenya also suffer the consequences of lack of a proper operational framework as the system gives the police all the authority to initiate a postmortem, lack of qualified forensic pathologists, lack of training opportunities on forensic medicine, and dogmatic cultural and religious beliefs.

Currently, the police are mandated to investigate deaths and send results to the Office of the Director of Public Prosecutions and to the magistrates for action.

But the police, the pathologists say, are overwhelmed and lack the experience to handle bodies or even study them. Human rights organisations have in the past criticised the commitment of the police, especially when their colleagues are involved in causing deaths.

CORONER GENERAL

With the National Coroners Service Act having been assented to by President Uhuru Kenyatta on June 21, 2017, pathologists are hopeful that the standards of death investigations in the country will improve. The Act provides for the establishment of an agency to investigate deaths in Kenya.

The country is in the process of creating a board that will kick off the implementation of the Act. The first step will have to be the creation of the Office of the Coroner General followed by appointments.

Another challenge faced by the pathology field is lack of sufficient training for forensic investigators.

None of the 12 forensic pathologists in the country received training in this country, as there are no universities offering the course.

VALUE LIFE

Dr Oduor and Dr Gachie trained in South Africa and Scotland respectively, after their bachelors in general pathology. One of the schools offering courses in general pathology is the University of Nairobi’s Department of Human Anatomy.

Although post-mortem in public morgues, including Nairobi’s City Mortuary, is conducted for free, private mortuaries charge up to Sh30,000.

The autopsy was concluded at 6.44pm. It answered more questions than I had. Looking back I feel more educated, I value life more, and I pay attention to details. I want to attend another procedure, this time, one meant to save a life- not to confirm death.

 — The Daily Nation is not revealing the identity of the deceased or the results of the postmortem analysis for ethical and legal reasons.