I was on my way to work one morning late last year when I saw an ad for a book entitled “Kuoleman monet kasvot – totuus oikeuslääärin työstä” (“The Many Faces of Death – the Truth about the Work of a Forensic Examiner”). You know me, folks – I immediately emailed the author, Chief Medical Examiner, Dr. Ursula Vala. Luckily for us, she said yes to an interview.
Thank you, Dr. Vala, for your time!
Who are you? Tell us a bit about yourself!
I am Ursula Vala, a doctor specialist in forensic medicine. I work as a senior medical examiner at the Finnish Institute for Health and Welfare. I am the team leader for medical examiners in the Helsinki area.
How did you become interested in medicine? What fascinated you about it?
In high school we were asked to think about what we would like to study. I was interested in the natural sciences, and I liked the broad range within the job description of a physician, as well as the opportunity to do something useful.
How did you end up as a forensic medical examiner? What did you choose this as a specialty?
Quite a few doctors happen upon their specialized fields by accident, and this is the case with me as well. I initially started out as a researcher at the Department of Forensic Medicine because there was an ongoing research project that was easy to get involved in. I ended up enjoying the work so much that once it became possible to make forensic medicine into my area of specialization, I grabbed the chance.
In your own expert’s words: what is a forensic examiner? What does a forensic examiner do?
A forensic examiner primarily does examinations into cause of death. Unlike in many other countries, in Finland the forensic examiner is a neutral expert. A big part of the work is conducting autopsies and writing statements and reports on cause of death based on findings from these autopsies. In addition to this, we also monitor and consult police officials and doctors on their investigations into causes of death.
What is you regular work day like?
I usually carry out autopsies on two or three days per week, in the mornings. On a single morning, I carry out three to four autopsies. In the afternoons, I write reports and statements and examine death certificates. There are usually meetings around a few times per week. I also take calls throughout the day from physicians and police officials asking me for advice on cause of death investigations.
Does a forensic examiner work exclusively with the dead? Do you consult the police on cases involving assault or other violent crimes?
My work consists almost exclusively of determining the cause of death of a person. I occasionally get requests for statements on injuries in living human beings. We have forensic examiners who deal more with these kinds of cases, and who work less with the deceased.
Again, in your expert’s own words: what is an “autopsy”?
In an autopsy, the organs and bodily system of the deceased is examined to determine the exact cause of death, as well other factors that contributed to the person’s passing. The internal organs are removed and investigated, and samples are taken for later examinations with a microscope. Samples are also taken of blood and other fluids and tissues to find traces of drugs or medication. Other special procedures can also be carried out, such as x-rays.
What kinds of situations will lead to an autopsy being carried out?
A forensic autopsy is carried out if the deceased did not have any known illnesses, and in cases where there is reason to suspect that the death may have occurred as a consequence of an accident, suicide, homicide, occupation-related illness. It’s also carried out if there is reason to suspect the death may have occurred as a result of a failed medical treatment, and generally in all kinds of cases where the cause of death cannot be determined from information gathered through other means.
Who can give the legal order for an autopsy? Can you? Or just the police?
The police usually order a forensic autopsy. Each police department has an officer with the authority to order one. According to the law regarding forensic examinations, the prosecutor, the court and the Finnish Institute for Health and Welfare can also order an autopsy to be carried out, but in practice, this never happens.
Has your own work with the dead changed your ideas about death in a spiritual sense? Do you believe in life after death?
The fact that anybody can die at any time becomes very evident in this line of work (and I realize this about my own mortality as well). This knowledge is just something one has to make peace with.
Have you ever had to conduct an autopsy on a person you’ve known while they were alive?
We have so many examiners in our unit that nobody will have to perform an examination on someone close to them. To be precise, it’s not even allowed, as a public official is not allowed to handle cases concerning people they are somehow associated with. I have, however, sometimes performed an autopsy on a person I had met once in passing.
Have you ever encountered anything “supernatural” in your work?
I’ve never experienced anything that could be described as “supernatural”. There are many fascinating aspects to this work, but they all have a natural explanation. For example, sometimes we’ll get several rare cases in a row, and then such cases don’t happen again for a long time.
Does your work ever appear in your dreams?
The job sometimes enters my dreams, but this happens to all working people. Sometimes my dreams involve being late for work, or I’m on way to work and encounter all kinds of obstacles typical for dreams.
What advice would you give to someone who has received a “death sentence” from a doctor due to a terminal illness? How should they deal with this information?
I’m not the right person to answer this. It is generally a good thing for all of us to be cognizant of the fact that we can die unexpectedly, even if we’re healthy. You should enjoy all aspects of life and not complain about meaningless little things.
What is the single strangest cause of death you’ve come across during your career?
I can’t really highlight any one specific cause. Rare illnesses in general can cause such cases, especially if they cause a sudden death with no preceding symptoms.
What is the most complicated case you have worked on?
In my own work, a complicated case entails several diseases or injuries none of which can be said to take precedence as a cause of death. For example, if a person has suffered a myocardial infarction, their thighbone is broken, and they have a bleeding ulcer, it can be difficult to draw a sensible and well-argued cause of death report. These kinds of cases are quite common.
Have you ever conducted an autopsy on a “celebrity”?
Celebrities die too, just like everyone else, and sometimes they end up on the table of a forensic examiner. Every forensic examiner will end up carrying out an examination on someone famous at some point.
What is the strangest or most memorable stereotype or common assumption related to your profession?
A common assumption is that we only do autopsies on victims of homicides, and that we are a part of the Finnish law enforcement community. In reality, the most important aspect of our work is giving statements on cause of death, and we work under Ministry of Social Affairs and Health monitoring and guidelines. We are neutral, impartial public servants.
What music do you play in the operating room during an autopsy?
The first person in the operating room gets to choose the radio channel. Of course, it’s courteous to ask if everyone is okay with the chosen channel. We either listen to Finnish channels playing music or American internet radio channels. The medical examiner ultimately makes the final decision about the channel. Some examiners don’t want any music at all and prefer to work in silence, so the radio stays off.
How do you relax and forget about your work when you come home?
I don’t feel any particular need to forget about work-related issues once I’m done for the day. You just don’t think about work when you’re carrying out tasks related to everyday life. In my free time, I do the same things as any middle-aged women.
Are there any “rituals” performed in the operating room before or after the operation?
No, we don’t have any particular rituals. We bid each other good morning and go to work. Once all the autopsies have been done, we thank each other for a job well done. The deceased are treated with respect, and are referred to as “Mr” and “Mrs”. We might say, for example: “Let’s take a bone marrow sample from Mister so-and-so.”