Solving the puzzles

As forensic pathologist, Dr Linda Iles heads a team of dedicated problem-solvers at the Victorian Institute of Forensic Medicine …

DR Linda Iles has to plan for the unthinkable — a mass casualty event on Australian soil, whether man-made or natural. It’s something most of us don’t ever want to contemplate, but for Dr Iles and her colleagues at the Victorian Institute of Forensic Medicine (VIFM), having plans in place for the worst-case scenario comes with the territory.

“We put a lot of work into contingency plans and exercises,” Dr Iles, who is Head of Forensic Pathology Services at the VIFM, tells the MJA.

“It could be 20 people, 200 or 20 000. We can only hope that it doesn’t happen here, but if it does, we need to know how to deal with those kinds of numbers.”

Dr Iles and her team have been instrumental in several large-scale victim identification events in the past — the Bali bombings, the Boxing Day tsunami, the Christchurch earthquake, the MH17 air crash in the Ukraine, and, on home territory, the Victorian bushfires.

The Boxing Day tsunami in 2004 killed at least 226 000 people across 14 countries, including 166 000 in Indonesia, mostly in Aceh Province.1

Dr Iles was in Thailand after the tsunami, as part of a team of pathologists, dentists, police, and others which identified around 8000 victims, bringing closure to their families.

“It’s hard to comprehend the numbers,” she says now. “But when you look at Aceh, those numbers are … you can’t comprehend them.

“Even though we have been involved in circumstances that are horrible, it’s always gratifying to help the families and loved ones. In fact, it’s a real privilege to be involved. It’s very rewarding. The important moment came when we decided to work at identifying everybody, regardless of their nationality.”

Dr Iles graduated from the University of Tasmania in 1997 and had the chance to be an anatomical pathology registrar at the Royal Hobart Hospital after completing her internship.

“Back then you couldn’t complete your anatomical pathology training all in one centre, but there were no other centres in Tasmania so I came to the Royal Melbourne Hospital to finish,” she says.

Hobart, it turns out, is an excellent nursery for pathologists, both anatomical and forensic.

“Everyone worked together in the same mortuary at the Royal Hobart, so there was good exposure to forensic and coronial cases,” Dr Iles says. “There’s really excellent training in Hobart — out of my graduating class of 60–65 I think six or seven were pathologists, which is a very high percentage.”

Two mentors stood out for Dr Iles. One was Dr David Challis, a staff specialist in anatomical pathology at the RHH, and a strong advocate for hospital autopsies, and Dr Chris Lawrence, who was one of three forensic pathologists who conducted the autopsies on the victims of the Port Arthur massacre in 1996.

Medical problem-solving is the attraction for Dr Iles.

“It’s not just the suspicious deaths, but also the sudden, unexplained deaths. Putting the pieces together and helping families to understand what happened — those are the core things about the work that we do.”

Cases that involve children are the most affecting, she says, but increasingly, the excessive violence associated with methamphetamine use are the cases that can be the most confronting.

“We’re recognising [methamphetamine cases] more, whether that’s because of increased numbers, it’s hard to know.

“But the victims of violence inflicted on them by [methamphetamine users] is over the top. The totality and extent of the injuries is very confronting.”

Seeing what they see and doing what they do on a daily basis, there is a risk of burnout and post-traumatic stress disorder (PTSD) among forensic pathologists, Dr Iles says.

“There certainly is a potential burnout factor. Here at the VIFM our staff take a sabbatical every 6 years. It’s really important to get re-energised. It’s great to see them coming back recharged and with new ideas.

As for PTSD, the VIFM has put together a working party to look at evidence-based approaches how the concept of “vicarious trauma” affects the staff. “We’re looking for the best way to see if our people are alright, and how we can support them,” Dr Iles says.

For Dr Iles what is important is balance in her life. She spends her off-hours with her partner and their pets, swimming and cycling — vital antidotes to the stressful and confronting realities of her “day job”.

“A happy, balanced home … that’s the most important thing,” she says.