Intrigued by Biology, Fascinated by Death

Author, pathologist, “death PR person” – few can boast such a variety of titles. But for Carla Valentine, Anatomical Pathology Technologist and Curator of Barts Pathology Museum at Queen Mary Medical School, these roles are just part of everyday life. Carla is a vocal advocate for forensic science awareness and death education – and so, when we sat down to discuss her career in the mortuary, the sound of a crackling phone line only added to the atmosphere… 

What inspired you to pursue pathology in the context of mortuary science? 
 

I don’t know why, but biology intrigued me from a really young age. I was always interested in how things work – bodies, flowers, plants, animals, everything. When I was seven or eight years old, my granddad died from a stroke in front of me. I was obviously slightly traumatized, but I was also fascinated by how someone goes from a walking, talking person to a dead one. I think I wanted to reclaim some control over the trauma. Funnily enough, I was reading a lot of Agatha Christie at the time, so I understood what forensics were and how you could apply pathology to crimes – and that was all it took. I knew I wanted to work in pathology, but I didn’t want to qualify as a medical doctor, because I honestly didn’t want to work with live patients. I was more interested in finding out about death processes. 

What title do you use? 
 

Because people have been interested in and looking after the dead forever, there are many different words that describe my work. For me, it depends on what kind of conversation I want to have. I might call myself a mortician, because people recognize that and understand that it means I work with the dead. Conversely, most people at a cocktail party don’t know what an anatomical pathology technologist is. There are a lot of euphemisms when it comes to death. Back in the day, you would see things like “she fell asleep” on a gravestone and, in the same way, euphemisms helped to legitimize the profession. Today, the Association of Anatomical Pathology Technology has made great strides in awareness and “APT” (anatomical pathology technologist) is a nice, succinct title.
 

What was your favorite part of mortuary work? 
 

My favorite part was coming in each morning and going through the cases that had been brought in overnight. I’ve worked in several different mortuaries and, in the last one, we had community deaths as well as hospital deaths. Every morning, I’d come in and have a look at the names, weigh, measure, and check the bodies. It was interesting because, in one instance, you might see a patient who had died of complications in the operating room and, in another, someone who had died on the street with completely different pathologies. I don’t want to make it sound like opening Christmas presents, but the anticipation of seeing an interesting variety of cases was exciting. 

Autopsy can be a controversial subject – what are your thoughts on its place? 
 

I support consented autopsies, which obviously happen a lot at hospitals for teaching and research. You might be surprised at the cases that happen, though. For example, you might imagine that a mother who had lost a baby would decline an autopsy because it might be traumatic – but they often say yes, because they appreciate the possibility of answering questions like: could it happen again? Was it something genetic? Is it something that could be treated in another child? I’ve learned not to guess what people will say. 

I have always been on the side of education and consented autopsy’s role in training. I think it’s important for students to see these kinds of cases, because they won’t see them in the dissection room. Those tend to be very sort of uniform, so-called “normal” bodies whereas, in consented autopsy, you will have a huge variety of diseases. 

Does that extend to your personal life as well? 
 

My private stances have changed and I think a lot of people can empathize with that. My brother died of Ewing sarcoma not long ago. He could have had a hospital autopsy, and I could have encouraged him – he wanted to help with research as much as possible because it is an unusual disease for young men to have. At the same time, I’d seen how much intervention he’d had throughout his treatment and I thought he didn’t need to have any more needles and tubes put into him. So I believe it’s always going to be a personal choice. Honestly, my opinion is very fluid. It really depends on the circumstances. 

Many people associate pathology with death, which can lead to negative stereotypes. How do you counter such misconceptions?
 

The main point is that pathology is a vast subject which also encompasses disease processes. My opinion can only be based on my specialty, which is autopsies. But, since leaving my role as a senior APT, I’ve tried to do some good public relations for the career for that very reason. I think pathology is considered a bit more glamorous these days thanks to the many books and television series that showcase it. It’s actually mortuary work where people really do think you are in the basement – and, to be fair, you are! 

(And when I call maintenance on the phone to say the heating is broken, they say, “Well, what do you need heating for? You’re a mortuary,” to which I reply, “But we’re alive!”) 

In the office, there was this strange sense of being isolated in the basement. In the old days, there was a thing called the taboo on the dead. If people touched a corpse, they were considered unclean for a long time. And that’s what I’ve experienced. I just want people to understand the reality of death and how mortuaries work, so I’ve sort of turned into death’s PR champion. It gets me into trouble sometimes. We don’t all necessarily agree on things, but I’m here to help create things like media guidance for an accurate portrayal of the mortuary. 

How do you feel knowing you challenge stereotypes of what people working in forensics look like? 
 

It’s funny you ask that. When I entered the field, I just went to the mortuary down the road and asked to volunteer. This was a long time before the “CSI effect” that increased the profile of forensics, so there were only three forensics courses available. I bring this up because the embalmer I volunteered with was a woman. Then, at my first full-time job, I would work with a woman one morning and then all men the next. I was lucky in that there wasn’t a mold that was expected of us because we were all so different. We had different interests, but death brought us together. I find that I actually experience more friction now, 20 years later. Whether that’s because of my hair or the fact that I have loads of tattoos, I don’t know. 

In the light of a global pandemic, do you find it more difficult to advocate for “death positivity?” 
 

People are looking for life affirmation and I can’t blame them. Everyone is a little bit sombered after the arrival of COVID-19. Exactly the same thing happened after the first and second world wars; everybody wanted to affirm life, rather than advocate for more positive views on death. 

As far as I’m concerned, I’m an ambassador of death understanding, preparation, and knowledge - I don't use the phrase "Death Positive". Not a lot of people want to think about death, but it is important. It was one thing I could really do for my brother that my mum couldn’t – she was devastated, but I helped him organize his funeral, got through the paperwork, and made sure he had everything he needed. The Reverend Richard Coles just wrote a book about this in which he calls it “sadmin” – the admin that comes after somebody dies. Death preparation and death understanding are not the same as death positivity. And of course, in the context of a pandemic, that’s a really difficult brand to sell, isn’t it? 

How would you describe a healthy relationship with death? 
 

All I can say about death is that the pain and the fear you feel from it comes because you’ve loved somebody so hard – whether it’s for a short or a long time. It’s inevitable, and sometimes it comes too soon, but there’s nothing to gain from wishing it away. Life’s not Frankenstein; we can’t eradicate death, no matter how much as people would like to. I think acceptance and understanding is just a part of love. That’s the way I get through it. It’s not very scientific, but it’s the best I can do. 

What are your goals for the future? 
 

I’ve always been interested in forensics, and that was partly because of Agatha Christie. So I find it really comforting to have been able to revisit all of her work. I was surprised by the amount of genuine forensics she discusses. She talks about a chemical reagent that will make blood visible – which is obviously luminol – but I hadn’t realized it was being used by that point. My passion is to talk about those really incredible developments in forensic science. I’d also really like to do a TV show, because forensics is such a visual topic. Something with blood spatters and poison bottles. That's the kind of thing I really want to get into at the moment!