Review: Vivien Horler

Blood has a Voice – Stories from the autopsy table, by Hestelle van Staden (Tafelberg)

Hestelle van Staden describes herself as a “normal, 40-something-year-old suburban Afrikaans-speaking woman” with two children, and yet she has a job she describes as “not always easy or nice”.

Well, no. She’s a forensic pathologist, and knew from when she was at high school in Pretoria what career she wanted to pursue. She credits Patricia Cornwell and her Kay Scarpetta books for inspiring her. Such was her enthusiasm for her job that on her first day at work she felt “like a kid in a candy store”.

Since then she was performed more than 7 000 autopsies, one of them on the reggae star Lucky Dube, who was shot dead in a hijacking in Johannesburg in 2007. She also testified for the state in the later murder trial.

Many TV viewers will be familiar with Van Staden and her work from the series Outopsie, which focused on the reality of what forensic pathologists do. The job might have got her on TV, but she points out it is not remotely glamorous – for one thing she wears gumboots to work.

She says she is not put off by the smells of the forensic laboratory, and tends to be unemotional about what she has to do, although performing autopsies on abused children is always upsetting. But on the other hand, she is driven by her belief that her job is to make sure a killer doesn’t get away with murder.

Some of the cases she has dealt with are extraordinary. One was that of Maureen Mashiyane, 30, who went into hospital to have a baby by Caesarean section. Before the operation – but after having an epidural anaesthetic – she became short of breath and her blood pressure dropped sharply.

A healthy baby was speedily delivered, but Mashiyane’s condition continued to deteriorate and, despite being surrounded by experienced medical staff who were doing all they could for her, she had four heart attacks and died a matter of hours after the baby was born.

The problem for Van Staden lay in establishing the cause of death. There were four main possibilities: that a blood clot had blocked one of the arteries in the lungs; that the pregnancy had weakened Mashiyane’s heart; she had had an acute allergic reaction to the anaesthetic; or, most unlikely, she had had an amniotic fluid embolism, an incredibly rare condition caused by amniotic fluid or foetal cells entering the mother’s circulation.

In the end, a study of Mashiyane’s tissues showed an amniotic fluid embolism was the culprit, and foetal cells were found in both Mashiyane’s blood and lungs. Later Van Staden could find only four such cases described in the literature.

What made this case even rarer was the fact the problem occurred before the baby was born.

Most of the bodies Van Staden has studied were ordinary people who died suddenly or unexpectedly, but she also has performed autopsies on wellknown people such as Dube, leading ANC member and government official  Stanley Nkosi, and the Johannesburg journalist Heidi Holland.

There were also some notorious cases, such as the Rhodes Park murders in which two couples, strolling in Johannesburg’s Rhodes Park one evening, were attacked by a gang of 12 who raped the women in front of their partners, and then forced the men into the lake where they drowned.

Blood has a Voice makes for interesting reading, but sometimes Van Staden who is, after all, writing a book for the general reader and not forensic pathology students, is too intent on using the language of a medical professional.

Here’s a short example: “An 80ml subdural haemorrhage was present over the posterior aspect of the brain. She also had a subarachnoid haemorrhage over the right frontal lobe, left and right parasagittal areas (the central areas over the top of the brain) and cerebellum (small brain)…”

I understand Van Staden is meticulous, but for the general reader you don’t need to say hypotension when you could say low blood pressure. A good editor could have made this book more reader-friendly, but I suspect the editor may have lost a battle of wills – Van Staden acknowledges “the lovely people at Tafelberg” who coped with “all my quirks and OCD stunts”.

She gives insights into how the law works, what it’s like to testify as an expert witness in court, the day-to-day business of dissecting dead bodies, and working with Cuban doctors in country towns such as Ermelo.

“Blood has a voice,” she says, “and I see it as a privilege to be the last voice of the dead.”

In her epilogue Van Staden describes her gratitude at being able to do a job she loves. But it has left her with a profound understanding of the brevity of life. And she concludes: “We need to love hard, appreciate the people in our lives and make every single day count.”