Dr. Kona Williams pauses when asked if she gets tired of being billed as Canada’s first Indigenous forensic pathologist. The daughter of a Cree father and a Mohawk mother, Williams concludes she doesn’t mind one bit.
“It gets me out there,” she says of her status as an Indigenous physician and specialist, “and that can make people, especially youth, think.”
Growing up in Ottawa and other parts of Canada, Williams didn’t hear about many physicians from First Nations. “So to get people thinking about what it is I do, and that it’s not impossible, that alone is worth (it),” she said in an interview in her office on the first floor of Ramsey Lake Health Centre.
Her goal is to not be the only Indigenous forensic pathologist for long, Williams says with a characteristic warm laugh. Still, “until the time comes that there are other people that can come up and help me with (that), the responsibility is quite heavy.”
Williams deals with death every day on the job at Health Sciences North, where she began working in October after a time at the Forensic Service and Coroner’s Complex in Toronto.
Positive and upbeat, she appears remarkably light-hearted despite the nature of her work.
What exactly is forensic pathology?
Williams admits it takes a certain kind of person to do the work she does, although the morgue is a workplace like any other, she says. Still, “you’d be in a black hole if you pulled in” the daily death and trauma. “People can go crazy with that.”
A forensic pathologist is a medical doctor who first completes a residency in anatomical pathology, as she did — the field of medicine in which practitioners diagnose cancers and other diseases — before further specializing. Anything that comes out of the human body in the hospital will eventually get looked at in the pathology department, says Williams. Because pathologists have the final say about what is wrong with a patient, they carry the weight of responsibility on their shoulders because a course of treatment will be based on that diagnosis.
Fortunately pathologists are rarely wrong. “It’s not that we’re never wrong,” Williams points out, “but the error rate is below one per cent.”
After completing an anatomical pathology residency, Williams did a year of forensic pathology, a field of medicine she describes as being on the border between medicine and the law.
Her job is to investigate the medical cause of death of some of the 100,000 people who die in Ontario every year. If there are questions – such as whether the deaths were accidental, homicide, drug overdoses or suicides – the deceased may end up before Williams and other forensic pathologists. They also investigate criminally suspicious deaths and deaths of infants.
About 17,000 of those 100,000 Ontario deaths become coroner’s cases. Coroners then decide if an autopsy is required to answer questions before sending the deceased to a pathologist or forensic pathologist.
In Ontario, there are six regional units and one provincial unit of forensic pathology. One of those regional units is located at Health Sciences North, where Williams conducts autopsies to determine how and why people died.
Looking for truth
Until last fall, Dr. Martin Queen was the only forensic pathologist working out of Sudbury, handling as many as 400 cases last year. The number has risen well above that, much more than one forensic pathologist can handle on his or her own. Williams does an average two autopsies a day in Sudbury where she used to perform four or five a day in Toronto where 30 to 40 post-mortems are conducted daily.
Population health statistics indicate people in the Northeast die in larger numbers than southern residents from chronic illness and accidents, and die younger than average, but Williams hasn’t been here long enough to note the differences between the two populations.
Drug overdose deaths are an issue “across the board,” says Williams. Forensic pathologists are seeing more people die of drugs such as “purple heroin”, street heroin laced with deadly carfentanil, a drug used by veterinarians to tranquilize large animals such as elephants.
Sometimes the people who end up on a table before Williams are not regular drug users and may not have known what they were taking. “And unfortunately it’s the first and last time.”
Autopsy procedures follow a pattern similar to that of a family physician examining a patient, says Williams. Your doctor will ask you what has been happening with your health lately if you visit his or her office with a complaint. “We do the same thing,” says Williams, but “obviously the person can’t speak.”
She pieces together information from police and the coroner, crime scene photos, medical records of the deceased and other documents. Sometimes she visits death scenes where she observes the conditions under which someone might have died.
“We know that it might not be entirely correct because the investigation is evolving,” says Williams of those observations. The body “will tell us things” such as how old a person is, if they look their age, if they are heavy or thin, if they look healthy and if diseases or injuries are visible on their bodies.
A family doctor makes similar observations before conducting an internal examination – looking in a patient’s eyes, nose and mouth, listening to their lungs, looking at their eyes. Forensic pathologists cut into the deceased looking for answers.
Like a family doctor, before giving her “diagnosis,” Williams reviews the results of tests she has ordered such as blood work, biochemistry and even genetics. Genetics is being used in the burgeoning science of molecular autopsy to explain the previously unexplainable, such as the sudden death of a young athlete. Twenty years ago, the conclusion might have been drawn that the young person died of cardiac disease. Now tests can be ordered that can identify genetic diseases, providing answers for grieving loved ones and pointing them in the direction of help if they face the same health risks.
Williams’ observations can tell her if the deceased is a person on the margins of society or someone with mental health or addictions issues. They can tell how the deceased might have lived and help her get a sense of how they died.
What she does, essentially, is find answers and reveal the truth, “and that’s really important to just about everybody,” says Williams. “Death is a very mysterious thing.” Williams comes up with the “closest approximation to the truth as I possibly can for the families and the justice system and the public.”
What does a pathologist do for fun?
Suffice to say the job is never boring. Every day, Williams makes her way to the morgue not knowing what awaits her. Sometimes the deceased are brought it and people think it is “one thing” that caused their death and she finds “it is 180 degrees” from that so Williams keeps an open mind.
There are rare instances in which forensic pathologists cannot determine the cause of death – fewer than five per cent and more in the order of two or three per cent, says Williams. Still, there are cases such as sudden infant death syndrome or SIDS in which the exact cause of death cannot be determined. The data forensic pathologists collect in these and other cases is recorded because technology may eventually provide firm answers.
“Until then, we just do the best that we can.”
Forensic pathology and anatomical pathology are considered “weird” by some. Looking back at her childhood, Williams says she was “totally normal,” then rethinks that and says, “No actually” she was not.
She began reading at two and consumed everything from the Stephen King novels she was not supposed to be reading to encyclopedias and the back of cereal boxes. If she found a dead rabbit, she regarded it as fascinating rather than gross. She was always collecting things and bringing them home to examine under the microscope her father gave her when she was a kid. “That was probably the best gift I was every given.”
Williams points to the large, very expensive microscope on her desk at work, a piece of equipment that costs thousands of dollars which she gets to “play” with every day. “I get to see things that most people never get to see.”
Williams’ active lifestyle helps her find balance between work and home. Before she entered medical school, she had done karate, but when she embarked on higher education, she told herself: “Look, this is going to probably be the hardest training you’re ever going to be going through. You have to be proactive and take care of yourself.”
In her mid-20s, she became active again in the martial art. A second-degree black-belt, karate taught her how to balance her professional and personal lives.
Martial arts and medicine both take mental discipline. Williams has to be able to focus and shut down everything else to do her work effectively. “There are people that need the answers. I need to focus on doing my best.”
Williams starts her day with a run or a bike ride and admits she can be silly in off hours spent with her family and friends. She continues to read “omnivorously.”
The breaks from daily doses of death keep her healthy mentally and physically. When asked if her work has changed her view of life and death, Williams says: “Death is a part of everybody. I’m just aware of it and in touch with it a lot more than most people.”
Williams wakes up every morning, takes some deep breaths, then heads out to get some physical activity thinking: “Well, here I am. I’m here for another day. That’s a good thing, that’s a gift.”
Carol Mulligan is an award-winning reporter and one of Greater Sudbury’s most experienced journalists.
