Pathologists are increasingly becoming more visible through patient-pathologist consultations, high profile research collaborations, mentorship and social media like Twitter and YouTube. We wanted to further highlight pathology by spotlighting pathologists from a variety of specialties to not only connect pathologists with one another but to show the critical connection pathology plays in every aspect of medicine. We welcome you to our fifth Spotlight featuring Forensic Pathologist Dr. Nicole Jackson.
We have to admit, we were especially excited to talk with Dr. Jackson (@NicoleJacksonMD). Forensic Pathology is fascinating to us because it seems so mysterious, yet when talking with Dr. Jackson about her work we realize it’s not a mystery at all. It’s both art and science. And it’s vital to life. Everyone dies, yet there is a real shortage among Forensic Pathologists and appreciation for the field is missing as well, which Dr. Jackson talks about below. It’s easy to forget we’ll all be a patient one last time after we pass, and a Forensic Pathologist just may be our physician.
We’re all familiar with #pathart. There’s beauty in the benign, and there’s also beauty that can be found in cancerous tumors when looking at them under the microscope. We were curious: Does #pathart exist in forensics?
Dr. Jackson said, “For me, there are a few areas of forensic #pathart that always makes me pause and appreciate what I am seeing. One is the pristine organs and tissues in most pediatric cases, both grossly and microscopically, young tissues protected from the effects of years of living on this earth are beautiful as they are pure, small, pliable things to see and hold. Another is some of the gunshot wound cases where either the trajectory of the gunshot causes a rare precise injury (i.e. an entrance gunshot wound through the auditory canal, a single gunshot that only hits the pulmonary trunk, a gunshot wound of the head that produces a characteristic keyhole defect, etc.). It is pretty amazing when something so explosive causes small, but precise and lethal damage, avoiding many structures and only hitting one. And lastly, there is something oddly satisfying about removing the calvarium to see a space-occupying subdural hematoma that is perfectly confined to one half of the dura - the juxtaposition against the fresh, clean, uninvolved opposing dura mater creates a very nice image.”
What do you love about your job?
“I love that my job is multifaceted! I love the technicality of performing the autopsy – some of our special dissections are very precise, requiring a steady hand and a detailed knowledge of expected anatomy. From a young age I enjoyed using my hands to draw, play musical instruments, and fix things - working with my hands has always brought me a sense of pride. It is what initially drew me to a career in surgery and it’s a thread of common interest that weaves into forensic pathology and why I knew I’d be satisfied switching career paths. With training in epidemiology, I love the interface this specialty has with public health. I recently joined some efforts centered on working with sudden unexpected deaths in infancy and childhood and it is rewarding to come to the end of my training and finally be able to use my public health background to work on multidisciplinary teams to hope to shed light on ways to decrease these deaths. I tend to get bored fairly easily with routine, so I love that every day and every case is different. Some days I’m down in the post room doing autopsies, some days I’m at my desk catching up on paperwork, talking to family and law enforcement, other days I’m doing lectures for local schools, and other time is spent doing research.”
What is most fulfilling about your work?
“The most fulfilling aspect of this job is hands-down providing closure to families. No matter the type of death or circumstances surrounding death, no matter how tired I am and how I think I might be faltering relaying the autopsy findings, these conversations always end with a sincere “Thank you” from bereaved family members trying to move past this painful part of their lives – it gets me every time.”
Is there an aspect of your work that is still surprising to you?
“There are two things that still surprise me in this field:
The first is seeing certain deaths in the elderly that I associate with younger populations, such as homicides, drug overdoses, and suicides. They are rarer but still occur. All my grandparents have been deceased for a while, so I feel a bit more removed from that demographic than the average person my age. It serves as a reminder to me that though we age, we do not suddenly stop fighting battles we have been fighting our whole lives, including depression and substance abuse. In fact, they can be worsened by increased isolation and dependence on others. At one point during the pandemic, I was seeing a sizable number of suicides in the elderly, which alerts me to the fact that there are new life stressors as we age including potentially feeling like a burden, or in the case of the pandemic a risk, to family and loved ones.
The second is the ability of the body to adapt to chronic conditions. Some of the disease processes you see or incredibly high drug levels at death can still give me shock. It is amazing how long the body can adapt to toxic stimuli.”
Everyone needs time away from work to decompress. Do you feel, as a forensic pathologist and the nature of your work, you need to decompress more than the average pathologist? And how do you decompress?
I cannot speak to the vicarious trauma experienced by pathologists in other specialties, but I would guess that on average, ours weighs a bit heavier since death is literally in front of us and many of our cases are violent and unnatural and/or involve vulnerable populations, which can really hit deep. There is an element of intellectualizing and thus distancing death, that helps, but decompression is regularly needed.
I was fortunate to complete most of my medical training down in New Orleans, which is a warm, vibrant big little city that conditioned me to decompress by getting outside and becoming involved in my community – whether that is walking or biking around, catching a music or art show, or volunteering with friends. The pandemic has been a bit hard for me in this regard – living alone, single, away from family, in a new city, and locked inside for most of the day, especially now that we are in the dead of winter. Most of my go-to decompression avenues are inaccessible and death seems to be pouring in from both sides – at work and on the personal front – so I’ve had to make some adjustments. My current decompression and wellness routine is a mix of research (studying what I am seeing to hopefully shed light on a particular area makes me feel good in my soul), working out (boxing and weight training), meditating, and catching up with friends and family (they are my everything and what got me here). I’ve found new joy and fulfillment in mentoring over the past few months – it’s amazing how talking with an excited, energetic trainee who wants to be where you are can be a real pick-up for the soul.
What do you want other pathologists to understand about Forensic Pathology?
“I have observed a split within pathology where a small group recognizes the value of Forensic Pathology in the greater community but a larger proportion either dismiss it or “don't get it.” It has been frustrating to watch members of our own community, fellow pathologists, dissuade interested candidates from pursuing our specialty, especially since we are in a critical shortage and need more trainees entering the field. From the many stories I have heard it is due to a combination of views including limited quality exposure to the field and the ideas that non-forensic specialties are more academic and/or profitable and that forensics is less intellectual. For those who lack an appreciation for the field and encourage their trainees to use it as a light rotation for their fourth year, I would like to highlight that we are of service to some of the most vulnerable populations - we are the physicians of many who had some system fatally fail them. This includes people without appropriate access to quality health care and determinants of health, veterans, unsheltered individuals, communities that have historically been disinvested in, people caught in vicious sometimes generational cycles with no realistic way out, etc. There is a gap in all of medicine, and particularly in pathology, between practitioners and the communities they serve, and I think one of the biggest gaps is between the community served by Forensic Pathology and pathologists in general.”
Why is it important to increase the visibility of Forensic Pathologists?
“Part of the reason the field is underfunded (and understaffed) comes from the fact that many people are unaware of the numerous roles filled by Forensic Pathologists. Many think something along the lines of “well, Forensic Pathology deals with the dead and what they do stops there, so why does that system need more resources, funding, attention, etc.,” missing that fact that we serve a major public health surveillance role. Along with clinical colleagues such as Emergency Medicine and Intensive Care healthcare workers, Forensic Pathologists and Emergency Response personnel are the first to see what is killing us as a population – in the here-and-now, before data is aggregated months or years down the road. Amongst the numerous types of deaths we see and investigate are those that are potentially preventable – if not for the decedent themselves, for others in the future. This includes everything from deaths related to consumer products that malfunction and cause harm to new infectious disease threats that cause death, such as COVID-19. Much of what we know about COVID, like the flu, was obtained from autopsy. This information was then used to help guide research to help save future lives. Us doing our jobs correctly can save other lives down the road through the acquisition of knowledge either about a disease process or a harmful drug or product, etc. – anything that is out there killing people we are amongst the first to see, especially if it hits fast and people are unable to make it to the hospital.
It is my opinion that increasing our visibility – by showcasing the many, varied roles we fill – will help us garner interest from trainees. Many if not most don’t realize the interface of our field has with that of public health, maternal-fetal health, etc. And we are in dire need of more people entering the field. Prior to the pandemic, it was estimated that there were around 400-500 full-time Forensic Pathologists nationwide to do the job of 1000-1200. As you can imagine, the job demand has exponentially increased this past year, and we need more people going into the field now more than ever. That means we need to do a better job recruiting, which means we need to get creative and think outside of the box and stop relying on past practices to carry us through. One of the ways I am fighting that fight is to do my best to showcase the broad range of what we do and why I love it in hopes that a few students and trainees out there will hear something that resonates with them and that makes them think “Hey, this might be a good fit for me – I could see myself finding joy here.” We need more visibility so that we are more relatable both to potential recruits and to the government that largely funds most of the offices across the nation.”
Dr. Nicole Jackson received her Bachelor of Science in psychology from Duke University and her Medical Degree and Master of Public Health in epidemiology concurrently from Tulane University’s Schools of Medicine and Public Health. Dr. Jackson completed her Anatomic and Clinical Pathology residency at Louisiana State University Health Sciences Center and her Forensic Pathology fellowship at the prestigious New Mexico Office of the Medical Investigator. She is triple board certified in Anatomic, Clinical, and Forensic Pathology and currently serves as an Assistant Medical Examiner for Cook County in Chicago, IL.
To date, she has published and presented over 30 abstracts and manuscripts. Dr. Jackson’s interests include clinical and medico-legal autopsy, deaths in vulnerable populations, medical education, quality improvement, mentoring, community outreach, increasing the visibility of Forensic Pathologists as first responders to threats on our nation’s life expectancy, and using population-based data to reduce the number of preventable deaths.
We hope this article shines a deserving light on Forensic Pathology. A huge thank you goes out to Dr. Jackson for her time in answering our questions and being a part of this series. We’d love to feature you in our next Spotlight article. Just email Kristin at email@example.com. Stay tuned because we are spotlighting more pathologists in the weeks to come! Be sure to read previous Spotlight posts which we’ve listed below:
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