When I was called at Sarita's house, she was already dead!
To be sure I didn't expect anything better. They don't call forensic pathologists when people are still alive. The very fact they had called me, meant that someone had died. That's in our fate you see. Sometimes I take perverse pleasure in describing myself as one who is called in when all doctors have failed! As you can plainly see I do not have any wrong intentions, but the people tend to get misguided somehow. Whenever I say this, I get appreciative glances from everyone around. I frankly do not know what they make of my statement.
Although I love forensic pathology, and would love to fiddle around with dead bodies, some forensic pathologists do want to shed off the image of the "doctors of the dead", and want to do some clinical work.
Not that forensic medicine does not provide a scope for this. In fact there is enough scope for this. For instance there is a whole lot of toxicology, which we can dabble with. We can treat patients suffering from poisons, and can devise new treatments for them. But as I told you earlier, I would rather fiddle around with dead bodies. I love dissection you see. I want to see the intricacies of the human body, and no one can do that better than a forensic pathologist- or perhaps an anatomist.
But Dr. Sunil Khanna, professor of forensic medicine in our department does not share my views. He is constantly seeking to excel in the clinical sciences. He has several patents to his credit, and his recent research concentrates on finding an effective treatment of some poisonings, especially poisonings by asphyxiants such as carbon monoxide.
In fact he has contacted me several times with a request to start a joint project on this, but I have always declined it, as I have no aptitude for clinical work at all. But of course I am taking interest in his work and am aware of all the developments he is making.
But coming back to our case. The moment I reached the spot, I was inundated with the usual questions. How had she died.... who killed her.... was her death suicidal or homicidal and so on and so forth.
Let me tell you a few details about Sarita. She had married only a year ago. Her husband Ramesh was a petty clerk in a private company, but they were carrying on very well. Of course there was a dowry problem in the family in the beginning, but everything had settled by now, and apparently the couple was living together in good harmony.
But the police would have nothing of this. They cooked up a theory that Sarita had been burnt by her in-laws. To be sure they were in a kind of bind. According to recent legal amendments, if a bride dies within 7 years of marriage, the case has to be registered as a murder. To the legally minded, I may add that the relevant section is 304B of Indian Penal Code, and it is entitled "Dowry Death". It was introduced as an amendment in 1986 when dowry death cases had increased to enormous proportions. In all such cases the presumption is that the husband or some of his relative has murdered the bride, and the onus of proving himself innocent lies on the husband or his relative.
This is a lot tougher situation than the normal. Normally a person is deemed to be innocent and the prosecution has to prove otherwise. When the presumption is the other way round and you have to prove yourself innocent, things become lot tougher.
This was the situation in which Ramesh and his family found themselves. It so happened that I personally knew Ramesh. I also knew that there had been some minor dowry problem in the house, but it had settled. In any case, I was not prepared to believe that he or any of his relatives could go to the extent of killing Sarita for bringing insufficient dowry. Of course there are people who do it, but Ramesh definitely was not among them.
I talked to Ramesh in isolation, and took him in confidence. He told me that Sarita was rather a sentimental girl. She used to get depressed very soon. Recently the results of her MA exams had been declared and she had failed miserably. She used to remain too depressed after that and that was perhaps the reason she had burnt herself.
Sounded like a fair reason to me. Sentimental people often do take their lives for petty reasons. I am personally aware of several youngsters who have committed suicide when they could not get admission to a medical or an engineering college.
But there was a snag. Such people often leave a suicide note, and in Sarita's case, no suicide note had been found. I asked about this from Ramesh and he couldn't explain about it to me either. Well, I let it leave at that. Although suicide notes are usually found in suicidal deaths, they are not invariably found in all suicide cases. In any case, I made up my mind to defend Ramesh. When I examined the scene of death, it did not appear to be too disturbed to me. You see, things like turned up chairs, fallen flower pots, rumpled up bedsheets and so on. Such a set up often points to violent struggle having taken place soon before death, which in turn could strongly point to homicide. Since the scene was too "clean", I made up my mind that it indeed had to be taken as a case of suicide.
Of course there are snags to this too. Murderers can set up a scene after having committed a murder. They can place everything back in order so that no one gets other ideas. But in such cases, I can often read it in murderer's faces. This is due to my long experience you see. I could see none of that in Ramesh or his family member's faces.
But you would surely agree, I couldn't defend Ramesh in a court of law on hunches. I had to produce sound scientific evidence to be produced in court. But what was it going to be? I must admit, I had no idea of that at that point in time.
Fortunately for me (and my case), the police had formed a rather weird theory of murder. They asserted that Sarita had first been killed by Ramesh and her family members by some means, such as gagging and then had been burnt by them, to give it the color of suicidal burning. Normally of course bride burnings occur when the bride is still alive. The traditional theory is that the mother-in-law comes surreptitiously from behind, pours kerosene on the hapless girl, and then someone lights a match.
You might tend to believe that the police was foolish in building up this theory in the first place, but I wouldn't blame them. Sarita had died at about 11 am on Sunday, when every one is up and about. If they had developed a theory of traditional bride burning, some of their neighbors would of course had heard her cries, and other sounds of scuffle, but no one had heard such sounds. Indeed this was another factor which helped convince me towards a suicidal theory. Since no one had heard her cries, the police were a lot better off theorizing that Sarita was already dead when she was burnt.
How could any forensic pathologist prove or disprove police theory? Gagging as we all know, doesn't leave any remarkable tell-tale signs of its own, especially when the gagging cloth has been removed from the mouth, and the body has been burnt subsequently. So an autopsy was not likely to prove with any conviction that the death had occurred because of gagging. In such circumstances, the only way the police theory could be proved was by showing that Sarita's was a case of post-mortem burning.
On the contrary, if Ramesh and his family members' theory of suicide was correct, then Sarita's was a case of antemortem burning. So basically the question boiled down to this: Was this a case of antemortem or postmortem burning?
I wouldn't bother you with details, but in a single line would tell you what these dreadful terms mean. An antemortem burning refers to a case of burning when the person was still alive, while postmortem burning refers to a case where the person was already dead when his body caught fire. While post-mortem burning almost certainly points to homicide, a case of ante-mortem burning could be anything- accidental, suicidal or homicidal- roughly in that order.
There are some very clever ways to differentiate antemortem from postmortem burning. One of them - and one on which I rely heavily - is the finding of carboxyhemoglobin in the blood. During burning of any carbonaceous object, especially if the burning has taken place in closed surroundings, lot of carbon monoxide is produced. If the victim was alive at the time of burning he would be respiring and would invariably inhale some of the carbon monoxide (or CO for short). CO binds very strongly to hemoglobin to form carboxyhemoglobin. This bond is almost 200 times stronger than that made with oxygen. Because of this, carboxyhemoglobin does not "break up" even after death and can be detected by forensic pathologists. On the contrary, if the victim was already dead at the time of burning, he wouldn't be respiring and would thus not inhale any carbon monoxide.
What does this piece of information lead us to? Simple. Do an analysis of the blood of the victim, and try to find out if there are appreciable amounts of carbon monoxide in his blood or not. By "appreciable amounts", I mean about 15-20% or more. People living in cities do tend to have small amounts of carbon monoxide in their blood anyway. With the vehicular pollution showing a steady rise - outdoing even our national economic growth rate- we couldn't expect anything better. Cities like Delhi would beat Hitler's gas chambers hands down any day. But I am straying away from the main line again. Let us come back to it.
I brought Sarita's body to my mortuary, took some blood from her iliac vessels and got down to work straightaway. I almost certainly expected to find carboxyhemoglobin in her blood, but try hard as I would, I couldn't find even traces of it. I tried again, with more sophisticated methods, with spectrophotometer, with everything else I could lay my hands on, but try hard as I would, I couldn't find any carboxyhemoglobin.
As you can imagine, this had grave repercussions for Ramesh and his family. Not finding carboxyhemoglobin in Sarita's blood could only mean one thing- that she was already dead at the time of burning. And that raised a very strong accusing finger towards Ramesh and his family.
To tell you the truth, the finding did send me in a bout of confusion. I tried hard to explain the absence of carboxyhemoglobin but couldn't, except assuming that she was already dead at the time of burning. If I assumed her to be alive at the time of burning, there was no way I could explain the absence of carboxyhemoglobin.
I was sitting confused in my anteroom thinking over the problem while the body lay in the mortuary. At five O' clock, the attendant came and informed me that he was leaving. I told that I would shut the department and asked him to leave.
I came home and continued racking my brains over the problem. The next day was a public holiday and then there was a Sunday. After that a public holiday once again, made a continuous break of three days.
It was only on the morning of the fourth day- the day when I was to go to the department once again- that I realized that I had left Sarita's body on the mortuary table itself!
I should have transported the dead body to the cold room before leaving the mortuary. The mortuary attendants always do that. But on that Friday evening, I had stayed in the mortuary longer than usual; the mortuary attendant had left and I had promised him that I would do the needful before leaving the department.
But I am not used to closing the mortuary. Coupled with this was the fact that I was quite puzzled that evening. That was the reason, I forgot to put back Sarita's dead body in the cold room.
It was horrifying to even think of the consequences. The body would be badly putrefied now. In this summer heat, three days could play havoc with a dead body. At best, it would be a swollen, greenish-black putrid and badly smelling mass of organic matter. Of course things could be a lot worse. There could be maggots crawling all over the body for instance.
What worried me was not the bad state of the body I would be confronted with, but that the putrefaction would blot out all medical evidence pointing to the mystery of her death. There was absolutely no hope of unearthing any more useful evidence now.
With the worst fears in my mind, I opened the door of the mortuary, and expected a strong gush of revolting smell to hit my nose. I was mentally prepared for it.
But nothing of that sort happened. I looked at the table where I had left Sarita's body, and was nonplussed to see the body there with almost no putrefactive change!
Now I do believe in wonders, but not in wonders of this sort. I mean the ones, which defy logic and science. Sarita's body was lying there out in the open on the mortuary table and had not putrefied in the least! This was a wonder I could not believe. Something extraordinary had happened.
But what could have happened? I started thinking about the problem, but couldn't come to an answer. Finally I took some of her muscle tissue and took it to Dr. S.K. Gupta, professor of biochemistry in our own college.
Everybody knows he is a genius, and I personally believe he is made of Noble Prize stuff. In fact it is a mystery to me why he has not been able to get it till now. Well let us not digress from the main point.
I submitted the tissue to him, and asked him to look for anything abnormal. I was a little surprised when two days later, he told me he had found abnormally high amounts of formaldehyde in the tissues. In fact so high was the amount that he asked me if I had preserved the body in formalin.
I surely hadn't, but perhaps Jamman Singh, the attendant who left the mortuary on that Friday evening had done it before leaving. That was perhaps the reason, the body had not putrefied.
I went to Jamman Singh and asked if he had sprinkled formalin over the dead body before leaving, but he informed me he hadn't done so. Why would he do so, when we have an excellent facility of a cold room?
This confused me a lot more- and I had one more problem on my hands- to explain the presence of formalin in Sarita's body. Sarita surely hadn't ingested formalin. She had no access to it, and it couldn't have been given to her by Ramesh and his family members as a homicidal poison. Formalin has a strong smell and a very acrid taste, and because of these properties, it is a very poor homicidal poison. All homicidal poisons must be tasteless and odorless. If you tried to kill me by putting formalin in my milk, I would know somebody had put something in it and I wouldn't drink it. Of course I would do so, if you put arsenic trioxide in it, because it is colorless, odorless and tasteless. So if you wanted to kill me you would be much better off with arsenic trioxide than with formalin.
The problem before me was how formalin reached her tissues. I thought for the problem for a few hours, and then a possible solution flashed in my brain, like the stroke of a lightning.
Well, the train of my reasoning was this. There should have been carbon monoxide in Sarita's blood and muscles, but it wasn't there. And there should have been no formalin in her muscles, but it was there. Was it possible that carbon monoxide in her body had somehow converted to formaldehyde?
Well, chemically it is not impossible. Formaldehyde is chemically HCHO, while carbon monoxide is CO. Plainly and simply, if CO can combine with water - which is quite abundant in human body- it can extract two hydrogen atoms from there and get converted to HCHO, while releasing the single oxygen atom free.
Theoretically it is possible, but can it occur actually? I am no chemist, and surely I did not know the answer to this. To find the solution to this, I had to see no farther than my own home. My wife is a professor of chemistry (besides being a great cook, just in case you are reading it), and one fine day when I returned from college, the first thing I asked her was if that was possible.
You can do that, she told me, but it is not simple. You have to have high temperatures and pressures and costly catalysts. Trickier is the situation in a human body- dead or living- where you have no catalysts, no high temperatures, no high pressures and so on.
Why don't we have catalysts in the body, I asked her. Catalysts are not merely the domain of chemists. We do have our own catalysts. They are the various enzymes in the blood and in the body cells. And they can do seemingly impossible jobs. Like burning glucose so slowly and deftly that the body does not get burnt. Instead a fairly equable temperature is maintained. Is there any catalyst with the chemists which could even come anywhere near it?
Of course she did not have to answer that, because she had gone to the kitchen to make a cup of tea for me, but her statement had already set me thinking.
I couldn't kid myself with the weird notion, that an enzyme existed in human body which could convert carbon monoxide to formaldehyde, but what I came up with was the thought that perhaps Sarita was a mutant and such an enzyme existed in her body.
Now why would such an enzyme creep up in the human body, you may ask. We all know that mutations do keep occurring in our bodies constantly, and they can lead to the formation of new proteins and enzymes. That is how evolution has occurred. Most mutations are of course deleterious to the body, but some are quite useful.
Take for instance the enzyme which could convert carbon monoxide to formaldehyde in a body. Both are poisons, but the body finds it harder to deal with carbon monoxide, especially because it sticks so strongly to hemoglobin. On the contrary, formaldehyde is much easier for the body to tackle. This mutation could be quite helpful to Sarita if she had survived, and perhaps had been doing good to her all her life. It is a built in mechanism to protect you from the carbon monoxide of this increasingly polluting city.
But we are again digressing from the main issue. The main point was whether or not Sarita had such an enzyme in her tissues. If I could positively prove that, only then could I simultaneous solve all my problems. In fact, the more I thought about it, the more I got convinced that this indeed was the solution. In science, the best solution is that which simultaneously solves several problems, however weird that may appear in the first instance.
And once again I found myself in the lab of Dr. S.K. Gupta, but with a different request this time. He is an expert in cellular enzymes, and if there was one person on earth who could help me, it was he.
I asked him to look at the muscle tissues once again and tell me if there was an unusual enzyme in it, especially one which had the property to convert carbon monoxide to formaldehyde.
Now Dr. Gupta knows for sure that I am a little soft in the head, but he also knows that I can turn violent, if my genuine hunches are not attended to. They have to be either proved or disproved. So despite thinking that I was turning senile, he preferred to keep quite and got to work.
He was in for a surprise. He did find an enzyme next day with exactly the same properties that I had predicted. It could effectively convert carbon monoxide to formaldehyde. He preferred to call it carbon monoxide reductase. He also told me that it was a completely unexpected finding- one that would stun the biochemical world.
All my problems were solved now. I now knew that Sarita was a mutant. There was a unique enzyme in her blood, which converted the carbon monoxide of her blood in formalin, and that is why her body was so remarkably preserved. The presence of carbon monoxide in her blood meant that she was alive at the time of burning, and this in turn meant that she had committed suicide.
One could of course argue that there was no carbon monoxide in her body from the beginning, but if we assumed that, we could not explain the presence of formaldehyde in her blood and muscles. So we had to assume that there was carbon monoxide in her blood to start with which got converted to formaldehyde.
The court accepted my findings and conclusions and set Ramesh and his relatives free. But the biggest surprise was when I found that Dr. Khanna had lapped up my findings and was trying to make an useful drug aimed to treat carbon monoxide poisoning. He got Dr. Gupta to decode the chemical structure of this new enzyme and got him to make samples of it in his laboratory. He is trying to give injections of artificially prepared carbon monoxide reductase to patients of carbon monoxide poisonings and see if it helps them. The initial reports are encouraging. He has published several papers on this. Some have been written with me as a co-author. I wrote some on my own, and some with Dr. Gupta. I am giving you the references for some of the more interesting papers. Interested readers may look for details in the said references.
1. Khanna S.K., Aggrawal Anil. The role of carbon monoxide reductase in carbon monoxide poisonings. Journal of the American Medical Association 1998; 247: 1471-1475
2. Aggrawal Anil, Gupta S.K. The story of the discovery of Carbon monoxide reductase. Medical History 1999; 145: 365-377
I hope these papers would satisfy the curiosity of the more scientific minded people. But I must tell you that the thing that surprised me most was when Dr. Gupta was called by the European Academy of Biochemists to give them a series of lectures on the new enzyme, and Dr. Khanna got a call from the American Medical Association to tell them of his latest developments on the treatment of carbon monoxide poisoning. As for me, I was being burdened with more autopsies! Well, I asked for it!!
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