Blood has a voice: Stories from the autopsy table

By Hestelle van Staden

 
As one of South Africa’s leading forensic pathologists, Dr Hestelle van Staden has conducted over 7 000 autopsies. She has witnessed the worst of the violence that plagues
South Africa, and gives voice to murder victims who can no longer speak for themselves. Van Staden’s court evidence has led to the conviction of numerous criminals.
In Blood Has a Voice, she walks us through nine of her most compelling cases. 

‘A captivating reading experience’ – Lt Col Mike van Aardt

• Language: English
• Publisher: Tafelberg
• Release date: Sep 15, 2023
• ISBN: 9780624093640

Hestelle van Staden

Dr Hestelle van Staden knew is a forensic pathologist. Having performed more than 7 000 autopsies, there’s not a lot she hasn’t seen. She is featured in the Afrikaans television series Outopsie, which gives viewers a glimpse of her professional world.

Book preview

Chapter 1

From murder to macarons

Why did I decide to write a book? Well, firstly because I was asked to and took a leap of faith and said yes. But also because, over time, I’ve realised that I live behind a curtain that very few people see behind. A lot of them choose not to look behind it – life is certainly easier that way – but a few do want to get a peek behind that curtain, out of curiosity or scientific interest, or perhaps because of a personal experience.

To illustrate my point: a few years ago, a death in custody occurred on a Friday night at the Park Station police station in central Johannesburg and I was the pathologist on call. There is always a forensic pathologist on standby from the local Forensic Pathology Service, but sadly we aren’t often called to the scene, so this was unusual.

It was during the early evening, at about 6 p.m., that I was called out. Park Station can be quite a dangerous place that time of the night, and I remembered a former colleague’s husband having sustained a fatal stab wound close to that station (during the day) a few years previously. So, I notified the South African Police Service (SAPS) that I would gladly attend the scene of death, but that they would have to fetch me from the Johannesburg Forensic Pathology Service Medico-Legal Laboratory in Braamfontein and drop me off afterwards.

A pitch-black minibus with darkened windows pulled up a while later, emblazoned with the SAPS insignia. Inside were about six police officers, all men. And I got in . . . I recall praying all the way to the station, thinking that if this was a scam of some sort I would never be seen again. (My occupation has led to my always being on high alert, struggling to trust anybody or anything until I’ve seen proof of their trustworthiness.) The situation at the police station was even worse than I had anticipated – all around there were rowdy drunk people who had been arrested, but the police officers were most kind and helpful and my job was easy to do. I examined the body and determined that the only injury was a friction abrasion (hanging mark) over the superior (top) part of the neck. This was caused by a shoelace, if I remember correctly.

I have seen prisoners use any part of their clothing, even a pair of pants, to commit suicide by hanging. When people hang themselves, there is a distinct type of abrasion to the skin of the neck caused by the weight of the body or the head and it tends to leave a mark that is quite different from a strangulation mark. As there were no other injuries, I had to conclude that the deceased had most probably hanged himself. I cannot remember what he had been arrested for, but I must be honest – whenever I’d be called to a death in custody, I would ask. It was not directly related to my medical findings – just natural curiosity, I guess. Afterwards, the same cops took me back to the mortuary. The postmortem examination was still to follow on the Monday morning and the cause of death was eventually determined to be ‘consistent with hanging’.

Which other normal, forty-something-year-old suburban Afrikaans-speaking woman has stories like this to tell? It dawned on me that I may have a few things to say that people may want to hear.

What I’ve always found daunting, though, is the fact that writing a book does not only mean telling the story of my job and the cases it involves. I am intensely private and choose not to share much about my own life and feelings with people who are not within my closest circle, and even that has become smaller with time. When you do what I do, you become a bit more careful about who you trust and with what – it is just easier to fraternise with the people who know and understand your world.

But ever since the release of the TV show Outopsie, I’ve realised that people want to know more about the person behind the profession. In Outopsie I was hesitant to give my opinion and emotional experiences, and I remember being very reluctant, while we were filming the Baby Daniel story, to mention that I had started crying when I’d originally seen the photos of the victim. Outopsie deals with a series of cases that we ‘dissect’ in detail. In some of the cases, I was the forensic pathologist, but in others I just comment on the autopsy findings. It attempts to show what it takes to solve cases – not only murder cases, but also some accidental deaths and even suicides. So, we look at autopsy findings, but also present interviews with prosecutors, investigating officers and various other (very interesting and knowledgeable) people. The Baby Daniel story was incredibly tragic: a little boy found dead with a number of acute and chronic injuries – burns on over 60 per cent of his total body surface area, a skull fracture and other injuries. Daniel’s mother was found guilty of child abuse and sentenced to twenty years in jail, while her boyfriend, who was not the little boy’s father, was found guilty of murder and received a life sentence. I was not the primary forensic pathologist involved with the case, but I testified in the bail application. I felt very exposed admitting that I had cried when I’d seen the photos. But then, as more and more correspondence from viewers reached me (something else I naively did not anticipate), it dawned on me that people wanted to know more not only about what we do, but also how we cope with what we do and how it affects us.

I must also add the following: I am quite aware of the narrative that some doctors think they are God’s gift to the rest of creation (some surgeons tend to subscribe to this point of view, I suppose because they really do hold a patient’s life in their hands at times). Nonetheless, I don’t subscribe to this notion at all. I believe we all have a calling in life and that, obviously, it can’t be the same for everybody. I believe myself to be incredibly blessed to be able to pursue a career that I love (not that it’s always easy or nice), but I don’t believe that my career makes me special in any way. If the COVID-19 pandemic has taught us anything, it is that we all rely upon one another; we don’t live in isolation. One silly example: I have never missed my hairdresser and nail technician more than in those first few months of hard lockdown. Even my children were incredibly happy to be able to have their hair cut again – I am great with a pair of scissors as far as my occupation is concerned, but my family does not trust me with scissors near any of their heads. With good reason: my brother (who was in primary school at the time) had to be kept home one morning after I, in my teenage wisdom, had attempted to cut his hair in my parents’ absence. And not just in any style; I was quite ambitious and attempted to cut his hair in a step, which was in vogue at the time. Needless to say, I’m sticking to my own profession now. But on a more serious note, it is the people in our lives who give life meaning; they give us support, give us context, and sometimes make us so mad that we want to pull our hair out of our heads.

So, this is my story.

I am the eldest of four children, having grown up in a household that was typical of the time. We lived in Westville, Durban, and I remember this as an amazing period. Life was uncomplicated; although very aware of the political turmoil of the times we were living in, I basked in the love of my family. The Afrikaans community in Westville was quite small, or so it felt, and we quickly learnt that to be attended to in shops we had to speak English, which has always stood me in good stead. The primary school I went to was small and sheltered, and consisted of only about 180 pupils at any given time. It has sadly shut down since, but its size meant that we all had to participate in every activity, as there were simply not enough pupils to fill the teams unless we all did everything. All of this helped shape me in terms of work ethic and ambition. When I reached high school, the situation changed a little. I went to Hoërskool Gelofte in Pinetown, quite an intimidating experience, as now there were about 600 pupils in my school. I felt like a very little fish in a massive lake.

This feeling was to get worse. In the middle of my Standard 6 (now Grade 8) year, we moved to Pretoria and I was enrolled in Hoërskool Menlopark, still one of the best schools in the country, in my opinion, and considerably larger than Gelofte. There are many great schools in Pretoria, but my parents wanted the high school and primary school for my younger siblings to be in close proximity and it allowed me to continue with Music as a school subject. It was at this school, in the Accounting class, that I told a friend I wanted to become a forensic pathologist. It was the first time that I had actually spoken the words. Not that it should have surprised anybody, really.

Years before, I was just a little girl (my mom recounts that I was five years old at the time) when I professed that I would become a doctor one day. I also said that I would write a book (and now I cringe at the nerve of youth), but I never considered that these two could be combined. My father used to watch television shows such as Murder, She Wrote and Quincy, M.E. We weren’t allowed to watch LA Law, but I remember always trying to catch a glimpse of the forbidden fruit. Which also speaks of my curiosity. I have to credit Patricia Cornwell and her Kay Scarpetta series of books, too, for opening my eyes to the possibility of becoming a forensic pathologist. It was after reading Body of Evidence that I became really enthused. An admission from my side, though: I am one of those people who gets incredibly irritated by the matric pupils who, at the end of the year, profess that they will be studying medicine and specialising in whatever discipline they fancy (I’ve always perceived it as a bit arrogant) . . . very hypocritical of me, I know.

After matric, I enrolled in medical school at the University of Pretoria, and I found the experience truly overwhelming. The classes were large, and my classmates all seemed so worldly and intelligent. I remember our Chemistry professor, Prof. Schoeman, calling one of my new friends to stand up right after our first semester test. Obviously, we were all a bit nervous about this; meanwhile he had scored something like 102 per cent on his first test at varsity! All I can say is that at least I kept good company. My first Molecular and Cell Biology test was a massacre; I barely scraped through. But first year was a great experience and over time I got used to the approach, which was so different from school. We could also participate in things like the Rag, the time-honoured tradition of the first-year parade at the beginning of each academic year where some students get horribly drunk. We didn’t do this often, as the workload in medicine was simply too much.

We moved from main campus to the medical campus in our second year and the course became much more focused. The approach in first year was relatively general, with subjects such as Chemistry, Physics, Molecular and Cell Biology and even Philosophy – it was basically a BSc course. The medical campus is physically quite far removed from main campus. In fact, this is probably also psychologically true – I found main campus to be much more laid-back, while medical campus was very intense and quite serious.

At that stage, what is now known as the Tshwane District Hospital used to be called the Pretoria Academic Hospital, which was the tertiary hospital (a major hospital with a number of specialities and subspecialities) attached to the university as a training facility. Campus consisted of lecture halls, offices, a library and a cafeteria connected via numerous passages to the main hospital building. This enabled students to move between attending lectures and working in the hospital with great ease. Anatomy and Physiology were the two major subjects in our second year, and we spent an entire year in Anatomy dissecting a donated body. These are bodies received from people (or their families) who had decided prior to their deaths to donate their bodies to further medical science. These are people who have died from natural causes and whose bodies are embalmed after their deaths, which means they can be dissected for an entire year without decomposition hampering the process. They look just like a person sleeping, but simultaneously appear quite leathery and parchment-like. I think it is an incredibly selfless thing for a person to do; even though we were still very young (nineteen or twenty years old) we always treated the bodies with respect, covering them at the end of the day with a sheet to protect their dignity. At the end of the year, the body would receive a proper burial.

We were also allowed into the Anatomy Museum, which was an amazing collection of dissected specimens – scientists had painstakingly dissected portions of bodies layer by layer to provide teaching specimens and 3D representations of what we usually only see in textbooks. It was wonderful to start doing something so practical, and I felt like I’d really become a medical student then. Our parents were invited to the Anatomy Department to see what we did, and probably for the lecturers also to explain why we always reeked of formalin. My father, who had studied Accounting but was always the one interested in all things medico-legal, did not last very long. We’ve chuckled so much about this since then. Having said this, I did not clothe myself in glory during this year. I actually failed the OSCE (objective structured clinical examination) of the brain, and to this day I remember wondering how people were able to recognise the different areas of the brain: they all looked the same to me. The exam entailed many different ‘stations’; at each one, we were presented with a dissected specimen of a brain and had to identify its structures. Thankfully, over time insight has dawned and now I don’t understand what I struggled with. But I think it’s a great reminder to never become blasé.

We also studied Histology during this year. Histology is the study of the microscopic structure of tissue and is the basis upon which Anatomical Pathology is built, which I refer to in Chapter 3. I was frothing at the mouth to start Forensic Pathology, but this was only to happen in my third year. During my entire time studying, I worked as a pharmacy assistant at Faeriedale Pharmacy, belonging to Karien (also a Van Staden, by chance), who became a wonderful friend and mentor and I still consult her if I want to know anything about medication.

Quite a number of medical students work as pharmacy assistants – it exposes us to medicine and the practical side thereof, but it is also a valuable source of income for a degree that was quite expensive at the time. Seeing medicine in practice was a wonderful learning experience and we had loads of fun in the pharmacy. I must admit that I’ve never been particularly brave when it comes to taking medicine myself, and although our Pharmacology professor (Jacques Snyman) said that any good pharmacist (and doctor) tested drugs themselves, I was never that daring.

However, if I had to apply the pay-per-wear clothing principle to my studies, I have paid a lot per class. I never realised before then (and only after reading a book about child rearing many years later) that I am incredibly hearing-sensitive. This is surprising, since I work in an environment that is as noisy as a mortuary. And I am not joking – I often have to raise my voice and tell people to keep quiet. I don’t function well sitting in a class with 180 other students, each one having a conversation to some extent while a lecturer is also trying to speak. I also don’t learn from listening, but rather from seeing and reading. So, the logical thing for me to do was to bunk class and work in the pharmacy – while being paid. This coming from a person who is duty-bound . . .

I never missed Forensic Pathology lectures, and I never missed General Surgery from my fourth year onwards, but for two very different reasons. Prof. JD Loubser was the head of the Department of Forensic Pathology and a very interesting lecturer. Upon his retirement, during my third year, he was succeeded by Prof. Gert Saayman, who was elected as our favourite lecturer in third year, for very good reason – he is a great orator and used to tell us amazing stories.

It was also here that I first came across Dr HJ (Hendrik) Scholtz, who would later become my professor at the University of the Witwatersrand, where I would do my postgraduate studies. He had recently returned from working in Scotland and used to introduce his lectures with interesting pictures and anecdotes from there. This is a habit he has kept up, and he’s still one of the greatest lecturers I’ve ever heard speak. Surgery was another story altogether, though. I was scared witless of Prof. JHR (Hennie) Becker, who was head of the Department of Surgery at the time. He would pitch up at our lectures with a class list, enabling him to ask questions of students by name . . . definitely not my idea of fun, even though I’ve never had trouble answering his questions.

I ended up being in Prof. Becker’s team (called a ‘firm’ by medical students) in my fifth (and if memory serves, also my sixth) year. We were meant to do ward rounds on the weekends; present would be all the students (fifth and sixth years), all the medical officers (junior doctors) and registrars (doctors training to become specialists), and a consultant (specialist) at times. We heard from the older students that Prof. Becker didn’t attend the ward rounds on Saturday mornings. In our youthful wisdom, we divided the group in two, half attending the round on the Saturday morning and the others on the Sunday morning, so that we could have some well-deserved rest at least. I was sound asleep one Saturday morning when my cellphone (quite a new invention at the time) rang next to my bed; it was my friend Sandra Spijkerman, who whispered to me that Prof was on ward round. She had, in fact, called me last as I lived the furthest away from the hospital so she didn’t think I would be able to make it there before the ward round ended. The blood drained from my sleepy body. I was in major trouble and I knew it. To say that I flew to hospital would be an understatement. But I eventually arrived and decided that I had to ask a few questions so that at least my presence (and the trouble that had gone into it) didn’t go unnoticed.

Funnily enough, years later I was chatting to a mother from my children’s school with whom I’d become friendly. As the conversation progressed, I came to realise that Prof. Becker was her father. She had a good laugh when I told her my ward-round story. I’ve subsequently seen Prof. Becker at school functions and I’m much less scared of him now. The other thing he taught us, and which has remained with me for all these years, is that he would never buy anyone alcohol as a gift – he said that we can never know what