Karissa French: Forensic Pathology and the Raymond Chang Fellowship
By Deanna Cheng as part of the Faces of Temerty Medicine by the Office of Advancement, Temerty Faculty of Medicine.
Dr. Karissa French was born in Calgary to parents from the Nazko First Nations and Neskonlith First Nations. She moved to Toronto for her education, receiving an undergraduate degree in forensics and biochemistry from the University of Windsor and a master’s degree in research biology from Cardiff University. Today, she is a G. Raymond Chang Forensic Pathology Fellow at the University of Toronto’s Temerty Faculty of Medicine.
We sat down with her to talk about her journey through medicine as a member of the First Nations community, the role of forensic pathology in medicine and her hopes for the future of health care in Canada.
What inspired you to pursue a career in medicine?
Originally, I wanted to study chemistry. As an undergraduate, I did a work placement at the Oakland County Medical Examiner's Office in Detroit where I observed an autopsy for the first time. One of the forensic pathologists there was able to take all the information and determine the cause of death. I thought it was amazing. It was the same forensic pathologist who asked me if I had ever considered medicine — up to that point it had never crossed my mind as an option. In many ways, they were the reason I decided to apply to medical school.
Why Forensic Pathology?
I entered medical school knowing I enjoyed forensic pathology and found it to be my niche, this was the place for me. It's a very integrative field. You take in a little bit of everything, and you put it all together — I really liked that kind of true diagnostic specialty.
Why did you choose Temerty Medicine’s Forensic Pathology Fellowship Program for your training?
There are only four Forensic Pathology Fellowship programs in Canada — in Edmonton, Winnipeg, Toronto and now Ottawa. Personally, I think Toronto is the best one.
In Toronto, the amount of teaching, the complexity of cases and the facilities here all come together. Despite it being very busy, you're not here to get through as many things as you can, you're here to learn to be the best Forensic Pathologist you can be. The program at U of T does that really well.
How have the first few months of your fellowship program been?
It’s been amazing! The nice thing about completing a fellowship is that you're finally doing exactly what you love most and what I love most is getting to perform autopsies and to pull together all the information for a final diagnosis. Now that's what I do every day!
Is there anything that you're working on right now that you could share more about?
There's been recent research into a more molecular genetics approach to forensic pathology. In a lot of cases, the cause of death can be very sudden — especially for young people. Sometimes, unfortunately, you're left without answers.
Growing up, especially with my background, persons of Indigenous descent have a very high mortality rate compared to other groups in Canada. You’re left with more questions than answers. Where I, as a forensic pathologist, can be helpful is with families. If I have a case where I don't have any answers, I can look at the genetics side because a lot of these things are inheritable. I can refer families to physicians or genetic counselors who would be able to screen them for similar mutations — like conductivity issues in the heart — that they don't know about. And that way, you can help the surviving family members in the primary prevention of certain diseases and you’re protecting other people.
What are you most excited to learn more about?
Everything, right? There are all sorts of interesting things. For example, I find accident reconstruction absolutely fascinating. This is where you take injury patterns and reconstruct what happened so you can work to prevent accidents from happening again. There's research about how patterns of pedestrian injuries are changing as car shapes change — meaning injury patterns from cars in the 90s are completely different than our SUVs today. We are also on the forefront of understanding social determinants of health because we see the people who die most frequently and who die at young ages. There can be a lot of areas for possible intervention because you can find patterns that might not be so visible otherwise. It contributes to the greater understanding overall because there's not really any better way to assess things than being able to see it all firsthand.
The G. Raymond Chang Forensic Pathology Fellowship is an endowment that was generously established by The Raymond Chang Foundation. What impact did it have on your experience?
Having this funded fellowship has a huge impact. It allowed me to stay in Canada for my training. The G. Raymond Chang Forensic Pathology Fellowship is building talent from all over the world, so we can then provide a vital service to our local communities that are often understaffed.
Because of the pandemic and international travel restrictions, they generously allowed Canadian fellows to apply for these positions. As I think about my own community, I know it is difficult to keep up with the needs of the death investigation system. In some jurisdictions, especially due to the opioid crisis, it’s not investigated as well as it could be because pathologists are just so busy. But that’s a vulnerable population that deserves every bit of our investigative abilities. Being able to cultivate strong forensic pathologists who are trained in Canada can only help with this.
For myself, it gave me the ability to get the best training I could and to work in the system that I want to.
If you could speak directly to the donors of this fellowship, what would you say?
First off, thank you so much. I really appreciate the experience and the possibilities that I’ve been given. Thank you for valuing this work. It’s not something that people often think about donating to. You don’t see fundraisers for death investigation the same way you do for other specialties. Our patients obviously can’t advocate for themselves.
The motto for coroners is “We speak for the dead to protect the living” and I really appreciate that they understand that.
You’ve received a lot of support from your First Nations community. What does this mean to you?
I’ve lost family members suddenly and unexpectedly and that helped initially drive that motivation to figure these things out — because I was left with a lot of questions myself. Now, I can help other people know why and that is often not really appreciated until you’re in that situation.
Can you tell me why your community is at the forefront of what you do?
With the high mortality rate in my community, growing up, every one of those deaths impacted the whole community. Having a sensitive death investigation system that understands, really helps the healing process. I think it is a service, we unfortunately as a group, interact with more than we should. The missing and murdered Indigenous women are always on my mind so helping to identify unidentified remains and working to solve these crimes is something that is very important to me.
Do you feel like the system is changing now that you’re in it and working with people in this field?
It is, it’s become overall a lot more visible to the public. I think opportunities like the G. Raymond Chang Forensic Pathology Fellowship and the support I received personally shows that it is changing. If you go back even 10 years, there were no Indigenous forensic pathologists and now I know several who are helping with some of the more culturally sensitive issues. Being able to have representation and advocacy in the system shows that it's changing and with more education and visibility, more people are aware and can understand. Even if it’s just in the day to day, I think it’s every bit as big as changing the system.
What advice would you give to the next generation of people who are interested in pursuing careers in medicine?
I think the best way to start is to imagine that it's possible. The first step is to imagine you can do this, that this could be your future. I had never considered medicine until it was suggested to me. In a lot of undergraduate programs, most universities have an Indigenous Affairs Office which offers a place to gather and is a good resource for advice and mentorship. This way you can see what other people's journeys have been like and see whether you think it’s a good career for you.
What do you think lies ahead for you?
I'd like to work in Ontario. We are the largest single jurisdiction death investigation system in North America. Wherever I end up, I’d like to work with medical students and residents, teaching how pathology can help and where it interacts with medicine as a whole, even if they're not interested in being a pathologist. But I’m always learning. There are still many things I haven’t seen yet!