The King’s Birthday honours: The amazing career of medicine’s Guardian of the Dead
Forty years ago, Emeritus Professor Roger Byard was working as a hospital pathology registrar with an interest in forensics when he was tasked with performing his first autopsy.
It meant he had to go to the patient and tell him he was going to die.
“He was an old digger,” Professor Byard tells AusDoc.
“He took it all in, and then he said, ‘So who is going to do this autopsy?’ I just looked at him and told him, ‘It is going to be me, actually.’
“He sat back on his pillow and was quiet for about three minutes, and then he just looked over at me and said, ‘Son, you are going to be alright.’”
Professor Byard took the man’s word as a blessing on his future career, and it proved to be — as Professor Byard is one of Australia’s most eminent forensic pathologists.
He originally trained as a GP in Canada in 1982 after working as a flying doctor in 1981, with stints in Arnhem Land.
The idea was to eventually enrol in an emergency medicine course in Canada, but he says he got sidetracked snorkelling in Belize on his way over from Australia.
“By the time I arrived, the only spots left were in pathology. It was not something I had intended to do,” he says.
“But I started in basic general pathology then got into paediatric and then forensic and found out it is the most fascinating part of medicine.”
Newly qualified, during his first week on call, he was asked by police to go to a small town 140km north of Adelaide to examine the contents of barrels stored in an abandoned bank vault.
Inside them were eight victims of serial killer John Bunting and his associates.
“Dealing with the Snowtown murders was bizarre. I think my colleague and I emptied the barrels on Friday, and then — I think it was about 3am on Saturday — I just sat bolt upright in bed, wide awake thinking, ‘What on earth was that?’
“It was the most bizarre response.”
He says the process took about 10 days, with his team identifying those killed using dental records and tattoos because the wet, acidic storage method had rendered DNA identification impossible.
“There have only been a couple instances in my professional life where I have had nightmares about cases, and this one, I probably had nightmares for probably three or four nights,” he says.
“I dreamt that the bodies were in the back of a ute and they were coming alive.”
New to the job, he still returned to work the next week.
“I think I was too shell-shocked to quit.”
Now, when the job gets to him, he leans on his colleagues.
“If you have a terrible case, you call them in to look at it and then you chat over a coffee afterwards. They know what it is like.
“Your colleagues have all been through it. We see terrible things year after year, but everybody expects us just to keep going. There is not much support. If you cannot stand the heat, get out of the kitchen.”
A film was made in 2011, dramatising the Snowtown case, but Professor Byard says he could not comment on whether his work was portrayed accurately on screen.
“I refuse to watch it because they did not get Sean Connery to play me.”
He says shows like NCIS have come close to capturing some of the realities of forensic pathology, but they usually fail to show how convoluted and often imprecise the work can be.
“What they are doing is compressing months or years of investigation into 60 minutes.
“Then you will have pathologists interviewing suspects and doing blood analysis and all sorts of things.
“Or they will be prognosticating about the time of death: ‘Oh, it is clearly two seconds past midnight,’ and my response to that is always, ‘Yes, plus or minus a week.’
“The only one that actually gets it right is Inspector Rex, the police dog drama from Vienna.
“It is beyond B grade; it is actually terrible. Rex is a German Shepherd who solves all these crimes for the police.
“But it is the one that, to me, is about the most real — at least in the fact that it didn’t take itself too seriously.”
Professor Byard has also been involved in research into the causes of sudden infant death syndrome (SIDS), something that is seen as a landmark for the power (and necessity) of evidence-based medicine.
He was one of the expert witnesses who testified in the retrial of Sally Clark in the UK in the final court of criminal appeal
She had been convicted in 1999 of killing her two children based on flawed expert evidence given by paediatrician Professor Roy Meadow — who, with bogus statistical reasoning, had estimated that the probability of two cot deaths in an affluent non-smoking family, such as the Clarks, was around one in 73 million.
Professor Meadow went on to tell the jury that a double cot death, the argument made by the defence, would be expected to occur once every hundred years. They convicted her of murder.
“My opinion was that the cases had been investigated in a very idiosyncratic manner and that significant information had not been looked at. And clearly, infection was involved in the babies’ deaths,” Professor Byard says.
“And I thought there was very much the chance of reasonable doubt, and the judge agreed with my assessment.”
Sally Clark never recovered from what she went through: the deaths of her children, the convictions, the stresses of the appeals. She died in 2007 from acute alcohol intoxication.
Professor Byard’s long experience explaining complex medical concepts to lay juries has made him a proponent of the inquisitorial judicial system found in Europe.
The adversarial system underpinning the legal process in Australia — where two opposing counsels’ expert witnesses describe conflicting technical information — asks too much of non-expert juries, he says.
He also notes that expert witnesses do not really have to prove they are experts to give evidence, which is a further burden on non-specialist juries.
His involvement in the Sally Clark case was a result of his work on the links between babies sleeping on their fronts and SIDS.
The first evidence that prone sleeping could kill babies emerged through the epidemiological investigations of the Adelaide paediatrician Dr Susan Beale.
From the early 1970s to the mid 1980s she visited more than 500 families who had lost children to cot death in an attempt to identify the common factors.
In 1988 she was able to definitively show that the rate of death was highest among babies who slept face-down.
“I worked with her in Adelaide and then with others on the information she put together,” Professor Byard says.
“Then with Fiona Stanley, I co-chaired a scientific review meeting in Canberra in 1991. It was the first meeting in any country to address this issue.”
Today the work of Dr Beale and her colleagues is celebrated as a landmark in evidence-based medicine, overturning 50 years of routine medical advice which had been popularised by US paediatrician Dr Benjamin Spock who believed it would reduce the risk of babies’ choking to death.
To get a sense of its significance, in 2005, a meta-analysis was published estimating that between the 1950s and the early 1990s, more than 60,000 infant deaths worldwide “were attributable to harmful health advice — ie, advice favouring prone sleeping”.
A decade later, Professor Byard was part of a team that discovered a link between neuropeptide ‘substance P’ and SIDS.
“SIDS babies had a significantly lower level of substance P in areas that controlled the response to low oxygen and also in areas that controlled head and neck movement,” he tells AusDoc.
“For decades, we have been saying, ‘Why do they not just lift their heads up in their pillows?’ And the answer is, ‘Some of them cannot because they have this chemical defect.’”
But what about the scientific developments in his own specialty during his career? He immediately says CT scanning.
“A colleague of mine in Sweden had a stab wound case, and the knife was still in the body when he did the CT,” he says.
“And what the knife had done was it had come in from the left side and pushed all the organs over to the right.
“But when he pulled the knife out and went to do the standard autopsy — and in standard autopsies, we do layer dissections and work out exactly where things are — all the organs had moved back.
“For all the world, it looked as if the stab wound had come from the front.
“So the traditional standard autopsy was wrong; the CT was right.
“With CT, we can sometimes identify a cause of death without having to do the autopsy, which is good for the families.”
But Professor Byard says the second revolution in pathology was simply cultural: he and his colleagues had learnt to be humble.
“If you read transcripts of some of the English pathologists from the mid part of last century, they were just pontificating about all sorts of things.
“Now, I think we are happy to realise that we do not have all the answers.
“One of the things I like most in court is if I am asked something I do not know. I just look at the jury and say, ‘I have not the faintest idea.’
“And I can see them looking and then thinking, ‘Actually that is good because, if he is honest about this, then if he says he knows something, we can probably believe it more’.”
He says one of his most memorable cases was that of an elderly woman who was literally pecked to death by a rooster, which had punctured a varicose vein in her leg.
“I wrote a case study for Forensic Science, Medicine and Pathology. It got a lot of media traction,” he says.
“If you have got varicose veins and get an injury — even a small injury — lie down, put your leg up and put your finger over it, and you will survive. Do not wander out in a panic; you will bleed to death.”
His worst case was the murder of Jasmeen Kaur in 2021, who was kidnapped and buried alive by her ex-boyfriend Tarikjot Singh.
Mr Singh kidnapped the 21-year-old nurse from her Adelaide workplace, bound her with tape and cable ties and took her out to the Flinders Ranges to kill her after she broke up with him.
Professor Byard says the cruelty of the killing angered and pained him.
“She was in that boot for five hours. This outraged me,” he told The Advertiser.
“Then to die like that — buried alive — one of the worst ways to die.”
It was the first time in his career he went to watch a sentencing.
Later that year, he wrote about PTSD in forensic pathologists and the right to mourn.
In it, he called for “recognition that years of intimate exposure to violence may lead to accumulated, ongoing and unresolved grief in practitioners” and more research into the extent of PTSD in forensics.
His work has taught him that he cannot shun or ignore death, an attitude he feels is too common in modern society.
But he is aware that curiosity about death and the morbid is a normal part of the human condition, and the proliferation of true-crime entertainment is evidence of that.
He has even co-hosted his own true-crime podcast, Guardians of the Dead.
“A century ago, there was a lot of death around,” he says.
“Kids were dying, and families would put the bodies out onto the kitchen table and have a wake to celebrate this person, and friends would visit.
“There would be a respect for the person, and they would be seen on their way, whereas now they are just out the door, into the coffin, into the crematorium and that is it.
“We have sanitised it a lot. I think we really fear it. And I think the more you fear it, the more fearful it becomes.
“I am not at all worried about death. It is how I get there that worries me because there are some very nasty ways to die.”
It is an attitude Professor Byard brings to his own cases.
Although people are dead by the time they reach him, he sees them as his patients — the same as any doctor.
“I think it is important to respect and remember these people. They are your patients even though they have gone,” he says.
“If you do not have compassion with your curiosity, then I think you are missing a lot.”
On Monday, Professor Byard was awarded an AC in the King’s Birthday Honours.
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