How the Legacy of Three Generations of Pathologists Lives On: A Q&A with Stephen Norman, MD

Stephen Norman, MD, introduces himself as a “semi-retired.” Truth be told, this is Dr. Norman’s third act. He currently crisscrosses the State of Louisiana in his electric truck, serving as the CLIA Director for three labs.

Here, Dr. Stephen Norman discusses how his family — two previous generations of pathologists¬ — influenced his career as well as the impact his solo autopsy practice has had on the grieving families of incarcerated inmates seeking answers and justice.^*

Critical Values (CV): Can you tell me about your family background and how it first sparked your interest in medicine?

Stephen Norman (SN): I have two family connections to pathology. My late great uncle, Dr. Foster Matthew Johns, was a clinical pathologist and a member of the Tulane University School of Medicine faculty, served as president of ASCP at the time of his death in 1936. He studied malaria with Dr. Bass, and they were the first to successfully cultivate the malaria parasite outside of the human body. My grandfather, his brother, talked about him a lot. Certainly, I’m very proud of my great uncle.

My late father, Dr. Tom David Norman, was also a pathologist and a member of ASCP. His career was primarily as an academic pathologist; he became the chair of the Pathology Department at the University of Arkansas Medical School. He loved teaching. But about the time I started high school he went into private practice.

CV: How did your family’s experiences shape your own career path?

SN: In the late 1960s, none of the hospitals around here had body coolers. If someone died in the middle of the night and there was an order for an autopsy, my dad would do it in the middle of the night.

That’s how I got started. When I was in high school, I started going with him to help with those autopsies. It was like attending a pathology lecture. I think that really influenced me a great deal.

CV: Looking back, do you think you would have chosen the same specialty if not for your family background?

SN: I have thought about it a lot over the years. I think that most of my classmates in medical school only thought of pathologists as the ones who taught us sophomore pathology. But I had the advantage of knowing what the practice of pathology was like — the frozen sections, the clinical laboratory decisions, the surgical pathology gross and microscopic look at everything, and the autopsies — along with the interactions with clinicians and technologists and patients and families. I think it's pretty likely that had I not had the experience of helping my dad in high school I may have ended up in something else. When I was in medical school, a lot of people expected me to become a pathologist. So naturally I completely rejected that! I really tried to experience every specialty before making my mind up. One by one I rejected them. I think that because I really knew what it was like to practice pathology, unlike my classmates, that I finally landed on pathology.

CV: After spending your early career working alongside your father, in his private practice, what motivated you to open a solo autopsy practice?

SN: It was lovely to practice with my dad. It was really, really cool talking about work outside of the office. But when I turned 51, I sort of burned out. My father had retired by then, and I left the practice that my dad had started after 21 years.

So, I started a solo practice, focusing on autopsies. It was around the time labs started getting serious about having a CLIA lab director. I quickly accumulated five clinical labs that supplemented my autopsy work.

A lot of people think that autopsies are a thing of the past, but you can work on incredibly important cases and answer incredibly important questions.

Every autopsy you do is in some way solving a mystery because, by golly, you are looking for the reason they died. It may not even be a big, complicated mystery. That can be a very exciting as a career.

CV: Even though pathologists — and those specializing in autopsies — often work behind the scenes, how do you think about patients and patient care?

SN: Autopsies can be so important to living families because there are so many questions that can be answered. For example, I developed a reputation in Louisiana for performing second autopsies on incarcerated individuals.

The whole concept of a second autopsy may sound strange, but a conflict of interest arises when the person responsible for the health of an individual is also the person who investigates the person’s death.

The coroner is responsible for the health of incarcerated people and death investigations if they die in prison. There is a lot of room for conflict of interest, because either the autopsy is done by the coroner, or someone who works with them. The family rarely trusts that first autopsy, and rightfully so. For example, I once had a case where supposedly the prisoner hit his head falling out of his bunk and died. According to the first autopsy. I had to say, after doing the autopsy, his head would have had to bounce approximately 100 times from falling out of his bunk. The truth was, he was beaten to death.

CV: After a long career — over 40 years — in pathology and clinical laboratory medicine, are you ready to retire?

So, I still run three clinical labs – one for a local physician and two in hospitals. But one hospital is north, and one is south. It’s just at the outer range of my electric truck—I barely make the 2.5-hour trip each way.

I currently serve as Laboratory Director for three labs. One of these is a POL, or physician's office lab, that performs high-complexity molecular detection of pathogens in urine specimens. The other two are both relatively small hospitals in rural locations. I mostly maintain contact with the Laboratory Managers by telephone and email, but I travel to them all for medical staff meetings. I also serve one of the hospitals in a monthly review of all their deaths in the hospital. I serve the other as Infection Control Chair and travel to meetings for those committee meetings. For all three labs I review instrument performance and verification, personnel evaluations and credentials, performance improvement studies and issues, transfusion practices and management, quality control, policies and procedures, and more.

I’ve had to stop doing autopsies. I really helped a lot of people. What I hate about quitting doing autopsies is helping families that need them. But I’ve had a wonderful 20 years in my nearly autopsy-exclusive solo practice, that’s been a really enjoyable part of my pretty long career.

^*This interview has been edited for clarity and length.