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Molly is a mystery to me and has so far defied all my expectations. She is so much more than the poor girl who fancies Sherlock.

This is my attempt to understand her professional career. 

In this meta I explore:


  • Why Miss Molly Hooper cannot be a pathologist
  • If Molly is really Dr Hooper what kind of pathologist she would be and what she would actually do.
  • What else Molly could be doing in a morgue –  technician or surgeon?
  • How Molly might have faked Sherlock's death

Feedback always welcome. 


The Royal College of Pathologists does not approve…



All pathologists in the UK are qualified doctors. Pathology is a specialty of medicine that requires speciality training of 4-6 years depending on which branch of pathology you choose to specialise in. All potential pathology trainees must have completed Core Medical Training programs beforehand and received their membership of the Royal College of Physicians (MRCP).

Pathologists have their own Royal College and administer their own fellowship exams (FRCPath) for everyone who wants to be consultant pathologist (i.e. the top job).  

Therefore if Molly was a fully qualified pathologist she should be address as Dr. Hooper. To give her full qualifications she should be Dr. Hooper MBBS, MRCP, FRCPath

However she is referred to as Miss Molly Hooper. There are three ways one can interpret this:

  1. Molly didn’t bother to correct it. Doctors find it rather hard to say “actually, it’s Dr Hooper”. It makes you sound awfully arrogant. 

  2. Molly doesn’t actually have a medical degree – this would make her more likely to be morgue technician. 

  3. Molly is a surgeon with a full medical degree and a Membership of the Royal College of Surgeons. For traditional reasons, Molly is entitled (and usually required) to drop the doctor from her title and revert to Miss. What on earth she’s doing wearing in white coat and wandering around a morgue will be explored later.



Possibility 1 – Molly’s actually a real pathologist


This is probably much more likely than the other scenarios because she certainly spends a lot of time looking like a pathologist.

There are four specialities within pathology:

  • Chemical
  • Histopathology
  • Microbiology and Viral
  • Haematology

If you’ve ever had a blood test or a biopsy: the pathologists are the people who actually do the tests and write the report that your doctor gets. They have very little patient contact, which suits some people, and spend nearly all their time working in a laboratory environment.

Side note - White Coat Syndrome

Technically patients in the UK can’t get white coat syndrome because their doctors do not wear white coats anymore and have not done for nearly ten years. White coats are not the most hygienic of clothing, given that they have long sleeves that can trail all over the patient. The NHS regulations now state all medical personnel who come in contact with patients must be “bare below the elbow”. Ties have also been banned in hospital because they can also pose an infection risk.

Nurses all have uniforms that signify their rank but doctors can wear whatever they like as long it looks professional. However I know one doctor who likes to wear colourful shorts in summer and his patients love it!

So fanfiction writers: please do not have John wandering around a hospital wearing a white coat. He should be in a shirt with the sleeves rolled up and not wearing a tie.

Going back to Molly – as a pathologist she will be wearing a lab coat because she works in a lab most of the time. She also appears to spend a lot of time in the morgue and knows who all the dead bodies are. Therefore it is more likely that she is a histopathologist because they end up doing the post-mortems as well as looking at specimens sent from live patients.

Histopathologists also do forensic post-mortems (which can explain why two murder victims were in Molly’s morgue in TBB). However the procedure for a forensic post-mortem is very stringent and requires special training. If you think Molly is a consultant pathologist (i.e. a senior doctor) she might be doing the hard post-mortem cases: the unexpected and suspicious deaths.

However the police force also employs fully qualified pathologists. In a big force like the Met, they would have their own resident pathologists (who are doctors) doing their forensic post-mortems. Police forces don’t usually have morgues, though, so this may be why they needed to store the bodies in Bart’s. Additionally at that point in TBB when we see the bodies - foul play had not been suspected and NHS pathologists do end up doing post-mortems for suicides.

Having said this, post-mortems do not take up all of Molly’s time. A large bulk of her work is actually preparing and examining specimens from both the dead and the living under a microscope.  Biopsies and excisions from any organ in the body need to be reviewed and reported on by histopathologists.

Pathologists usually work very sociable hours. Their patients/specimens are not going anywhere - mostly because they are dead. However there are always pathologists on call because there are genuine emergencies when a result is needed immediately perhaps for the patient’s individual treatment or public health concerns. It is not far-fetched that Molly would be on call at Christmas. She does not need to actually stay in the hospital nor does she have to put her social life on hold. She just needs to turn up if there is an emergency sample to be processed. Therefore, I think she wouldn’t have really minded going into hospital again to show Sherlock Irene’s “corpse”. She was mentally prepared to go into hospital at a moment’s notice anyway.

Side Note  - what Sherlock really did at Uni…


Given the types of experiments Sherlock tends to run – I often wonder if Sherlock actually did Natural Sciences at Cambridge instead of just Chemistry in another University (Natural sciences in Cambridge form is not offered anywhere else).

In Cambridge the Natural Sciences course contains modules from all branches of science: physics, chemistry, biology, geology, material science etc. The Natural Scientists (Natscis) all have to do Chemistry in their first year regardless of what other modules they choose. In their second and third years they get to choose just the bits they like. In my personal opinion (and given there is a head in the fridge) Sherlock specialised in pathology.

The pathology course at Cambridge is the same course that the medical students take. There are lots of lab practicals, which teach students how to stain for bacteria, test for toxins, culture bacteria/viruses and examine post-mortem slides and gross anatomy. No practicals that involve microwaving eyeballs or saliva coagulation, though.

Sherlock uses all these skills in his work as a detective. For example: he manages to identify C. botulium on Carl Power’s shoelaces.

(By the way, that image we get shown is not actually of Clostridium botulium. It is also an electronic microscopy picture that you have to use a huge machine to generate. Under a light microscope: C.botulium spores have to be stained before you can see them. However it is not far-fetched that the spore can still be on the laces after all these years. Bacillus anthracis causes outbreaks decades after the initial outbreak)

This is what Clostridia actually look like stained properly under a light microscope (they are the blue rods with white heads).

For a more detailed exploration of Sherlock's university life please read: Oxbridge - Camford? Sherlock's University Life



Possibility 2 – Molly’s a morgue technician

Pathology labs and by extension the morgue employs lots of technicians. They generally keep the equipment in order and file away specimens if need be (this actually includes corpses). In haematology labs they may run samples of blood test for the doctors and perhaps fill in routine paper work.

Otherwise they don’t make any of the decisions about what happens to specimens/corpses, nor do they do any medical stuff such as post-mortems. However they do have the same unrestricted access to the lab/morgue where they work.

This is consistent with what we see Molly doing during the TV series but this explanation is a bit boring.


Possibility 3  - Miss Molly Hooper, the surgeon

This is personally my favourite interpretation – I’m all for women in surgery because there’s current not enough!

If Molly is rightfully addressed as Miss Hooper, she would have already passed her Membership of the Royal College of Surgeons (MRCS). This exam allows her to progress into a surgical speciality training program. We have no clues as to what kind of surgery Molly might have chosen to specialise in but we can deduce something from the fact she is spending a lot of time looking like a pathologist.

Getting a consultant post in surgery is very hard – many surgical trainees who want a post in big teaching hospitals like Bart’s take time out to do either a PhD or an MD. They are both research degrees but an MD takes less time than a PhD.

In order for the extra degree to count in a job interview, you need to do something related to your surgical speciality. Orthopaedic surgeons like to investigate how bones heal, for example. 

Molly is wandering around the morgue in a lab coat because she's doing a research project in the pathology department as part of her surgical training. 

The fact that Molly is doing a (most likely) histopathology project can suggest anything. However she does spend a lot of time in the morgue, although we never see her doing a post-mortem. I personally think that Molly is doing a research project into surgical mortality.

The surgical specialities with the highest immediate mortality rates are: colo-rectal surgery, cardiac surgery and heptobilliary surgery. These usually involve very large operations that require anastomoses (joining up) of bowel or blood vessels. Patients can die on the table due to blood loss/shock or immediately afterwards due to short term complications like infection, anastomosis failure, blood loss etc.

If you want to imagine Molly doing lost of post-mortems in the morgue, her project may be investigating the causes of anastomosis failure in patients who have died in hospital. She may be training to be an, upper GI, colo-rectal, hepatic or heptobiliary surgeon.

Most surgeons doing a PhD also do on call rotas at the hospital they are working. This may explain why Molly appears to be in the hospital any time of the day or night. She’s not actually doing her project but helping out with emergency cases.

This puts a whole new slant on Molly’s character. Being a woman in surgery is difficult because it is still a male dominated profession. It is also extremely hard work. I personally think Molly is an very strong character despite her reactions to Sherlock. Sherlock is not a patient or a colleague, he is her unrequited love interest. Just because Molly occasionally goes a bit soppy over Sherlock and lets him walk all over her doesn’t mean she isn’t capable of making tough decisions or leading a team of doctors. 


Faking Sherlock's Death



Good news to all those fanfic writers out there: Molly could totally forge Sherlock's death certificate (as long as she's a doctor).

Any qualified doctor is allowed to write a death certificate. Usually in the middle of the night, it's the most junior doctors who get the grisly task of pronouncing someone dead and then filling out the form. If they can do it, everyone more senior is able to as well regardless of what speciality they are in. 

If a body is bought straight into the morgue off the street, it will be the pathologist-on-call's duty to certify death. If Molly is a pathologist she can easily arrange to be on call during Sherlock's suicide attempt. If Molly is a surgeon doing a research project she may still be able to do this.

Doctors doing PhDs "moonlight" as a great number of things for money. PhD funding is about minimum wage and doctors are used to living on much bigger pay cheques. Being on the pathology on call rota is actually a much easier (if less well paid) way to spend your time. Pathologists do not have to be in the hospital during evening and weekends if they are on call, unless an emergency happens. Surgeons below the level of Consultant must stay in the hospital because they will be the person responsible for all the surgical patients in many different wards. 

The pathology department could be practically begging Molly to do some on calls to take the pressure off everyone else. This might have been very attractive to Molly as you don't actually have do every much as an on call pathologist. There are very few occasions when you have to examine a specimen right now. All you have to do is prioritize the list of jobs received over the on call period for the person coming into work the next morning. 

The Non-existent Post Mortem

Many fanfic writers have been quite caught up in how Molly is going to fake Sherlock's post-mortem. 

The answer is: she doesn't have to. 

Post-mortems are usually only carried out in the cases of unexpected death, suspicious deaths or undetermined cause of death. 

There are two distinct types of autopsy:

  1. Medico-legal/forensic autopsy - carried out at the express request of a Coroner in order to ascertain facts that will have bearing on a police investigation or legal case. For suicides, these are really only carried out if there is suspicion of foul play  by the police. Non-suspicious cases fall under the second category of autopsy
  2. Clinical autopsy - perform only with written consent from the patients family to determine the pathological sequence leading to death. This is usually only done for unexpected deaths. Open and closed suicides are a very sensitive topic and pathologists usually do not offer an autopsy to the family. 

Therefore as long as Mycroft does not demand an autopsy and the police decide the carnage at Bart's was a double suicide, there is no need for Molly to even produce a post-mortem report. 

If Mycroft is in on the whole thing, Molly might not even need to produce a body. A simply death certificate filed correctly will be more than enough. 





Other Parts in the Series:



Part 1 - Exploring Dr Watson's Army Career
Part 2 - How can an Army GP be fighting on the front lines? John's Dual Career
 

Part II.I - Dr Watson: scientist and psychiatrist
Part 3 - Guide to making John a Realistic Army Surgeon


Comments

( 34 comments — Leave a comment )
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(Anonymous)
Sep. 20th, 2012 05:06 pm (UTC)
I'm fairly certain, and I may be mis-remembering this, but I'm sure I've heard Moffat refer to Molly as Doctor Hooper. Can't recall if it's in commentaries or interviews but I'm so so sure he's called her Doctor somewhere along the line.
wellingtongoose
Sep. 20th, 2012 06:40 pm (UTC)
Perhaps you're right - Molly may be a straight forwards pathologist. I just though I'd explore all the options. It was really fun.
aim2misbhave
Sep. 20th, 2012 06:08 pm (UTC)
Interesting! Moffat has referred to Molly as "a pathologist" before, so that's what I always assumed, plus the implications in Reichenbach Fall that she had some kind of power when it came to determining the disposition of the cadavers in the St. Bart's morgue.

I also really, really like your idea about Molly being a surgeon and doing research, though.

And I never really knew about how the pathology thing worked in the UK - in the US, there are specific morgues where everyone who dies a sudden or unexpected death goes, and those morgues employ full-time forensic pathologists whose training includes histopathology (although some larger ones may also have histologists or histopathologists who do nothing but review the more complicated samples), and this is all run either through a local police force or through a local government's health department.
wellingtongoose
Sep. 20th, 2012 06:39 pm (UTC)
I think the US system is probably much more practical than having every hospital with its own bunch of forensic pathologists.

What I'm still trying to figure out is how Sherlock managed to abscond with those body parts. Molly wouldn't have helped him - not if she didn't want to go to jail for a very long time.
(no subject) - aim2misbhave - Sep. 20th, 2012 08:03 pm (UTC) - Expand
azriona
Sep. 20th, 2012 06:20 pm (UTC)
Seriously, are you looking over my shoulder when I write? Because a week before I start posting a story about John Watson's background, you start posting those metas, and now that I'm working on a story that features Molly in her lab, you post this. I would tell you to cut it out, except I'm finding it endlessly helpful and informative.

(Even if I elected to largely ignore the John Watson one.)

I agree, the third option for Molly is a fantastic one, because it does make her out to be far more of a complex character than the other two possibilities. The only problem with it is that at some point, she'd finish her research project, wouldn't she? I mean - she's in the morgue throughout the two series so far, which covers 18 months of time. How long would Molly's research project have taken her to complete?

And this also brings up another issue, though this is more fanon related than not: most post-Reichenbach stories have Molly signing Sherlock's death certificate and post-mortems, and thus she's in on the ruse. If Molly were in the morgue solely to do a research project, would she have the authority to sign such documents?
wellingtongoose
Sep. 20th, 2012 06:38 pm (UTC)
I am waaatching yoooou....

A PhD takes between 3 and 5 years depending on how lucky you are at getting data and how hard you work. An MD only takes two years.

Molly is a qualified doctor so she definitely has the right to do death certificates. Given that her research project is very "morgue-based" she would also be trained in how to do post-mortems. She may also be "moonlighting" as a pathologist in her free time. PhD funding is below minimum wage level and Molly as a doctor is used to much bigger pay cheques. It's not far fetched that she would do some work for the histopathologists particularly as post-mortems are not a popular part of the work.

So yeah she totally can sign Sherlock's death certificate and cut him open if she so wishes...
leopardwrites
Sep. 20th, 2012 06:53 pm (UTC)
Can I (as a person who works in a hospital) just take a moment to thank you for writing these?

Understandably, due to peoples' varying degrees of medical knowledge, there's a great deal of variation in fics when it comes to John's career and Molly's as well. Fair enough, can't expect everyone to know these things, but it's always jarring to me if (as you mentioned) you have John walking around in a lab coat etc.

Molly has always confused me as well - she states in ASiB to Mrs Hudson that she 'does post-mortems'. And then there's the fact that, in the morgue with "Irene", Sherlock and Mycroft, she says 'everyone else' was busy with Christmas, suggesting she would be the one to do the necessary with "Irene" and there appears to be no one else in the morgue with them. And then there's the fact that she is involved with the high-profile suspicious deaths, suggesting seniority to her position. And THEN there's the fact that she is referred to as Miss Hooper, although I think this was by Sherlock(?) and could therefore just be read as another way he devalues her, and her not bothering to correct him.

My interpretation has always been that she must be a doctor to do post-mortems.

As an aside, Sherlock doing Natural Sciences at Cambridge has been my quiet personal headcanon for some time! Nice to see someone who thinks along those lines too :D
wellingtongoose
Sep. 20th, 2012 07:48 pm (UTC)
Thank you very much! I'm happy someone else thought along the same lines as me.

I hope Molly gets more screen time next season because she's an awesome character and so much more than just Sherlock's fan girl.
eglantine_br
Sep. 20th, 2012 08:30 pm (UTC)
The sleeves rolled up is a great idea. I don't think we do that here. I am sure those cuffs get germy...
(Deleted comment)
wellingtongoose
Sep. 20th, 2012 10:58 pm (UTC)
John is a GP and they can pretty much wear what they want. Most of them are old fashioned and wear a suit and tie like John does. Bare below the elbows is only for hospitals. If John worked in A&E he would have his own personalised scrubs with doctor written on them to wear all day.
sunken_standard
Sep. 21st, 2012 01:35 am (UTC)
Thank you for writing this, it's really interesting and informative. :D

I have a few general questions, feel free to ignore them. These are all assuming she's a histopathologist, rather than a morgue technician or a PhD candidate.

How much interaction would Molly have with students? Would she ever be called upon to do practical demonstrations, or have to share her lab space with students?

How much additional education would she need to take up teaching (presumably for Bart's)?

How likely is it she trained at Bart's, assuming there was a position open there when she finished her education?

How likely is it for her to be doing independent research for publication if she isn't going the surgery PhD route you described?

How many pathologists would generally be on staff at Bart's?

Would she be paid a standard salary and receive a per diem for actually working while on-call? What would her pay rate be (I'm guessing on the higher end of 8a, but I don't quite understand everything about the NHS pay scale)?

Again, thanks so much for taking the time to write all these up. :D
wellingtongoose
Sep. 21st, 2012 01:47 pm (UTC)
Thank you or the support. To answer your questions:

Molly can have as much or as little contact with students as she wants. She can easily volunteer to teach/demonstrate post-mortems for medical students. Bart's no longer does human dissection as part of their medical course but students are still encouraged to attend at least one post-mortem. As Bart's is a teaching hospital Molly's job contract will include a clause about doing some teaching. In reality students tend to avoid the pathology department just because all the patients are dead and no really useful for learning.

Some medical students stay within the Deanery (group of hospitals) where they trained. Bart's students won't all be at Barts all the time, they get sent out to lots of different small regional hospitals within North East London and Essex. It's not unlikely that she trained at Bart's medical school but it is more likely that she got a surgical or pathology training post at Barts having worked elsewhere in London.

Pathologists are very lab based so they get many chances to do research, although it would not be independent research. It has to be approved by the lab, be of relevance to the area Molly is working in and most projects take more than one person to complete.

I have no idea how many pathologists are on the staff at Bart's. In a big teaching hospital there are usually at least 20 - 50 pathologists but only a small proportion of them would be consultants. The rest would be Registras and junior doctors.

If Molly is a pathologist, her pay depends on how many years she's been a doctor. If she's a junior consultant: £70,000 - £100,000. If she's a specialist Registra: £40,000 - £70,000. A certain number of on-call hours is included in your basic salary. If your contract requires you to work more than these on call hours you get banding e.g. 1.5x basic salary or 2x basic salary.

However you will not be paid for any hours worked outside of the European Working Directive which is average 48hrs/week over a period of six month. The hospital just gives you several weeks of unpaid leave at the end of each six month period so your hours average out.

Therefore on-call is not a separate part of the Molly's pay cheque if she's a pathologist.

If she's a PhD student: she will do locum work for the hospital (which is usually on calls at evenings and weekends) and this is paid per hour rates vary from £15 to £30. The PhD will also provide her a basic salary.

These are very rough estimates to the annual salary because you also get extra money for living in London. Every job can in theory have a different salary depending on exactly how much you work.





(no subject) - sunken_standard - Sep. 21st, 2012 03:39 pm (UTC) - Expand
Opal Grey
Sep. 21st, 2012 02:27 am (UTC)
I've been loving this series!

Thanks for this look at Molly-- since in the US it's not common knowledge that surgeons in the UK don't go by doctor, I feel she sometimes gets stereotyped as "just another poor young lovesick woman" instead of a "surgeon doing cool things in a morgue who also happens to be lovesick for Sherlock." Molly's got a lot of potential hidden away under those frilly blouses!
burning_moon117
Sep. 21st, 2012 03:29 am (UTC)
I really love all of these informational posts!

Funny about the white coats, all my nursing instructors wear them during clinicals (when we are in the hospital)
alicambs
Sep. 21st, 2012 07:47 am (UTC)
Just shows you how long ago it is since I worked in a hospital since I hasn't realised that white coats were totally out. Glad they are though.

Very much enjoying your informative essays.



PS pay cheque not check! :-)
wellingtongoose
Sep. 21st, 2012 01:27 pm (UTC)
Thanks! I really need to beta read these essays before they get published.
gurrier
Sep. 21st, 2012 02:44 pm (UTC)
really like the surgeon option, even if it is less likely. I can't imagine Mycroft being so crass as to use the wrong title! And as well as needing to be a doctor to sign the death certificate, she needs to be sure she's the one to handle the "corpse". I think that points to not just being on call, but being there when Sherlock is brought in. If she were off-site, he wouldn't be able to maintain the pretence long enough for her to get there, surely! Doctoral students are renowned for long and odd hours, so it'd be easy and possibly not unusual for her to be there from early morning (still dark outside when Sherlock texts Moriarty.)

Which makes me wonder how much access a student would have to the labs. With the actual employed pathologists and technicians doing their jobs 9:00 - 5:00, would a student be more likely to be there after hours for their research work?

Also, are female surgeons more likely to go the teaching route than their male colleagues? I imagine it'd lead to more flexible working conditions, which might appeal to women wanting a family as well as a career. That'd be another nod towards her being a student.
wellingtongoose
Sep. 21st, 2012 03:45 pm (UTC)
Oh yes, I think Molly would have to be in the morgue when Sherlock was bought in but she would have 24 hour access to labs/morgue as a PhD student, technician or pathologist.

In most hospitals there's swipe card access and the morgue is never physically locked with a key any more. Obviously only the qualified individuals had swipe card access but Molly would have been one of them. PhD students are treated more like a proper working scientist than an actual student. You are completely right that they work weird hours so no one is going to be surprised if Molly was there.
However Molly does have to be the on-call pathologist or she wouldn't have been able to get sole access to Sherlock's corpse or certify his death.

Actually there are less academic and teaching opportunities for surgeons than physicians. Being an academic in the field of surgery doesn't make for a particularly good work life balance unfortunately. You must do research and you are pressurised to produce papers. On top of this you also still have to do some surgery for the NHS.
(no subject) - gurrier - Sep. 21st, 2012 04:14 pm (UTC) - Expand
(no subject) - wellingtongoose - Sep. 21st, 2012 04:56 pm (UTC) - Expand
frodosweetstuff
Sep. 21st, 2012 06:57 pm (UTC)
Very very interesting! Thank you so much for this.
pennypaperbrain
Sep. 22nd, 2012 07:33 pm (UTC)
Love this one! And I really want to see more Molly in S3.
bootoye
Sep. 24th, 2012 10:21 pm (UTC)
I am still loving your meta series.

I am familiar with doctors and hospitals only as a patient but it seems the system here int he Caribbean is very much like there in the UK.
Our doctors don't wear the white coat unless they are students it seems...all the specialists I have ever seen just wear a shirt and trousers^^ The women too actually. :)

We have a lot of female surgeons here esp in ob/gyn, seems it's the most lucrative branch of medicine here. XD

I think Molly is a pathologist and Mycroft knows her since their exchange does not seem to be that of strangers. So he continues to address her as Ms. Hooper.
(I do the same thing with a friend who has been ordained a priest, to all his congregation he is Fr. Richard to me he is just Richard unless I am speaking about him to a stranger.^^)
pipmer1
Oct. 10th, 2012 12:22 am (UTC)
I'm under the impression that Molly is a technician, since that's what's listed under her character profile on the official Sherlock BBC website here: http://www.bbc.co.uk/programmes/b018ttws/characters/molly-hooper


But if that's the case, I would wonder who would have had to sign Sherlock's death certificate. I suppose a post-mortem isn't always necessary in certain cases, but I assume that a death certificate is always necessary, yes?

wellingtongoose
Feb. 2nd, 2013 12:06 am (UTC)
Hi!

Yes a death certificate is always necessary - but a junior doctor could write that out without ever having seen the patient alive.
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