Dr. Mary Fowkes, a neuropathologist at Mount Sinai Hospital in Manhattan whose autopsies of Covid-19 victims early in the pandemic discovered serious damage in multiple organs — a finding that led to the successful use of higher doses of blood thinners to treat patients — died on Nov. 15 at her home in Katonah, N.Y., in Westchester County. She was 66.
Her daughter, Jackie Treatman, said the cause was a heart attack.
When Dr. Fowkes (rhymes with “pokes”) and her team began their autopsies, little was known about the novel coronavirus, which was believed to be largely a respiratory disease. The first few dozen autopsies revealed that Covid-19 affected the lungs and other vital organs, and that the virus probably traveled through the body in the endothelial cells, which line the interior of blood vessels.
“We saw very small and very microscopic blood clots in the lungs, the heart, the liver — and significant blood clots in the brain,” Dr. Fowkes said in an interview on the CBS News program “60 Minutes” for a segment, broadcast on Nov. 22, on the long-term effects of Covid-19. She had been interviewed by the correspondent Anderson Cooper on Oct. 30, a little more than two weeks before her death.
The clots in the brain suggested that there had been strokes, she told Mr. Cooper.
Mr. Cooper asked if she had expected to see the breadth of damage in so many organs.
“No, not at all,” Dr. Fowkes said. “”Nobody’s seen it like this.”
Dr. Fowkes “had a curious scientific mind and an uncompromising attitude to doing as many autopsies as possible to produce something that was unique,” Dr. Carlos Cordon-Cardo, chairman of the department of pathology, molecular and cell-based medicine at the Icahn School of Medicine at Mount Sinai, said in a phone interview.
Dr. Cordon-Cardo said that the findings from the autopsies of Covid patients done by Dr. Fowkes’s team had led to an aggressive increase in the use of blood thinners, resulting in a marked improvement in the health of some patients. The medications were adjusted to account for the elevated response to Covid by patients’ immune systems, he said.
Dr. Fowkes and others involved in the Covid autopsies wrote a paper on their findings and released it in May, but it has not been peer-reviewed and published.
Mary Elizabeth Fowkes was born on Nov. 1, 1954, in Clayton, a village in northern New York, and grew up in Syracuse. Her mother, Isabel (Walroth) Fowkes, was a social worker. Her father, Glen, wrote insurance policies.
Dr. Fowkes graduated from the SUNY College of Environmental Science and Forestry in Syracuse in 1977 and then worked as a physician assistant.
Looking to improve her chances of getting into medical school, she became a technician at a cell and developmental biology laboratory, then enrolled in a doctoral program in anatomy and cell biology at SUNY Upstate Medical University, also in Syracuse. She eventually entered a combined Ph.D.-M.D. program at the school and graduated with both degrees in 1999.
Dr. Fowkes completed her residency in pathology at Beth Israel Deaconess Medical Center in Boston in 2003. She then had fellowships in neuropathology at New York University Medical Center and in forensic pathology at the office of New York City’s chief medical examiner, where she was mentored by Dr. Barbara Sampson, who was on the staff at the time, in 2006, and is today the city’s chief medical examiner.
“What she really learned from us is what can be learned in an autopsy, the importance of giving families closure and the importance of an autopsy to public health and understanding disease,” Dr. Sampson said in a phone interview.
After her city fellowship, Dr. Fowkes joined the Icahn School as an assistant professor of pathology and remained on the faculty until her death. She was named Mount Sinai’s director of neuropathology in 2012 and its director of autopsy service two years later. She encouraged the hospital to perform more autopsies, citing their educational value, and pushed for an expansion of the hospital’s brain bank.
Her wide-ranging research included a recent focus on recurrent meningiomas, slow-growing benign brain tumors.
She also mentored many young doctors, including Nadia Tsankova, a neuropathologist.
“I was very passionate about combining research and clinical service,” Dr. Tsankova said in an interview. “And Mary was very passionate about research. Sometimes you take a job and you aspire for something and your boss says, ‘No, you have to do this.’ But she would say, ‘I understand what you have to do and we’ll make it work.”
Dr. Fowkes viewed autopsies as essential to understanding disease and felt obligated to perform them on Covid victims despite her being in a vulnerable age group.
When performing autopsies, which are done on the hospital’s main floor, she used an oscillating saw to open the skull cavity to remove the brain, which potentially exposed her to the virus through aerosolized bits of bone and blood.
“There were only four pathologists who were willing to potentially risk their lives to start doing autopsies on these cases,” Dr. Fowkes told the BBC in June. But, she added, “I considered it critically important to end up doing this work so we could get some answers to know how to treat the patients correctly. So we did use all the protective equipment, but we were still very scared, to be perfectly honest.”
With protective equipment in short supply during the late winter and early spring, Dr. Fowkes would wear an N95 mask for a week at a time.
In addition to her daughter, she is survived by her mother; a son, Derek Treatman; and her brothers, Mark (her twin) and John. Her marriage to Scott Treatman ended in divorce.
During the “60 Minutes” segment, Dr. Fowkes held a slice of a Covid victim’s cerebellum in her left hand. Mr. Cooper pointed to a brown indentation on the brain matter.
“That’s a stroke?” he asked.
“That’s a stroke,” she said.
At the end of the report, Mr. Cooper told the audience that Dr. Fowkes had died.