What I'm reading: White Heat, by Brenda Novak
Back to my notes from the Writers' Police Academy. The latter part of Friday was spent listening to Dr. Jonathan Hayes, Senior Medical Examiner for New York City. He began by explaining what a forensic pathologist is and does. Forensic pathology is a sub-specialty of pathology, and the major expertise is the evaluation of injuries. He also explained the difference between coroners and medical examiners, the former being elected officials who may or may not have any medical or forensic background. Medical examiners are not elected officials. The trend now is to move from coroners to medical examiners who are specialists in the examination of death, and are apolitical.
To become a medical examiner, beyond the normal medical school, internship, and residency, one needs to deal with 250 autopsies, as many homicides as possible, as many crime scenes as possible, and then have lab experiences with DNA, blood spatter, criminalistics, and toxicology (and more).
Medical examiners, at least in New York, are part of the public health system, NOT law enforcement.
They must determine cause and manner of death, the cause of death being the disease or injury that leads to death. Manner of death explains how that death came about. There are only a limited number of them: Natural, Accident, Suicide, Homicide, Therapeutic Complication, and Undetermined.
Of the above, suicides require the highest degree of proof. And, contrary to what we see on television, only about 5% of deaths are ruled homicides.
A typical scenario: Body is found; 911 call; police response; EMS response; referred to the ME's office. Some apparently natural deaths go straight to the funeral home.
With the exception of EMS intervention, the body should not be touched prior to the ME's arrival if he is needed at the scene.
Body storage isn't in those nifty refrigerated slide-out compartments. Instead, bodies are stacked in body bags on trays that sit on open shelving – more like a baker's rack. For overflow, they'll rent refrigerated trucks. In New York, unidentified or unclaimed bodies are buried within about two weeks. They keep dental charts and DNA samples for future identification.
He then spent some time on autopsies. Before the autopsy, the body is x-rayed. Clothing and body surfaces are scrutinized. Photographs are taken. The body is undressed, weighed, and measured. Any external findings are noted: injuries, tattoos (they love them for identification purposes), and under the right lighting, will show up even when the body is totally discolored due to putrefaction. They'll also assess rigor mortis and livor mortis. The former is caused by muscle proteins coagulating, and the latter are discolorations due to the settling of blood.
Other tidbits – brain fluid is a good place to look for cocaine.
Dr. Hayes said he spends a great deal of his time talking: to police, to witnesses, to family members.
One thing that impressed me was the way Dr. Hayes demonstrated his sensitivity to the families of the deceased. His caring attitude came across even as we looked at slides of bodies in various stages of decomposition, or at the lividity patterns. He definitely shows his respect for both the dead and those they've left behind, although he is honest with them. Religious beliefs can often impact the way he has to perform an autopsy, but he respects the practices of the faith, going so far as to perform the entire autopsy in the body bag so as not to lose any part of the deceased.
Assuming the jurisdiction doesn't use a coroner, the ME is responsible for issuing the death certificate, which is required for the funeral home to remove the body, and then given to the family.
Tomorrow, things will lighten up when Jenyfer Matthews is my guest, talking about being an American living in Egypt—and it's not what you'll expect. She's looking at the culture shock when she comes home to visit.