scene photos

a man stands at the back of the picture at the edge of a roadway or parking lot. you can see the yellow tape in the foreground, but it's a little out of focus. he's wearing a dark blue suit in a style forty years out of date. behind him is a disorderly row of bushes. he's squinting slightly; you can't tell which way he's looking.

in the second shot, the camera has moved toward the bushes. there is a pale thing stuck into them. it is the back and hips of woman, crumpled into a strange, awkward seated position, crammed against the bushes. she is nude.

on smell

so we have a cadaver-sniffing dog.

i know, i know, she's there for when thebody is buried or hidden or has been dead for a very, very long time but some days i hit the autopsy floor and i think for this you definitely don't need a dog...

a word about props...

so, on tv shows, they tend to show us dictating into a microphone that hangs from the celing. it would be nice and would save a lot of time but how are you supposed to do that in a room full of buzzsaws?

also, they tend to give us surgical trays on tv. the thing is, medical instruments are expensive and, well, that level of precision is no longer necessary if your patient is dead. so we tend to use stuff from restaurant supply companies and Home Depot...

Research

So there's this guy on the autopsy floor today talking to the chief and I walk up, thinking that this is one of the mucky-mucks wandering about on a tour of some kind and we've got some really good cases on the floor that I can spontaneously talk up.

Turns out the guy is a mystery writer and he wants to know what coroners wear.

So there's a picture of me in full regalia on a cell phone somewhere...

More about Aaron

So Aaron and I are hanging out in the office and I tell him that I'm hardly supervised anymore. I mean, there is still a senior medical examiner assigned to my case and all, but they kind of show up at the end and leave after a little prefunctory poking of the organ bucket. I'm thinking this means I'm nearly done, I've demonstrated some measure of competence, and that people feel comfortable with my assessment of the body.

So Aaron says that they tended to hang out on the autopsy floor more with the previous fellow, but, then again, she was good-looking.




(For the record, I have never wondered why Aaron does not do well with women.)

Court day today

One of the things I really like about my court days is that no one in court knows who the @#$! I am and what the @#$)(*! I'm doing there. I just show up in my little court suit, watch the DME testify, and then scoot out the door with him at the end of the whole thing. I like being the mysterious woman from nowhere. For a nerd with a microscope, that's pretty much the most I can hope for. I mean, look, I come home to an apartment full of cats and my boyfriend of a bazillion years to sit down to an evening of Trader Joe's salad and netflix-- glamour I don't have.

It reminds me of one of our professors. She was described by my stylish gay friend as a Monet (beautiful from far away but kind of strange-looking close up...) but believe me the far away manifestation was all Rita Hayworth: leggy brunette with a wide, Earthy smile that promised wild, worldly indescretion. She's moved on to other medical centers-- hobbies like hers are not conducive to successful office politics and, besides, people don't take you seriously when your nickname is "legs"-- but I used to love living vicariously through her: the time she wanted to bring one of the med students from her study group (whom she was dating) to the office Christmas party (hosted by our department chair, whom she was also dating)... the time she got caught in the frozen section room all tangled up in a (married) surgeon...

While a part of me would also like to be legendary, sitting at the edge of the gallery for no apparent reason and leaving suddenly in the middle of a murder trial is as close as I'll ever get.

This just in

Rumor has it that at the last big ACGME meeting (ACGME stands for blah blah blah Graduate Medical Education and means that they are in charge of residencies and fellowships) it was decided that, as of July, 2007, forensics fellows will no longer have to take microscopic sections on every single @#$)ing case.


To the class of 2008: you're welcome.

Old friends

So you might well wonder why on Earth I need a whole year to learn how to count bullet holes. This is a valid question. I think there are a couple answers to the question "why is a forensics fellowship a year long?"

Firstly, it's the shortest unit of time that seems to be recognized by boards. I don't think there's anything out there shorter than a year. Secondly, I think there's a lot that I'm still not going to know at the end of the year, not the least of which is how to avoid the traps that seem to loom all around me in my imagination, arranged around the general theme of "imaginary defense attorneys trying to make me look/feel stupid in public." But the thing I really feel myself learning is the feel and look of normal organs. At this point, no one has to tell me that the lungs are congested or the liver is fibrotic or the heart is pale/scarred or the brain is too soft for this postmortem interval. These organs and I are old friends by now-- familiar enough to feel too heavy in my hand or to catch my attention with a slight change in their usual shade of pink.

Coping strategies

Here are some coping strategies I've noticed around the office.

1. prayer
2. spiritual reading
3. mutual support
4. volunteer work
5. way too many office houseplants
6. loud music
7. gallows humor
8. overeating
9. non-threatening flirting
10. creepy staring
11. unfocused bitterness
12. very focused bitterness
13. despair
14. alcohol
15. hiding in the locker room
16. sudden, bizarre revelations
17. a whole lot more alcohol
18. veiled threats
19. open hostility
20. funny hats
21. camaraderie of the damned

Autopsies for beginners: watch your back!

So another thing I kept doing in the beginning is leaning back against the table. The thing is, all the protective gear I strap to myself doesn't actually cover the behind. There are two things that then begin to get on your nerves:
1) the damp feeling coming from the stripe across your backside placed there by the bloody edge of the autopsy table
2) people telling you that you've got some blood on yourself

I can't draw skulls either

So my main pet peeve with tattoo artists is anatomic incorrectness. Look, if you are going to be a tattoo artist, you should, if only to suit the purposes of self-respect, learn to #$&@^%ing draw. So far, I've noticed two particular problem areas: breasts and skulls. Both are very popular in tatto art and both, apparently, require more knowlege of normal human anatomy than many tattoo artists possess.
With regard to either subject, you should look at a few before you attempt to draw them. You should also practice.
For my diagrams, sometimes I'll draw in the tattoos in rather than just describing them (if I'm just standing around waiting for my professor to show up, if I'm in the mood to draw anyway...)
Today's guy had a whole lot of skulls and they were all wrong. Every last stinking one. And not just a little: these were really funny-looking-- bumps where there are no bumps, teeth that don't look like teeth (think little picket fence), noses instead of little nose-holes...
So I'm muttering and drawing them in and finally take a look at my final product and, well, here's the problem with my skulls: they always look way too, well, cute. At least his skulls looked mean. Mine looked like he had a bunch of skeletonized hello kitty heads tattooed all over him (which, come to think of it, might be kind of cool...)

Here is a summary:

My skulls
Big, round eyes
Small, human teeth
Little, teardrop nose holes

His skulls
Big, frowning eyes with fake eyebrows
Small, square-ish, non-tooth objects
Sometimes actual noses, sometimes stuff that looks kind of like webbing

Autopsies for beginners: keeping it clean

Keep the water running down the table. In fact, keep the water running in the little basin for your tools. That way, you spend your time looking at brushed steel (rather than idly wondering "what's that on my knife? Is it brain?..."

Knees

I don't know what you do, but in autopsy I always wear a gown and trauma boots. So your gown goes down to about an inch or two above the knee and your trauma boots go up to about an inch or two below the knee. And I don't know about you but I tend to really focus in on what I'm doing during the cases to the fairly complete exclusion of all else. You can imagine the consequences. Generally, at the end of the case, there is a moment where I look at my knees and try to decide: is that blood? bile? poop?... sheesh, what is that?

Aaron

Aaron is one of the faculty now but I know him from when he was in residency, about a year ahead of Sebastian. Aaron is one of those people who skipped a bunch of grades and never quite figured out how to relate to people. (There is a small collection of them at the office.) You get the idea: brilliant, but definitely not a people person-- has a tendancy to notice if you're being stupid and feels an overwhelming need to point this out to you.
One he graduated, he went out into private practice and bounced right back into fellowship at the Coroner's, reportedly because the surgeons couldn't stand him. It's the sort of thing you'd imagine happens to a guy like Aaron. So he sort of backed into forensics. I'm not judging; I never figured I'd be here, either. The thing is it's just so darned interesting. But I digress.
Every morning, one of the doctors is assigned to look over the list of cases that need to be done and assign them to the available doctors. They tend to be pretty thoughtful. If you like, say, traffic accidents or gunshot wound homicides, they'll toss those cases your way. (Reportedly, if you complain about a type of case, they tend to steer those away from you. There are two docs who seem to do only the easy stuff and that might be why...) But I've also noticed that if you're good at a type of case, those cases start to get given to you.
Aaron's good at multiple multiples.
I don't know if he coined the term, but what I mean is homicides featuring a multi-modal attack: beaten and stabbed, say, or strangled and beaten and set on fire, or garotted and sexually assaulted and beaten with a hammer. You get the idea.
These cases are, as you may expect, complicated, as they not only combine the findings of each modality, injuries can overlap, multiple attackers can be involved, and questions can arise regarding the lethality of each and every wound (as each defendant points at the others and says okay I hit her/stabbed her/set her on fire but I didn't kill her.) Your diagrams end up full of little numbers and letters and things pointing at other things and your report goes on for page after page after page. Somehow, Aaron can turn one of these things around in a day. (Mere mortals take a full day just for the diagrams and need another to put the report together. )(Obsessive/compulsive types need three days, which I cannot imagine.)
Anyway, the other day, Aaron and I are in the atrium talking about whatever and I ask him how he can turn this stuff around so fast and he tells me his system. In brief:
1) In general: Write the wound number (or letter, see below) in White-out [sp?] on the skin. It stays well even when the body is repositioned or gets wet.
2) For gunshot wounds: If you've got a whole lot of them, don't spend time thinking about which ones connect to each other (entry-exit pairs), just assign each hole a letter, starting at the top of the head and progressing down the front of the torso, down each limb, and then down the back. Make a little chart for your measurements, draw each wound on its own diagram form, and make a summary diagram with all the letters on it. Once you've got them opened up, you can note the entry-exit pairs by number (A=>V, R=>B, and so on) and put that notation in your paperwork wherever it seems to go.
3) For stab wounds: Now this is a judgement call, but you can gently probe the wounds superficially with a short probe to get an idea of direction and take summary photographs with the probes in place (works well for clusters of wounds.)
Well, our conversation was overheard by a passing senior doctor (one of the ones who does a lot of assigning) who naturally assumes that I'm asking about such things because I really want to do these kind of cases (which is true, but to be honest they're a little intimidating) and in a burst of helpfulness he starts assigning me multiple multiples.
Based on my vast hours of experience, I would like to add my own tip:
4) Keep an eye on your tech and bring him to a screeching halt whenever you see blood by saying "ooooh!" in that interested/excited tone of voice that says "we've got something!" and immediately take over dissection in that area.
5) Expect to be surprised. Not all injuries will show up on external examination.
6) Do the neck dissection yourself under photographic control. Palpate carefully before you remove the hyoid and laryngeal cartilages, and expose/photograph any breaks.
Talking with my co-fellow, she had a similar experience: she was asking one of the docs about how to optimally handle young adults who die for no good reason. (She was asking because she hates these kind of cases.) You guessed it, she's overheard and ends up with almost nothing but young people who died for no reason for the next few weeks. Which brings me to tip #7:
7) Ask other people for tips if and only if you are sure no one is listening. Otherwise, you are volunteering.

Things that have been on my shoes, in increasing order of ick

• Blood
• Pus
• Poop
• Bile
• little unidentifiable bits that are pink or yellow
• little unidentifiable bits that I find a few days later because my shoes smell funny

Running the bowel

So there's this trend you notice cropping up everywhere where, in the interests of thoroughness, you end up having to do more and more picky little things that are very, very low-yield: filling out a little check sheet that says "yes, this guy had an appendix, yes, this guy had a spleen, yes, this guy had a gallbladder" and "yes, I checked my jar labels, and yes, the head tech checked them, too, and, yes, they look all right to both of us." And there's running the bowel.

Running the bowel means taking your scissors and sliting the bowel open from the ligament of Trietz to the rectum, making sure there's no blood or holes or Meckel's diverticulum or foreign objects or polyps or whatever in there. The thing is, you can tell if there are going to be bullet holes because your guy will have bullet holes elsewhere nearby. You can also tell if there's going to be blood because it turns the outside of the gut purply-red. Polyps, okay, that's precancerous and, in the large (but not small) intestine, you can kind of make a case for that. Ditto for foreign objects, if you have no cause of death and there's some external evidence of bowel injury with no other reasonable source.

But running the gut on every case indiscriminately is a waste of time. I know because I have to do it.

Wanna know what I've learned? Lots of people eat corn.

Goo guy, an update

So goo guy was last seen fighting with people. (Things do not seem to have turned out well for him...) All this means that we have to examine his bones for signs of trauma, as there is precious little soft tissue to go mucking around with.

The thing is, he's got enough soft tissue to get in the way of the bones-- (not enough to get a good look at, but clearly enough to cover the bones with, well, goo.)

So the way you get rid of soft tissue is you cook him until it falls off. The problem with that is that cooking causes shrinking, which would keep us from comparing any weapon with the marks on the bones, which is kind of the point of the whole exercise. So he gets a soak. With meat tenderizer.

We disarticulate the arms and legs at the shoulders and hips and dunk him in a water bath with some meat tenderizer, checking on him every week or so to see if he's "done."

Well, he's not done, but he's also not getting any done-er, so we go ahead and examine him as is. No wounds anywhere, so far as we can tell, which is not to say he didn't get beaten to death, it's just to say that we don't see any gunshot wounds or stab wounds or fractures or, really, anything that helps us figure out what happened to him...