Status report

So far I'm only about ankle deep in my fellowhip but it is safe to say at this point that forensics has already taken over my life. At work, I'm working as fast as I can all day long to get my case done, written up, and signed out in time for my afternoon lectures. After that, I drive home, change clothes, box until they close the gym, change clothes, drive to either gym #2 for weights or kung fu (for, well, kung fu.) Then it's home for dinner and reading, reading, reading until I pass out and the whole thing starts up again.

It's fair to say that, despite my best efforts to keep current during the week, I end up catching up with my required reading on the weekends. Honestly, when I'm not cutting dead people I'm writing about dead people, listening to lectures about dead people, reading about dead people and, hand to God, when I come home from my workouts what's my boyfriend watching on TV? @#$king CSI, Law & Order, The First 48, The Closer,...

Story time with the boss

So apparently, a couple of years ago, the cops notice a stolen car parked by the side of the road near a park. No one's in the car, so they start asking around, hey did you see the guy who was driving this car? And some people say, yea, they did, and he's in the restroom. So the cops go over to the restroom and ask the guy to step outside so they can talk. And he says no. And the cops say, no really, you have to step outside and talk with us. And the guy says, no really I'm not coming out.

So they get the SWAT team out there and they do their thing with the pepper spray and the guy comes out. So the cops go in to see why on Earth the guy didn't just come out in the first place. And then they call the coroner.

It turns out he was in a stall. And in the stall was a dead prostitute. A very, very dead prostitute. Propped up against the wall. In order to allow her to, um, continue working.


Post script:
Level 1:
Now, not to put too fine a point on it, but dead prostitutes-- not to mention very dead prostitutes-- are (how shall I put this?) an acquired taste. So I'm thinking there's a whole lot more to this story than I heard. As in he didn't simply discover her there, think to himself, wow! this is my lucky day, and capitalize on his good fortune. I'm thinking this guy made this happen for himself. And I'm wondering to myself how on Earth he feels so comfortable out in public like that if she is the first one he's kept in such a state.

Level 2:
These are the kind of cases that really get to me. Not because of him. It's her. There's just something about people that get treated as if they were worth exactly nothing...

More fun with petechiae

So, apparently, you can also get petechiae from hyperthermia (which makes sense if you think about it" they get DIC, which is doctor talk for "their clotting and bleeding system gets all out of whack" which is a pretty good way to get little bleeding areas which is a good way to describe petechiae...)

Random case

The exposure deaths are starting to hit the office: right on schedule-- about a week after the heat wave starts. Apparently, all the stuff your body is doing to try to compensate tends to poop out after about a week. So if you're hot, you've got about a week to figure out a better strategy, which, for an accidental cause of death, is more than fair.

Random case

So the coroner's office has to store decedents for a period of time before and after the autopsy. Dead people with families who love them are in a big hurry: they've got funerals to be at, morticians to pick them up, families to call and ask that they be ready. People who are unidentified or. well, unpopular are lonely and bored and tend to stay in the fridge.

When things get busy, the fridge gets full, which means that in order to get your guy you have to move a whole bunch of other guys out of the way. Then you have to put them all back. And then you have to do it again at the end of the case.

So things have gotten busy and the fridge is getting pretty full and it's starting to take a while to find your guy. Now, the techs go get them for you, so you, as the doctor, get to hang around in the autopsy bays trying to figure out which bay is almost done getting used so you can be right there to claim it as soon as your guy shows up. (Okay, so they're not even open yet but over here they're starting to sew up the head!)

Today it took 45 minutes to get my guy and I had to kick a resident (who was still waiting, by the way-- never did find out when that case showed up) out of a bay.

Ultimate assault

So I know I shouldn't let things like this bug me but the other day one of the criminalists--who seems like a perfectloy nice guy, let's just get that out of the way-- fires off with "as if the autopsy itself isn't the ultimate assault." This is in response to the sentiment that I've noticed among investigators that our determination of body core temperature is a little, well, invasive.

Okay. I know what it looks like I'm doing when I'm doing an autopsy. There's blood (and, frankly, worse) all over me, all over the table, and all over the decedent who appears, to the untrained eye, at the end of the procedure to be, well-- empty. And I'm standing over him (disproportionately, it is a "him"-- be careful out there, guys!) holding what, to the untrained eye, appears to be a gigantic knife and peering with unseemly interest at something that could reasonably be described by a sane person as, well-- slimy. (Look: no offense, but inside, you're kinda slimy.)

The word that's missing from this whole discussion is: thorough. It's the same reason you do a rectal exam when you admit a patient to the hospital: it's not because you're mean, this isn't something you're "putting them through," and it certainly isn't because you like to shove your finger into random people (that's between you and another consenting adult and, being neither, is none of my business): it's because you're thorough. The person in front of you is your patient and they are going to get the best care you can provide and that means that you do the whole thing, even the parts you don't really like. There's a dignity to it: they deserve the best you can do which means they get the whole enchilada.

Look, I trained a very, very long time for this. I fought for this. I think about what I do, I read about what I do, and I do the very best I can every time. Which means that I have to check, for example, the heart. Which menas that I have to look at the heart. Which means that it has to leave the chest. Those things that are preventing it from doing so are called "ribs." Hence the branch cutters. I know what it looks like when I'm taking those branch cutters to my patient-- hey, I know-- but it has to be done or else we never get to find out whether it was his heart or not. You can say it's for the family but you do it whether there's a family to claim him or not (and depressingly often it's not) because this is a human being and when a huiman being dies we don't just chuck him in the trash. He matters. He has dignity. He deserves to have his life close properly: with an answer. We care what happened to him. We want to know. His very human dignity demands it.

You may not notice it at first but that's love at the tip of the knife.

Random case

Sinus dissection:

This is a whole lot easier than it sounds. Basically, you get yourself a Striker saw and make a little box around the clinoid processes. Then go find a hammer and a chisel and pry out the block you just made. Once it's out, spend some time frowning at it and changing your mind about which sinuses are which.

The scary thing was worrying about accidentally sawing straight through the face (which, no matter how many times you look at it always seems to be way closer to the skull base than it actually is.)

Skin to skin

There is a lot of variability in the amount of dissection that gets done by the tech and, thus, the amount of dissection that you end up doing yourself. Today's tech was of the "minimalist" variety, so I was left to my own devices for the first time ever.

Back story:
So we have to do at least 50 cases in order to be eligible for the pathology boards, but in my program the techs pretty much just handed you organs to dissect. So while I'm supposed to be able to do the whole thing myself, I never really actually technically, well, did.

So what if it took me twice as long to do it by myself-- you do get the feeling that you haven't missed a thing-- not to mention the sense of accomplishment you get standing over a nice little pile of organs that you made all by yourself...

Random case

So I was preparing for one of our rotations (this one's "sexual assault" and is being given by a person who could probably be described as the goddess of sexual assault) and I ran across this article in the orange journal on staging and posing (staging is where the scene is rearranged by the murderer, posing is where the body is rearranged by the murderer) and it keeps going on and on about how rare either one is and how you're never going to see a case in your life. So the next day it's my turn to go to court with the senior medical examiner and I'm flipping through the case file trying to get a feel for what's going to come up and there's staging... and I keep skimming through the report and there's posing... There's staging and posing!

Table for one?

So things are getting a little backed up around the office and getting a station at 9AM is kind of like getting a table at the hospital cafeteria at 12 o'clock sharp.

The up side to all this is that the autopsy assistants appear to have banded together and are jumping all over each other to help us get through the cases and, incidentally, get the @#$! out of the station so that we can get home while we're all still young and cute.

Fun with petechiae!

So I'm doing my daily lit search and I run across a reference to petechiae and asphyxial deaths. So petechiae and asphyxia go together like peanut butter and jelly: when you think of one you think of the other but you sure as shootin' see one without the other and the other way 'round.

The thing is, they reference this paper where they took volunteers and just asked them to be upside down for a minute and when they checked afterward they found conjunctival petechiae. And I'm thinking-- Hey! I've done yoga! One minute upseide down: no sweat! So with my boyfriend timing me I give it a try (complete with pre-inversion exam, just to be sure) and hey! It works! I got one (only one, actually) on my right eyelid.

So, unlike most forensics, you can go ahead and try this at home...

Sparring day

Walked in today and another gym had shown up for sparring. Ended up spending the whole time watching the fights. Damn, people get really good. Some of the kids were fairly young, too...

Sidled up to one of the other fighters, who is really, really good, and asked questions. So, okay, I didn't get sweaty, but sometimes you gotta work the brain...

One of the things I was hoping you'd be able to do as a forensic pathologist is to kind of "read" the injuries like you're Sherlock Holmes or something.

(I was kind of hoping I would be sitting there in the witness box in a sharp suit peering astutely over my glasses asserting articulately that "Clearly, this teeny tiny little mark that a lesser person would have missed demonstrates that blah blah blah trajectory blah blah blah blood spatter and blah blah blah therefore..." So I'm always on the lookout for those sorts of things.)

Yesterday, one of the professors called us over to take a look at a ring fracture of the skull base. (So far, skulls seem to be a great place to look for injuries full of little clues about the mechanism of injury...) Basically, if you pick up a skull to say "Alas, poor Yorrick" your hand is on the skull base. There's a big hole in the bottom for your spinal cord to fit through. If you draw a circle around that hole-- but draw it wide, so it goes up the sides a bit-- you've drawn yourself a ring fracture of the skull base. (This is based on my vast days of experience in the field, so be prepared to revise your initial opinion.) Apparently, you can get these if a whole lot of force is applied to the skull in an up-down direction (like if you're hit on the top of the head or if you land really hard feet-first.)

Flash forward to today: different professor, different case. I'm off dissecting the heart or lungs or something when the tech calls me over to take a look at the skull. She's been at the head and has reflected the scalp forward and there's a collection of blood in the scalp and stuck to the skull on the top of the head. I was kind of expecting a head injury, as there was blood around the ears and nose, which shows up when there's fracture (of any shape) in the skull base. She lifts off the top of the skull and the brain has a bit of swelling and a little bit of bleeding (subarachnoid, for the medical folks) but nothing special. My tech asks what I'm thinking the cause of death is because the abdomen and chest weren't too banged up (this was a trauma case) and she was expecting to see more damage to the brain and I say basilar skull fracture because of the ears and nose thing. We reflect the brain and there's a bunch more blood at the base of the brain. As we deliver the brain and there's a ring fracture of the skull base (which looks nearly identical to yesterday's) and she says "hey, you're right" in that very satisfying hey-this-one's-pretty-good way that's so nice to hear when you're a fledgeling. So my professor walks up to sign out the case and asks me the mechanism of injury and I say blow to the top of the head ('cuz of the blood at the top of the head combined with the ring fracture) and I'm feeling like the border collie that caught the frizbee.

So maybe it's not dazzling brillance swooping in to save the day in a hushed courtroom, but, hey!, score one for the rookie...

Rules of forensics, an update

Hanging around conference today and got the professors off topic and onto war stories (always a good idea and, actually, my new strategy for topics and/or days that are ho hum.) This resulted in a new rule:

Beware the private defense attorney.

Public defenders are busy. Private attorneys have all the time and budget in the world and they will (will!) find something wrong. I don't care how careful you are, I don't care how meticulous you are-- nothing will stand up to the relentless scrutiny of very well-paid people who are very highly motivated to make you look stupid.

Office plant census

1. Maidenhair fern
2. Boston fern (condition: guarded)
3. Tropical fern-like thing
4. Sweet potato vine (purple)
5. That vine-ey office plant people always have that sort of takes over the space
6. Another sort of tropical-looking thing with big, fat stalks at the bottom
7. Venus flytrap (condition: critical)

Autopsies for beginners, continued

So the trick to the liver is to stand on the decedent's left side (for righties) and pull it towards you. The right adrenal and kidney will present themselves for your evaluation as you're freeing up the posterior aspect, so be ready for these enthusiastic volunteers.

Also a good idea is to get the intestines out of your way. By now, they've become a nuisance. Just dig around behind the stomach for the ligament of Trietz and, once you've got it, transect the intestine right there and start delivering the intestines from the wound using the "sweet spot" of a pair of scissors directed right at the mesenteric border. (That'll make it easier to run the bowel later.) Pause at the cecum to identify and stock the appendix (people are very, very particular about appendices, as they have heard of them.) Then finish up your colectomy, digging deep at the rectum for your second transection. Now you've got a nice visualization to help you with the spleen, left kidney, and left adrenal.

If you've got a male (which I almost always do-- males die under suspicious circumstances with alarming frequency: be careful out there, guys!) go ahead and dig out a hernia on each side then reach into the scrotal sac and deliver the testes one by one. Be very careful that you've really got a testis and not the corpora of the penis, as transection of the latter results in a nasty shock for the embalmers and a long, awkward conversation for your boss and the family. No, they will definitely not understand that this is an easy mistake to make so just don't make it. If you're not 100% sure you're doing it right, go find someone who is.

The neck dissection is tricky and best left to the professionals (meaning your assistant) as the main danger here is that you will mistakenly transect the skin as you round the curve at the base of the tongue, resulting in a "buttonhole" which results in more work for the morticians. (Plus they'll snap you with wet towels in the locker room.)

Lecture topics

Today was intro to Sexual Assault. This makes for very interesting conversations:

"Oh no, I can't make it: I've got sexual assault in an hour..."

(Also clearly a contender in the "most depressing atlas" category...)

Office plants

So I'm sitting in this little Italian restaurant on Saturday afternoon having my habitual Saturday afternoon lunch out with a book-- (this time, the "book" is the grey journal and I'm reading about criminally insane mothers who murder their children)-- and I really can't stop thinking about my murder victim. I mean really. I keep running the testimony over and over in my head: how long she could have lived (suffered) with the wounds that she had and how quickly she would have been incapacitated (helpless.) I keep thinking about how there was a history of domestic violence between her and her murderer and how she probably saw it coming although not right then and there. I keep thinking about her driver's license photo and her fingerprint and how she looked like she'd led a pretty hard life-- like the kind of person who pretty much expects to get spit on and yelled at and hit. The thing that sends it over the top is how no one, no one ever wants to be seen like this-- dead and rotting and covered with purge and blood.

So now I'm crying in the middle of this nice little Italian restaurant on a sunny Saturday afternoon, trying not to move or make noise and I'm just sobbing as quietly and inconspicuously as I can, trying not to disturb the nice people who aren't going criminally insane and murdering their children because the voices in their heads told them to or stabbing their girlfriends and leaving them to rot.

I have apparently decided that the solution to all this is office plants. I keep buying little office plants. I put them in cheerful little pots and scatter them about and, to be honest, the place is starting to look so downright homey and nurturing it's almost like mother nature herself works there.

First day in court

Went to court today for the first time.

Back up, back up...

So as part of the fellowship, they send us to court with one of the senior medical examiners so we can watch them testify and get a sense of what we're supposed to do in court and whatever.

(I always have paranoid fantasies that start out "Isn't it true doctor..." and end up exposing some embarrasing something or other like how I didn't do so hot on some test or other or how I once stamped a paper wrong and had to go back and re-do it or something and there I am squirming and making a complete horse's patoote of myself) but this isn't about me, really.

So I can't tell you about the case because everything is not yet said and done or anything but I think it's okay to let on that it was a very violent, very hands-on murder where the victim and the killer had a long, intimate, and fairly complicated relationship. And, as criminal cases go, the whole thing happened about six months ago or so.

So we get the the court, we go through the metal detector (I'm there with a very nice, avulcular forensic pathologist), and we head up to the court and the thing that's most striking is how quiet it is in there and how, well, bored everyone is. I think the only people who were, for lack of a better word, excited to be there were the defendant and me.

The whole time my professor is testifying, all I can think of is how weird it must be for the defendant to have what must have been the most passionate, most violent, most vivid experience in his whole life picked apart so meticulously by a bunch of bored people he doesn't know.

The other thing that was striking was being introduced to people as a "friend of the court," which sounds like I'm meeting blindfolded Justice for lunch or something.

How to cheat at maggot races

Encourage "your" maggot by flicking a lighter at the end you suppose to be the "back."

Personal best update-- new category

Grossest thing I've ever heard of:

People call the coroner's office to say they've-found-something-that-they-think-might-be-human-body-parts-but-they're-not-sure-so-can-we-send-someone-out? with surprising frequency.

So a while back we get called for a box of possible human intestines out behind a dumpster in an alley.

Turned out to be a box of squid tentacles covered with maggots.

Random case

Advice: don't go walking around in the dark while you're drunk-- you never know what you'll impale yourself on.

The score so far:

Things sticking out of the ground: 2
Drunks: 0

And that's just this week.

Lists

I've been keeping a list of personal bests. It's time to share:

Worst tattoo:
(Includes sub-categories for worst workmanship, longest list of crossed-off ex-girlfriends, and most implausible subject matter.)

The award for worst tattoo overall for the first two weeks of July, 2006 goes to "Lady in a see-through top and sombrero." During her acceptance speech, it will be important for her to explain why her see-through top looks like a sewing class accident, why people decide that they are tattoo artists when they are clearly unable to draw a convincing human face, and where, precisely, one is expected to wear a see-through top and sombrero.

In the category of workmanship, the award, once again, goes to all those people who appear to be doodling on themselves while in jail. Note to people: you can just draw-- it does not need to be permanent.

The record-holder for longest list of crossed-off ex-girlfriends goes to the giant biker dude with three.

And, for most implausible subject matter, the award goes to guy with a tattoo of an elephant on his pubic area with the penis for a trunk.

Most depressing atlas:

The award for most depressing atlas goes to the Netter atlas of child abuse. Photographs are depressing enough, but there's just something about meticulously executed paintings of 1950s children with horribly disturbing wounds that allows this atlas to prevail over some, let me tell you, stiff competition. Runners up include "Sexual Assault" and "Taphonomy" (which is doctor talk for "rotting.")

Worst accidental specialty:

The award for worst accidental specialty goes to my co-fellow, who is apparently accidentally specializing in the very obese and very decomposed.

Rules of forensics

Probably, these will accrue over time, but (so far) the first rule of forensics is:

There's always a fetish.

A little too close to home

Lots and lots of cops outside my apartment today, holding down two large men in handcuffs...

Serial homicide task force

So one of the cool parts about being a fellow is that you get to meet with people who are way too important to meet with you in the first place and one of those people is the head of the investigations division. So he's in the middle of trying to explain his whole department in the allotted time and list all the annoying things that he's hoping we won't do when he mentions the serial homicide task force.

(This is the coolest thing I've ever heard of. Isn't this the coolest thing you ever heard of?)

So because the coroner's office handles all the deaths in the county and the other agencies kind of split it up, we're in a good position to notice homicide patterns. Everybody has to take these training classes, of which there are apparently zillions, and the task force people concentrate on classes in their chosen specialty: disasters, hazardous materials, accident reconstruction, child abuse, elder abuse, and, apparently, serial homicide. (!)

(It's very hard at times like this not to leap out of your chair and shout pick me oh please pick me pick me!)

The icky stuff

So I'm having another one of those meetings that you have when you're starting a new job and in the middle of the whole handing-you-a-binder-you-will-never-read and signing-stuff-that-can-be-used-against-you-God-forbid and nodding-your-way-through-a-powerpoint-presentation we get to "icky stuff." This is the (very nice) IT guy referring to my job casually as the "icky stuff."

Apparently, to the rest of the world, what I do is the "icky stuff." I sort of thought that, at the Coroner's Office, they'd think of it as, oh, I don't know, the heart and soul of the organization. I kind of thought that what I was trying to do was, well, cool.

So you go to med school, you go to residency, you get into fellowship and and all set up to take a grand total of three specialty boards. You are licensed, background checked, educated to within an inch of your life, and up to your ears in student loans all for the privilege of doing what everyone else on Earth will forever refer to as the "icky stuff."

I walk around in this fog where I think I have this totally glamorous job that anyone would love to do or hear about. Honestly. We have our own TV shows-- CSI, Quincy (for heaven's sake)-- not to mention novels (Patricia Cornwell comes to mind.) Seriously, there aren't all that many specialties that have their own TV shows (sure, ER; yes, House, but you have to admit we're overrepresented.) When it's all said and done (God willing!) I'll be not only a licensed physician but a triple boarded subspecialist and people will still refer to what I do as the "icky stuff."

Great. Now I'm not just a nerd, I'm an icky nerd.

(hard to articulate, but it seems kind of worse somehow.)

Autopsies for beginners

There's a room just off the elevator with all the protective gear in it. I wear a vapor-lock mask (works great!, looks kind of like those world war two gas masks), face shield (looks like a welders' mask), hat (with skulls and, for some reason, roses on it), gown (like a surgical gown but, for some reason, with no back), kevlar cut-resistant gloves with rubber size 7 autopsy gloves (look like biogels to me, but they're bulk/non-sterile), and trauma boots. You can customize: some people triple glove, some people wear shorter shoe protectors, some people like butchers' aprons, some people like PAPR hoods or particle filters. Visiting detectives and investigators often wear disposable masks (which, in my experience, just don't cut that trashy smell.)

When we're explaining what an autopsy is to families, we tend to say it's performed in much the same way as any surgery is performed. If we're in a formal mood, we refer to ourselves and each other as autopsy surgeons which, if you think about it, is accurate. We're cutting people: we are surgeons-- just not the type you usually think of. There are some fairly glaring differences between autopsy surgery and any other surgery.

• we do not maintain a sterile field
• we do not maintain hemostasis (that's controlling bleeding)
• and we don't put everything back together better than how we found it

(In case you're wondering, we just tuck everything back inside and sew the body shut.)

But other than that, the analogy holds up pretty well.

There are a couple of different ways to do autopsies-- different autopsy surgeons and different institutions have different preferences. Basically, there are two main strategies:

1. Take the organs out of the body all at once (if you do it right, they come out in a neat, orderly pile that you can lay down on your table and inspect)
2. Take the organs out one by one

We do the second type.

Before you cut, you take a good long look at them from the outside, checking for any signs of disease or trauma, anything that could confirm (or call into question!) their identity, and, basically, anything at all that catches your eye (you never, ever know what could be important.) You can then take samples of femoral blood (just get a ten cc syringe and 18 gauge needle and aim for the soft spot in the crease), urine (same idea, but aim just above the pelvic brim), vitreous humor (from the eye, it's a good source of information about blood chemistry before death because it changes so slowly after death), and jugular blood (you're going to have to make an incision for this at the base of the neck and dissect down to the jugular vein, but it's easy to find.)

In order to get at someone's insides, you generally have to make two incisions: one that's shaped like a "Y" and extends from both shoulders to the sternum (people are telling me that the mid-sternum is a good place to aim for) and then extends all the way down the middle of the abdomen, and a second incision from ear to ear across the top of the head so you can get at the brain. Special circumstances call for special handling, which may require more incisions, but two will do fine for most cases. (The incisions are placed where they are to keep the hands and face nice in case they're scheduled for an open casket funeral.)

You then reflect the skin off to the sides using sharp dissection (a scalpel and a good strong non-dominant hand) and separate the abdominal musculature from the lower border of the rib cage. Take a look in the abdomen to see if there's blood or scarring or pus in there. If there's a lot of fluid it'll start to decompress as you're making your abdominal incision: try to collect it so you can get a good look at it and measure how much of it there was. To get at the heart and lungs, you'll need to remove the front of the rib cage: branch clippers work well-- aim far enough to either side that you can get a good look inside the chest. Then you'll open the pericardial sac (around the heart), check for fluid (or scarring, or pus-- you get the idea) in there. You can poke a hole in the pulmonary artery to check for clot (this is a good idea, clots there kill people suddenly and might explain why you're doing an autopsy.) Pull the heart forward, wipe the pericardial sac clean with a paper towel, and place a ladle in the sac. As you remove the heart, cutting the great vessels at the pericardial reflection, any heart blood will spill into the pericardial sac (and your ladle.) Put the heart on the scale and head back to the chest cavity. If you grasp the lungs at the hilum and pull a bit, you can take your scalpel and neatly remove them. The bronchi and vessels fit very comfortably between your fingers, so you can cup your hand around the lung to keep it clear of the blade as you go.

This part I'm pretty good at. But it's time to tell you a terrible secret. (Shh...)

Look: there are people who come from these residencies where they're all gung ho about autopsy being the mother of pathology and they get just tons of high-quality autopsy training and they hit the Coroner's Office and just tear the place up. Those people make me feel very, very inadequate. In my residency, the guy who used to be in charge of autopsy was a crazy old codger who alternated between harassing the department at large and teetering on the verge of getting fired and was almost too busy with these pursuits to properly ignore me during my rotations on autopsy. (We can get into how awful that is for everyone involved, least of all me, most of all the families who were hoping for a real answer to "why did Uncle Fred die?" some other time-- for now, let's just acknowlege it and move on.)

We all spend one month at the Coroner's as part of our residency and when it was my turn I was earnestly awful, a fact which was emphatically not held against me, as everyone knew why people from my program were all awful at autopsy. I loved my rotation, decided to go into forensics, and was welcomed into the fellowship with very large, very sincere-looking smiles, great parking, and pink crepe streamers, but that does not imply any autopsy skill on my part: I'm starting at a disadvantage and playing catch-up the best I can. My co-fellow and I are from the same program (which, by the way, has since fired the codger, hired a very good new professor to handle autopsy, and is in the process of sprucing itself up admirably but a bit too late for us) and spent this afternoon commiserating about how cruddy we are at autopsy. (Today's focus: the heart and what an annoying organ it is.)

So as soon as I figure out how to gracefully remove the liver, we'll pick up this thread.

Oh yeah, and before you start worrying about the dead, you should know that I am hovered over by full-fledged forensic pathologists and very, very experienced autopsy assistants (called, for reasons I do not know, dieners) who perform the parts of the procedure I can't yet reliably do. The plan is that , as I get better, they can start letting go (picture dad holding the back of your first be-training-wheeled bicycle.)

Starting out

So not everybody at the Coroner's Office works directly with dead people. There are administrative people around to answer phones and stock shelves and fill out paperwork and file things and fix things and basically keep everything moving along. The thing that surprises me about them (but probably shouldn't) is how squeamish they tend to be about the dead. I used to think that, working in a place like that, you'd expect everybody to be fairly comfortable with the idea that a lot of the people in the general vicinity are dead but it really doesn't work that way. And I mean really. I'm not talking blood-on-your-shoes squeamish, I'm talking people whose eyes go all wide if you're wearing squeaky-clean, pressed greens on your (brief) way to your office squeamish.

(I remember there was this secretary at my residency who used to make us hang our white coats on a hook outside her office or she wouldn't let us walk in. If you asked her why, she'd say something about how you might have just walked out of an autopsy or something. Never mind that we don't wear our coats during autopsies. Never mind that we're covered head to toe with all sorts of gear when we're actually doing a case. Never mind that we only spent six months out of a five year residency doing autopsies at all. Never mind all that: all throughout that whole five year residency you had to hang up your coat outside her door because she thought your coat might have maybe seen a dead person. That's what I'm talking about.)

At our office, and I get the feeling that this is not uncommon, there are a lot of safeguards in place to make sure that you don't accidentally walk down the wrong hallway and end up face to face with a dead person. Dead people are only allowed in one of the two buildings. (No dead people are allowed in the administrative building at all.) Dead people are only allowed on one floor of the other building and you need a special key to get on that floor (even when you're using the elevator.) When you get off the elevator (or step out of the stairwell) you are not going to be immediately covered in a pile of rotting dead people. Honest. While the hallway, truth be told, smells like a trash truck, the first dead people you will encounter are lying on gurneys behind closed doors to your right and left. And they're not hiding behind the door to jump out and yell "boo" or touch you or whatever. Honestly, I don't know what people are thinking.

All I'm saying is, if you decide to be a forensic pathologist, try to remember that while you are getting used to being around dead people, the people around might not be. They might be a little freaked out about it. They might even, in that weird backward way that psychology works sometimes, be even more freaked out about dead people than your average, non-Coroner's-Office-Working person might be. All I'm saying is just remember to change out of your scrubs before you go barging into the lunchroom.

Oh yeah

So we get tomorrow off, but that's our last holiday. (No holidays for medical examiners: that's when people die.) Wednesday, we cut.

We still need:
scrubs
badges
parking
and cut-resistant gloves

But we do have lots and lots of manuals.

Fellowship begins

July 1st is New Years' Day for doctors. Given that July 1st fell on a Saturday, and given that we are pathologists-- and thus, unlike other doctors, work normal-human-being-type hours-- my forensics fellowship began today.

I wasn't really sure what they were going to do with me and my co-fellow today, so I wore something nice with a pair of sturdy (and not-too-beloved) shoes, just in case we'd been assigned cases (just to start us off with a bang!)

As you may have guessed, it was a largely ceremonial day, consisting of signing things that no one reads, having my picture taken, swearing in, and collecting keys. However, there were two notable highlights:

1) Lunch with the boss!-- a very nice and very approachable gentleman-- accompanied by the second-in-charge-and-heir-apparent (our immediate supervisor), the boss' secretary (a friendly woman) and her assistant (a very young woman who seemed surprised to be included)-- held at a nice little buffet restaurant about half an hour away.

2) Cubicle-warming decorations!-- placed by one of our co-residents while she was there on rotation last month, including streamers, a venus flytrap, snacks, and a CD of snapshots from residency.

Also nice: for once I didn't overshop. Usually, upon beginning a new stage of life, I tend to stock up on stuff I think I need (and usually overshoot by about 10%, which I've pretty much learned to accept.) This time, things seemed to fit just perfectly. Thus, I am proud to recommend the following shopping list:

Shopping list for forensics fellowship:
1) air freshener, shower gel, & moisturizer-- all on sale at Bath and Body Works!
2) drawer organizers, in/out box, three ring binder with calendar month dividers (for tear-offs of cases, push pins)-- all not on sale, but pretty cheap at Staples
3) surge protector/power strip
4) Spitz and Fisher
5) DiMaio and DiMaio (Forensic Pathology and Gunshot Wounds)
6) "I see dead people" poster

Also bring:
1) photos of friends and family
2) little office toys (I've got a little spaceman and some Homies)
3) your awards and certificates (look really wow! on a real office wall)
4) Henry's, Harrison's, Ackerman's, etc.