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San Diego medical examiners examine the grossness of dead bodies

Doctors after the fact

Boyer’s and Bailey’s bodies lay quiet in the sun; time hadn’t passed for muscles to stiffen, and limbs were still limp. Bailey — six or seven holes in his neck and torso — had gurgled “Dad” from his knees before he’d dropped. Boyer had uttered nothing.

Heat was sticky and reeked of raw death, so ponchos were brought and wrapped ’round each to smother the mess; to beams robbed from splintered trees the lumpy cocoons were roped and hoisted dangling between reluctant shoulders. Evacuation began.

Four carriers manned each beam — two in front, two in back — and had to negotiate a descending trail. Their loads swayed back and forth awkwardly like deer carcasses. The carriers at the front of the beams had it toughest — dead weight’s always heavy — but downhill put it all on them. They stumbled over dips and bumps, tripped on rocks and roots, smacked their faces on branches, and sweated in the vaporous heat.

At one point a carrier slipped and his partner behind tripped backward; the beam fell hard against the partner’s shoulder, pinning something soft between — Boyer’s head. Pushing in revulsion, he thought of hamburger until he felt the ooze squeezing through his fingers drip on his face.

“...lasagna?”

“What?”

“Chicken or lasagna?”

“Neither.”

She brings another drink and I look west over the wing at the remains of day; then scribble...

‘You’re back with the bodies,’ friend said; and he’s right. Perhaps it’s time to address the issue — if all goes as planned, there are people alive at this moment who I will soon encounter dead...

Finishing my drink and chewing the cubes and wondering at the approaching glow of San Diego, I think of the transience of life and its most unsettled wonder — when?


In a run-down house on Josselyn Avenue near East Oneida Street in Chula Vista, the bodies of Armando and Luis lay stinking in their own blood like day-old roadkill.

Deputy Medical Examiner Dr. John Eisele (forensic pathologist) and one M.E. investigator work behind homicide detectives and complete reports. No signs of struggle, but cause of death is pretty apparent: stucco of blood and gray matter is spattered across a wall.

One body lies on top of the other, both on backs, both faces up — if “faces” they can be called: 9mm slugs at close range pulverize facial bones and turn brain to pulp. Eisele and investigator — wearing rubber gloves and distant expressions — inspect and utter in primitive aphorism:

...entrance wounds in the face...at least two in immediate range...covered with blood, can’t tell...three exit wounds in the back of the head — Um...there’s three holes immediately behind his head...down on the baseboard, essentially — Um...’nother hole about five feet up...above and to the right...has some hair on it...so...that’s one gone through a head...

Many hours after any regrets, a contracted crew of two arrives for pickup and delivery. Uniformed like carpet cleaners, they busy themselves tying plastic bags over the hands now stiff as claws, the feet still shod, the heads turned fat as puffers. Then the fully dressed bodies themselves — cold inside their own crusted fluids — are picked up and moved like full canoes wobbling across some old river and passing into darkness...zipped... locked...sealed.


Office of the Medical Examiner — 5555 Overland Avenue, Building 14 — sits near a Taco Bell, just outside the barbed chain-link fence surrounding the rest of S.D. County Operations. Presenting a prefab and pebbled façade in the shape of an L, its appearance implies no crossing of the Styx. Neither does a step through the front door.

It is eight a.m. (half a day after Chula Vista). Assembled at a table in the Conference Room are four forensic pathologists (plus one in training) and three technical specialists (toxicologist, investigator, autopsy assistant). On the walls hang certificates and plaques and photo-recognitions, including the fiery image of PSA Flight 182 “screaming” in blue sky. Investigator Calvin (“Cal”) Vine slides me a piece of paper and whispers, “Here’s the morning menu.”

“Um...there’s a bullet beneath the shoulder —” Dr. Eisele explains “— so we thought we had it figured out with one of the bullets hitting the wall and bouncing out. And maybe two came out one hole, you know...the exits were grouped.”

Dr. Blackbourne (head of the table and opposite Cal) nods. Somebody else clicks a pen. Dr. Davis (who looks like John-Boy Walton) speaks in a Tennessee accent: “Whether it’s related or not, but...that case from Chula Vista that I did a week or so ago...um...the police said they thought that there would be retribution for that —” pen clicks “— so I don’t know if this has any bearing on that whatsoever.”

Dr. Blackbourne looks to Dr. Swalwell (who looks like Omar Sharif in Dr. Zhivago) and reads the next name on the “menu.” Swalwell paraphrases from a report:

“...is a 35-year-old German man —”

“— wouldn’t you know he’d use cyanide —”

“—working on some kind of...says here ‘Exchange Visitor’s Facilitative Staff.’ Anyway, he came over here apparently with his girlfriend, recently broke up with his girlfriend, was unhappy with his girlfriend’s daughter, was also unhappy with a previous girlfriend —”

“— basically was unhappy — ”

“— parks the van in front of her residence, which she didn’t check on till the next morning — in fact she asked a friend to check — and found him dead inside. Next to him is a test tube that contains another test tube that contains a white substance. And there’s an apparent suicide note...”

(Someone yawns.)

“...if anybody speaks German.”

As a Polaroid makes its way around the table — decedent appearing simply curled in sleep — Dr. Davis volunteers he has friends from Germany studying at UCSD.

“— more spies.”

Blackbourne redirects conversation: “Dr. Davis, tell us about Tony.”

“Tony is a single white male in his 30s visiting San Diego from New York found dead in a hotel room. On the 19th he was running around the lobby with his shirt off and seemingly hallucinating. That was all right, of course, because he’d paid through the 21st. It wasn’t all right when the 21st came and went and he hadn’t checked out. Decedent was found decomposing on the floor beside a bottle of [a prescription narcotic] with a friend’s name on it. Brenda called this friend, and he said that the decedent is known to have used heroin. Um...there’s possible track marks.”

Blackbourne — white hair, white beard — scans a report in his hands and summarizes that “a 51-year-old guy, cardiac disabled who always drives on the right because of his heart condition — has congestive heart failure, severe coronary artery disease, two years ago had abdominal surgery for removal of blood clots — was south on I-805 in the far-right lane. Another driver witnesses him clutch his chest and drive off the road onto the vegetation. Apparently his mouth hit the steering wheel, because when they get him to the hospital they suction teeth out of his oral pharynx. X-ray finds another tooth in his pharynx, and they cleared a bunch of loose teeth from his jaw. They could not resuscitate him.

“Apparently anything that makes you a driving risk is reportable by the doctor. But how many people have angina and are driving all over town?”

“Or can’t see?” adds Davis. “When I was in ophthalmology clinic I was stunned. It’s just incredible the number of people who couldn’t see. They’d say, ‘You gotta hurry up ’cause I’m double-parked.’ ”

Dr. Leena K. Jariwala is an East Indian woman no more than five feet tall. From time to time she has made indiscernible soft comments in an accented voice.

“Sixteen-years-old Cambodian student here in the United States since 1983 and living with his family. Fourteenth March the decedent had been a passenger in a Jeep stopped in traffic near mid-span on the Coronado Bay Bridge and the vehicle contained several young persons who related the following to the police...”

Jariwala reads verbatim, but the gist is that the boy was arguing with his girlfriend who’d just announced their relationship was over...

“...as the Jeep came to a stop, the decedent said, ‘Now you will never see me again...’ He jumped out of the vehicle and jumped over the rail of the bridge. The other occupants of the Jeep ran over to the rail and looked into the water for the decedent, but they did not see him. He was found seven days later by a boater — a seriously decomposed young person, 3:00 p.m. on 3/20.”

Dr. Eisele shares a similar case. “Forty-one-year-old executive, divorced and severely depressed as a result of it. Car found abandoned on the bridge at the highest section of the bridge. They found the decedent floating in the water last night.”

“Two off the bridge in one day...unusual —”

“— boy jumped a while ago —”

“— I know, I know... found —”

“— doesn’t help to get stuck in traffic —”

“— in the right lane....”

“So. You’re going to do the homicides, John?” asks Swalwell.

“Yeah. I guess.”

“They know nine o’clock, Dr. Eisele?” asks the autopsy assistant. “You want me to call? Make sure?”

“They’re probably on their way.”

“Prob’ly leavin’ the donut shop.”


Each step was a struggle for balance. A bloody slime on his hands had made the beam slippery, and flies had begun swirling and striking like mosquitos at his eyes and mouth and anywhere the slime had smeared. And the poncho intensified heat and accelerated decomposition until the odor of something freshly gutted had putrefied into something more liquid-like and sulphurous that coated his tongue and lined his nostrils. “God! he’s rotting inside!” Then the rope securing Boyer’s head came untied and the meat hit the ground with a whump of rubber unwrapping and a crash of beam thrown down and everyone turned ’round swearing as the one smeared stumbled away retching.

“You’re dealing with death. That’s our job. You deal with death. And grieving families. All day long. Every day. It is the toughest thing about this job.”

There is part of Calvin Vine — supervising medical examiner investigator — that rings a bell: the “former Navy corpsman” part. Where had he been stationed?

“Aboard the USS Sanctuary. Went aboard November of ’68 and got off December of ’69.”

Damn! So was I. Or rather, a seriously blown-up patient aboard June of ’69. For Vine, his connection between past and present — the dead in Vietnam to the dead in San Diego — is not astonishing.

“Seeing the death and the trauma there made it a lot easier for me. When I was a hospital corpsman, if any of our patients expired, I always went down and watched the autopsy to find out if we could’ve done anything to have prevented their death. In Vietnam you quite naturally had a young patient, and theoretically you’ve got the ‘golden hour’ — from time of trauma to hospital ship — when you should be able to save ’em. So we went to the autopsies. The field just started fascinating me at that point...studying death.”

Vine — a medium-sized man with a persistent half-smile — continued his Navy career until “I made so much in promotion I promoted myself right out of the field.” Retiring from the Navy eight years ago, Vine returned to San Diego and said to his wife, “ ‘I want to be an investigator,’ and I got hired within ten months. You have to go through psychological testing, psychiatric exams. They want to make sure that you’re stable enough, that you’re the type who can deal with death.

“There are things you see in this field that people associated with medicine never have seen before. They have no idea what a decomposed body looks like. I had seen a lot of burned humans in Vietnam from napalm, seen the fire strikes and everything, and it bothered me. It really did. And major trauma, you know, blown-apart bodies. But a decomposed body? A skeletonized body? There’s no training for it.

“You jump in one of these cars and go to a scene, and you may have a body that’s been dead for three weeks, three months — or three years. There’s nothing to prepare you for the odor when you walk in. Or the sight that you’re going to see. Doctors in the hospitals — they never see that kind of stuff. The first few times I had decomposed bodies and I’d go home, my wife would say, ‘Get out of here!’ She’d make me take my clothes off outside before she’d let me come in and jump in the shower.”

I ask Vine for a “typical” case requiring investigation by the medical examiner’s office. “There is no typical,” he says. “Every death is unique. But I’ll give you a particular from the meeting this morning: the male who bystanders saw clutch his chest and go forward onto the steering wheel. He’s 51, has a long history of cardiac disease, yet when the paramedics start doin’ CPR they find his teeth knocked out and probably down his throat and possibly into his lungs.

“At this point it’s a ‘sudden unexpected death.’ His doctor says he has a long history of heart disease, but he’s driving a motor vehicle, so I have to think there may be damage to the car, which his insurance company won’t pay unless we’re involved. We have to determine whether it’s an accidental death due to the traffic accident or a natural death if it’s a heart attack. They’ll probably have to do an autopsy to determine which came first — chicken or the egg.

“Every death really is unique.

“Really is. Well, there’s one hospital that, long time prior to my starting work here, had some instances of neglect or abuse. Since the county stepped in, they won’t let the doctors there sign death certificates. We do the investigation, we sign the death certificate. Most of ’em are aged people or they have AIDS, one of the two. All well-known histories, but we still have to go out there and see if there is any indication of abuse or neglect or foul play. Just by walking in and lookin’ around you can tell whether the individual’s been abused or not. Does he have ulcers? Things like that. Or was it an anticipated death? Those I guess you’d call a ‘routine death.’

How about the unroutine?

“Probably one of the more fascinating-type cases we see is called an ‘auto-erotic death,’ which normally is an asphyxia death by hanging — but it’s an accidental death, not suicide. Most ‘asphyxia by hanging’ are suicides. Very, very, very seldom will you ever see one that’s a homicide. But rarely you get the ‘accidental death’ where somebody — sometimes a cross-dresser, dresses up as a female, has pornographic material around — is getting sexual gratification by this...this...by oppressing the oxygen flow to the brain. They usually have an elaborate setup for relieving the tension so they don’t hang themselves — soft towel or innertube around their neck hooked to a rope they can loosen up. And sometimes these people just...just...get carried away and hang themselves.

“It’s fascinating to see the setups. Most would take at least an hour, two hours, maybe three hours to even put together some of these contraptions. First one I ever walked into I’d never seen anything like it. He had converted an area of his mother’s garage that he actually lived in. Grown man. Twenty-eight years old. Been married. Divorced. And mom finds him.”


“Ready to roll?”

Hell, yes!

“Let’s go then. Got a torso on the beach at La Jolla.”

And with that I grab my stuff to join investigator Everett B. Mauger in ride-along to another scene of death. Entire day’s been spent perusing the “gore” of medico-legal books (in an unoccupied office) and scribbling frustration into journal...

Cal just said: ‘Everybody’s sittin’ around lookin’ at each other, waitin’ for somebody to die. Isn’t that terrible?’

...all day been here grossing myself out with books. Cal says: ‘Very, very seldom do we get nothing...’ but NOTHIN’S exactly what we got — YOU’RE WELCOME! San Diegans.

...feel ambivalent ’cause of just what it is I’m waiting around here to see happen. Can you grasp? For me to see what I want — SOMEBODY has to die. Man? Woman? Daughter? Son? And somebody(s) has (have) to grieve.

...only defensible rationalization is if it’s GOING to happen, if it DOES happen — I wanna see it. Maybe I can roll in it like a dog...

The voice of a woman asks, “You are ready for this?” I see Dr. Jariwala standing in the hall. “Some people are not, you know.”

“Yes.”

I follow Mauger’s big frame out the door.

“Why people don’t return their seat...” Mauger grunts, squeezing behind the wheel. “...somebody drove this thing today.”

“This a boating accident?”

“We don’t know. Talked to the parents one night. When that arm and some other piece floated up, they swore, by God, it was their son. And they adamantly insisted that they be allowed to come to our office and have a look. And they were. But there were no tattoos or anything.”

“He had no tattoos?”

“Nothing on the arm, nothing that...”

“I mean, their son?”

“Yeah....”

I wonder where we’re going, exactly.

“Where we’re going is one of the finer restaurants in the area insofar as scenic view. When the ocean gets real rough, the waves bounce against the glass of the dining room. You’re not from this area, are you?”

I aside briefly about a distant place near some glaciated peaks. “That’s a ways away,” he says. “What’s in our office that tickles your fancy?”

It’s hard to explain, but I try.

“I know what you mean. The idea of just sitting around waiting for somebody to die isn’t the job that you’d, like, say, get up in the morning and go, ‘Hot damn! It’s Tuesday, what a beautiful day!’ This is work. And you don’t work unless it’s a death. It can be very tragic, really tear your —”

A white van with satellite antenna merges into traffic.

“Hope television isn’t goin’ where we’re goin’....”


Indelible image of paled swimmer fished out of water onto dock, back sliced thrice and splayed thrice, smooth splits bloodless as gills, liver, and lungs exposed and glazed...returns from childhood (shock-poster at the lake for boaters and swimmers alike) as Mauger leads our way down past Marine Room Restaurant to the beach at La Jolla. We stop beside a lifeguard’s truck on the sand under gray sky. Littered by the surf is seaweed everywhere and a large clump of twisted cardboard. Members of a fancy wedding reception crowd the darkened windows behind us. An officer approaches Mauger.

“Who’s he?”

“He’s with us.”

“Oh.”

I look in the pickup bed — nada — then at the TV film crews and reporters kept at bay on the fringe. Where’s the torso? Officer speaks to his two-way — “Coroner’s here” — and orders a crew for pickup. Mauger reaches into his bag of tools — “Guess I’ll take the picture now” — walks ten paces and focuses on the clump of cardboard. Click. Now I notice the crawling things and dancing flies...broken femur shafts...chunk of vertebral column...rotting meat.

Pretty people in jogging suits try to get close. Looking “official” (coat, tie, proper shades) and acting the part (“Go around, please... Tryin’ to keep this area clear, ma’am”), I am inevitably stalked by a woman reminding me of Barbara Walters.

“I’m not here officially, ma’am...”

She sniffs a “scoop” and succeeds in “squeezing” a few “tidbits” from my lips as camera crews zoom on pickup and delivery while the wad of flesh and bone is rolled into the zippered white bag.

Throwing his gear and slamming the trunk, Mauger escapes a last reporter and grunts himself back into the car.

“She’s a very pushy lady,” he says. “Get a kick out of watchin’ these people where there is somethin’ newsworthy,” he chuckles, “way they muscle each other. Their tricks are unlimited. Few of us interview. Guess I can’t really say why, except I don’t need any publicity.”

As we pull out, I note the removal crew’s van (like the car we’re in) is unmarked. “All our vehicles are low-profile, and that’s what I like.”

Mauger is not by nature aloof; returning over back roads and avoiding rush-hour traffic, he is at ease sharing his world at work. How’s his rapport, I ask, with homicide detectives?

“You know, at one time we used to be a big group of friends. They never rotated, and stability in our office was unbelievable. Every time you went to a homicide scene it was almost like a reunion — Hi, Bill; Hi, Everett — tease each other. Sometimes humor’s expressed. Now I go to a homicide and I feel like the stranger in town. Weird.”

But part of an investigator’s business, he explains, is to know when (and when not) homicide needs to be involved. “Had one last week I sweat bullets over. We finally decided to take it in [to our office]. And sure enough, it turned out a ‘natural’ [death] but...”

What was the situation?

“A young lady was found dead in her apartment with an awful lot o’ — professionally we don’t say ‘bruises’ — an awful lot of ecchymotic areas on her body. Like I said, I sweat bullets. But I kept puttin’ it together and puttin’ it together and finally figured out she had weird sexual manners and the marks could’ve been from bondage. Doctor Eisele found out they were all superficial. They’re now running tox. Every now and then you get into those. God, I hated it when I first heard it, but the first thing you should say when you walk in is, ‘Who killed this person?’

“I ran into a hanging inside of a van, right in this neighborhood, and there was a very territorial dog in there. We coaxed that dog and coaxed that dog until we figured: With a dog like that, nobody got in there and put that seat belt around him. I took him in as a suicide. But you still have to ask: Who killed this person?

“Picked up this lady in a downtown motel — natural gas was on; place just reeked of it — and her cats were in the bathroom with the rugs pushed against the seal. Boy. From all indications we had a suicide by inhalation of gas. Then we rolled ’er over and there was this fine ligature mark.”

Ligature?

“Rope or any choking device. And she had on a very loose blouse, so it wasn’t that. So all of a sudden what we thought was a suicide turned out to be a homicide. Whoever did it, you know, was hopin’ the place would blow up. Can you imagine?”

Ever find out who did it?

“No. Heck. I’ve seen homicides for a cigarette. In a doorway right down there on Fifth Street one night: Wouldn’t give me a cigarette, that sonofabitch, so ah killed ’im. What’s wrong with our people? Yesterday was a drive-by shooting. Child eight years old. Now, what the heck is going on there? Is that how they show their bravado? To be initiated? I don’t know.”

This initiates a mutual dialogue about cowardice and shooting people who can’t shoot back.

“I left some blood in Korea.”

Now there was truly the Forgotten War.

“Yeah.”

Friend of mine was a corpsman in Korea.

“Well. That’s what I was.”

The blinker ticks loudly as we round a corner.

“Right over that Sport Mart sign,” Mauger points. “We’re right close to Montgomery Field, this guy came right over Balboa and then flamed out. Couldn’t land on Balboa because of the traffic and went into that parking lot. They were from Utah. And I pulled four adults and a baby out of that plane.”

None of ’em made it?

“Naw. He’d just refueled. You just pray they don’t break apart when you’re trying to get ’em out of there.”

As we pull onto Overland by Taco Bell, I ask Mauger (who has 5 children and 12 grandchildren) if “notification” is the toughest part of his job.

“Cold notification, yes. Christmas Eve. Right at the stroke of midnight. It was an on-scene traffic, and I was up in Julian and had every dog in Julian awake tryin’ to find this house. The man’s son had called and said he was gonna stay in town for the night. But because it was Christmas Eve, Dad said, ‘Don’t stay in town, son — come on home.’ Well, the kid fell asleep and drifted off the road. And here at this father’s door at the stroke of midnight instead of his son...I stand.”


Thoughts are washed down with a Coors Light at top of Horton Plaza. I’d left word for night-shift investigator Robert Engle to call my hotel if anything happens. Still, I had to eat. Barman sets a basket of hot buffalo wings beside my change. On the big screen Michigan scores a three-pointer and a drunk bellows. I finish the wings and wipe the sticky red stuff off my fingers. Time to leave. Driving up First Avenue, I glimpse the illumined body of an airliner descend soundlessly from nowhere and vanish like some ghost ship loaded full of snatched lives. I could sense someone had died. Back in my room, I see the phone light pulsing like a heart.

Eight a.m., next day.

“I think this is the same number of that arm and leg,” Dr. Davis says, holding Mauger’s report. “So I presume that this is more parts.”

“This must be the torso on the news last night.”

“Is there a head?”

“Newspaper just said torso.”

“Pretty hard to identify a torso,” says Dr. Blackbourne.

“Has the mom called yet?”

“Mom...” says Dr. Super. “The torso’s mom?”

“The arm ’n’ leg’s mom.”

“Her missing son’s car was found in La Jolla.”

“The leg looked like it had a propeller mark,” Davis adds, “but if predators are pulling the body apart or whatever —”

“— he’s coming back in parts.”

Blackbourne rubs his cheek. “It’s unusual for the way bodies float. Usually their extremities are down, and propellers going over the top —”

“— aren’t dicing ’em up like sushi.”

“No. Unless he’s actually swimming. If he’s got his arm and leg out when a boat’s crossing—”

“— or boat hits you first ...”

“Exactly. Forget about normal orientations, you’re tumbling underneath the keel.”

A moment passes. Dr. Blackbourne’s hands and fingers are locked together like a church, the tip of his steeple slowly tapping his lips. Then he looks to Davis, who holds, I know, Engle’s report.

“Okay, Dr. Davis.”

“This person is a 29-year-old Hispanic woman and homemaker. She and her boyfriend were driving along Orange Avenue in San Diego about ten o’clock last night when at the 4500 block a 1988 Jeep Cherokee shot out of an alley and collided with the driver’s side of their car. The Jeep was stolen. The force of the collision knocked the driver’s seat and the driver — her boyfriend — backwards into the rear compartment and the decedent was thrown across the seat of the driver’s side and her head impacted the front of the jeep. The driver of the Jeep fled the scene, and the officer said it looked as if both victims were wearing their seat belts. She went to Mercy Hospital and lived for about one hour.”

“How’s he?”


Gregory G. Davis, MD, looks so young it’s hard to believe he’s a real doctor. Here, however, his official title is “Fellow” — the designation given candidates in their final year (atop four years’ medical school and five more pathology residency) of education required to be a forensic pathologist. Davis is 31.

“This is where we all split, go to our respective offices, think for a few minutes, do whatever it is we need to do to get ready, and then wander back and do our autopsies.”

His youth and conviction are my access. In the others I sense an immunity to my presence.

An autopsy assistant dressed in blue surgical garb approaches Davis with a question. Davis replies, “I’ll do him first, if that’s all right with you. And then the other one, I guess, in the stinky room....”

Assistant leaves. Stinky room? I ask.

“Oh, there’s a room that’s separate where we do especially noxious cases; we call it the Decomp Room, usually. It’s just around the corner — have you been in the back?”

Not yet.

“You were asking if people supervise what I do.”

Yes.

“Generally it depends how comfortable I feel; for example, with these autopsies today, one guy is in his 30s and he may have some of the problems of drug addicts, like, ‘vegetations’ on their heart valves or something — and I’d show that around just ’cause it’s interesting. Usually you don’t find anything anatomically wrong. There’s just an overdose. I don’t show these guys normal hearts or anything — they trust that I understand what that is.”

Vegetations?

“Well, for your heart to function effectively as a pump, the valves are thin —” he lifts a sheet of paper “— maybe a little thicker than this. They’re real pliant and they billow back and forth. People who inject drugs usually don’t use sterile technique. They’ll use anything that is handy to dissolve the drug, even water out of the back of the toilet. Basically they’re injecting bacteria along with drug.

“But a human is very resilient. You’d think that these people would die within days from that stuff, but some of them go for years. And what will happen is the bacteria can seed and start growing on that valve. So now you’ve got this one valve with this big mass on it, and it doesn’t function very effectively. That’s a vegetation.”

That’s not the technical term, is it?

“Well, most people are probably familiar with endocarditis, but for us ‘vegetations’ is a technical term. See, pathology is a visual field: we look at things, we describe things, and then we give them names. And to recognize things and to be able to talk to one another about it, we liken it to whatever we can. Something might look like moss, for example, so it’s called a vegetation. And other parts of the body are in some way related to food, like, a ‘chocolate cyst’ — it has the coloring and consistency of chocolate. And a lot of food is also meat; it looks like what we eat.”

Davis says he realized early in his training that he wasn’t cut out for traditional medicine. “I was particularly frustrated by patients who would come to me and say, ‘I’ve got this diabetes and I’d really like to get rid of it.’ And then I’d say, ‘Well, lose 20 pounds and start exercising and chances are you’ll be completely cured.’ They’d say, ‘Oh, no, I can’t do that.’ Some people can handle that. I didn’t care for it. But I liked the lab. I liked that branch of medicine. And in pathology I enjoyed doing autopsies. However, I didn’t think I’d enjoy the medical examiner’s office.

“Before that first day, you know, I thought child-abuse cases and such would be too disturbing. They aren’t. It’s still sad. And on days when we have those cases, it’s quieter in the back than what it usually is. And the idea that somebody, yesterday, was alive and walking, that today they’re dead, the brevity of life — I think of that every time I do an autopsy. And yet I can handle that. Can’t handle the patient who won’t heed common sense, for some reason, but I can handle that. Like these two guys I have today — they are my patients. And they do exactly what I tell ’em to.”


“Kennedy’s autopsy was not ‘botched’—” Dr. Mark A. Super asserts. (I’d sort of ambled onto the subject during course of unplanned conversation.) Super (like Dr. Davis) looks younger than his 42 years. “What was fouled up was that people above the pathologist doing the autopsy didn’t stand behind him; they allowed several national figures to come to the forefront and say other things had happened and that it was botched up, when there’s never been any evidence to suggest that it was botched up.

“Take the recent book that came out by this emergency room doctor in Dallas. Emergency physicians — he eventually became a surgeon — don’t interpret gunshot wounds. I mean, he may see hundreds and hundreds of gunshot wounds in his career, but he doesn’t interpret ’em. He tries to repair them. He doesn’t do any work in interpreting direction of fire, range of fire — or anything — because his job is to try to save the guy.”

I suggest that he has pointed to a clear distinction between a primary-care physician and a forensic pathologist.

“Yes. And it’s a very important distinction. Studies have shown that if you take the interpretation of trauma physicians, let’s say in gunshot wounds, and you look at them over a long period of time, they’re wrong a large share of the time. For one thing, they don’t have the time, so they don’t take the time, to look the whole body over: they miss entrance wounds they thought weren’t there; they misinterpret exits from entrances frequently; they misinterpret stab wounds that are really gunshot wounds and vice versa. And that is understandable — it’s not their job.

“What we [forensic pathologists] train to do — what is really our area of expertise — is to look at the body, all the body, and take all the time we have, to look at all the little marks and bruises and soot or particles on the body, foreign material, to look at them, to recover them, and to interpret what it all means in light of what happened. That’s what we do. That’s not what they do.”

I convey to Dr. Super my strongest impression — based on the numerous meetings I have witnessed and contrary to the “laid-back demeanor” shown by all — that forensic medicine is cerebrally exciting.

“Oh, this is the most fun job in the world. First of all, it presents such infinite variety — that’s number one. I think for a lot of people, it’s the variety in their job that makes it interesting, keeps you getting up in the morning. When I wake up, I don’t know what’s going to be here; what unusual disorder or disease; what weird event that occurred to somebody; what thing of local or sometimes national significance may have happened in the time since I left work. That’s one part of it.

“The other part is that the job fulfills that chase-the-fire truck need that people have — What’s going on? Why is that cop car going down the road? — And we get involved in that. We’re not going to be able to solve cases alone — we’re only one part of an investigation — but we’re close enough that we know what’s going on. That’s exciting to me, and I think that’s exciting to a lot of people in this field.”

Then what’s the downside?

“Money.”

Really?

“Physicians — even in large, multidisciplinary groups — make a lot of money.”

Family physicians?

“Oh, yes! The more people you see, the more money you can make. In the private sector I could easily double what I make here. But,” he sighs, “we have to understand that when we go into this field that we’re going to be working in the public domain — public servants.”

Checking the time, I note I’m late and ask Dr. Super for directions to ‘the back.’

“You haven’t been in the back yet?”

Not yet.

“Oh, man! You need to see the pulse of this place!”

The what?

The pulse...” he laughs. “Or, no pulse.”


The Back — as it is referred to — is not some Gothic chamber of cold steel tables nor a graveyard of zombies. It does, however, possess an unpleasant odor. You can get here three ways: one, die (which is no guarantee and doesn’t mean an autopsy); two, enter the front and pass through a maze of push-button doors (if you know the codes); or three, go to the freight doors outside and walk in. Near the entrance are the color mug shots of all “cleared” to be here (detectives, office personnel) and a county map poked (solidly in downtown) with red “homicide pins.” Around the corner in the main area (large enough, it appears, to accommodate four autopsies) Dr. Jariwala and one assistant work on a young woman killed last night while I drank a beer.

Two stenches predominate: the steamy rawness of a slaughterhouse — and bleach. Corpse scalped and split open. Jariwala lifts a dipper full of dark fluid from the wobbling cavity. My basic sentiment (aside from some ambivalent loneliness) is that this is nothing.


“If I were you, I’d double glove,” Dr. Davis tells me. “I do it always for protection, but it also keeps your hands from picking up the odor nearly as much.”

Stretching and snapping on the latex — body, head, face, and shoes already covered in blue cotton or paper — the only part of me not prophylactically clothed are my eyeballs. At the ready, however, are solutions for optical rinse (in event anything should splatter under the lids).

Is this the “stinky room”?

“Well, no. Actually this is the ‘auxiliary stinky room’; the real Decomp Room is back in there.” (I peek inside the “reefer” and see a couple pair of feet sticking out from covers.) “Those are autopsies that have already been done.” Davis’s immediate task sprawls on the table before us — the torso from La Jolla. The odor is that of food left in the fridge for half a year.

“As you heard, an arm and a leg washed up on La Jolla Shores ten days ago — that was all. And the arm and the leg had been in the water long enough that the fingerprints were mostly gone. So we didn’t have a lot to go on as far as identification — can’t tell whether it’s male or female on the basis of an arm or a leg. When they get tumbled in the surf, the sand grinds them just as sandpaper would.”

Davis manipulates the shattered bones and skinless muscles into an approximation of original arrangement. “This is someone’s pelvis,” he explains. “Here: this is the sacrum, your tailbone...and these are your femurs, the thigh bones. And they’ve been broken, of course. If you actually run your hand over the edges...”

(I touch it —)

“...the end is jagged but the edges smooth, which means this was broken at some point. It’s been tumbled in the water long enough that it’s been sanded smooth. I don’t think they were cut.”

Nobody sawed him up?

“Probably not.”

If bones are fractured and fish nibble, then the legs could fall off?

“Exactly. Once you die, you’re fodder. And they don’t just casually eat. Sharks wouldn’t be interested in this, but predators tug and pull apart and take their piece home with ’em. So that would happen to this person as well.”

I recognize that the lumbar section of the spinal column is scarcely connected by a few strands of tissue. Davis starts to put it together.

“So this goes...and see, it’s actually attached — no, this is anterior, it’s going to sit up here like this...there: that’s him. The way he’s supposed to be. If it is a him.”

Can you tell by the pelvis if it’s male or female?

“Yes, you can. If you’re good. I haven’t had very much experience in that yet. But the male pelvis is narrower, a female larger. So...you put this back together...that...is pretty narrow. A female’s tends to lay out more like...” he spreads the disarticulated pelvic bones “...that: kind of like a bowl, see? You could cup something in that; whereas with a male — like this, see — it’s just going to slide off. Actually, we’re missing part of the pelvis. The front part. But it still seems to me that that’s narrow. I really think this is a male.”

Long ago, I too wanted to be a doctor; and in that world I participated in the dissection of two cadavers. Eager to convey my knowledge, I ask, “Where’s the greater trochanter?”

“Ah, if you put your thumb in here...”

(And, like Jack Horner—)

“...you can feel it. Feel that knot?”

Yeah.

“That’s it.... But the thing that we need to do — since we just found this and really don’t know what’s goin’ on — is look for any injuries that we would really understand, like a gunshot wound. Or make sure there is no bullet buried in all this tissue. The best way to do that is to take an X-ray. The detectives are going to come in a little bit and take some photographs. They’ll do an abbreviated workup, not what they usually do. They don’t know that it was a homicide, but they would hate for the head to wash up a week later with bullet holes in it.”


“Nausea. You’ll throw up a hundred times a night. You’ll crap all over yourself, you’ll piss all over yourself, you can’t even get out of bed, you don’t care...you don’t care. You can’t eat. You can’t swallow anything, because you have mouth sores so bad. It’s just constant, constant...misery. And there were a couple times I was questioning, ‘Do I want to continue? This is bullshit. This is really bullshit.’ And I thought about killing myself...”

Frank Barnhart — MEO’s interim supervising toxicologist — has twice survived lymphoma and medicinal horrors of chemotherapy. Perhaps his appreciation for the Swan’s final number is keener’n others. I ask him rather awkwardly —

“— Why are we here? Let me tell you something: we’re not about saving lives, obviously, and I’m not even sure I buy the old business that ‘We learn so much through death that we’re helping life.’ Sometimes we go so fast, and we have so little time to go back and expound about a particular finding, that I doubt much gets back to the clinical world.

“But I think it shouldn’t be just accepted that people die. When someone medically ill dies under normal circumstances, under a doctor’s attention, then you understand why they died. It’s documented: this person had cancer; this person had AIDS, whatever. But for most of the cases that we investigate — except for the traumatic suicides, the motor vehicle accidents, the homicides — while we may have an idea why they died, we don’t know for sure. And the last thing you do is die. Shouldn’t someone know why? You know, why’d you die? Parents want to know. Relatives want to know. Friends want to know. Employers want to know.

“There’s times, yes, where I think we do some toxicology testing that is unnecessary. Someone shoots himself in the head, someone jumps off the Coronado Bay Bridge, someone hangs himself — I don’t feel we’re personally obliged to do an incredible amount of toxicology testing. You know why they died. Then again, this laboratory has been responsible for some major discoveries.

“A doctor from the East Coast brought his female companion out here a couple years ago for a high school reunion. Early one morning he places a 911 call, says that after having sex his girlfriend got up, went into the bathroom, and boom — collapsed. We send investigators, and they can’t find a cause of death. Maybe some arrhythmia, something congenital — must be, ’cause she’s young!

“Well, the pathologist orders a total toxicology — a general toxicology screen — which is the most comprehensive thing we do. And what was interesting is that essentially the whole toxicology panel was negative, except the screen for chloral hydrate — the old ‘mickey’ they used to slip in drinks back in the ’30s and ’40s. It’s a sedative, hypnotic, but not used much anymore. It was still in our panel. But then, even though we got a slight reaction for that, when we did the confirmatory reaction for TCE — by-product of chloral hydrate — it was negative. We could’ve just stopped at that point and said, ‘Okay, it’s negative.’ Instead we said, ‘You know, there’s some reason why that first screen reaction was slightly pink.’

“And to make a long story short, that led to one of our toxicologists doing some more work with that sample on the gas chromatograph. And he determined that there was chloroform present. We ended up taking the blood and the brain and the lung and all these different matrices, and we demonstrated not only the amount but qualitatively— there was in fact chloroform present. Ultimately there was a full-scale investigation that ended with this guy, this doctor, being convicted of murdering his girlfriend — intending to render her unconscious and rape her — with a rag of chloroform stuck in her face.”


Dead babies. One after the other — white one, black one, brown ones — flash on the wall. Dr. Brian D. Blackbourne (San Diego County’s Medical Examiner) shares his slides.

Click...

“Ten-month-old, perfectly healthy baby, chubby — if chubby’s healthy, it’s very healthy — not a mark on him, not a scratch, not a nothin’; we could autopsy that kid for a hundred years and not determine the cause of death. Cause of death is determined in the investigation. Child was found face down on a couch that’d been covered with plastic for protection and had apparently asphyxiated from the plastic.”

Click...

“The fire hazard: those bags from the cleaners frequently collect on the floor of a clothes closet...”

Click... (oh, my God)

“This little boy was four years old and he’d gotten a good spanking for playing with matches; so the next time he wants to play with matches — he hides in mother’s closet. It burns his fingers and he drops it on these things on the floor...the flames advanced so fast the mother couldn’t even get into the bedroom.”

Click...

“Baby drowns in bathtub, ten-month-old. Children under two years of age should never be left unattended in a bath, even for a few moments. It only takes a split second for a baby with water in his lungs. The baby may be revived, but damage to the lungs is so severe the child may die later on. We have a bunch of these, and usually it’s the telephone rings or sometimes the front doorbell. What’s even worse...”

Click...(ah, Jesus)

“...is when they turn on the hot water. A mother of five children — a five-year-old, a four-year-old, a three-year-old, and the two ten-month-old twins — finds that she needs to get something from the grocery store that’s just a block down the street. What does she do? She puts the twins in the playpen in the house; the other three kids are playing in the yard. She goes out and blocks the front door with a chair, tells the three kids, ‘Don’t go in the house, don’t play with the twins.’ Simple instructions. What’s the five-year-old do? He goes in the house and decides to give the twins a bath. Right? So, he puts them in the tub and turns on the water and they start to scream. And in his five-year-old mind, he doesn’t know why. You know, all his neurons aren’t connected yet. But he does remember that Mother told him, ‘If anything happens when I’m not home, go next door and get the neighbor.’ So he runs next door, gets the neighbor lady, she comes back. This baby is lying down in the bathtub — see how he’s burned? Skin comes off just like a glove — and he dies. The sister is still sitting up and is burned to the waist and survives. Surely miraculous at that age. But, that is what hot bathtub water can do....”


Dr. Blackbourne’s résumé (encapsulating 30 years’ experience) requires several pages; several more pages list material he has published. As a “qualified expert” in forensic pathology, he has made several hundred court appearances. In said regard, preliminary education of the “masses” is generally required.

“ ‘Forensics,’ ” he explains, “is a rather broad word with many uses. My definition — I might as well give it to you — whenever I go to court they ask, ‘What is pathology? What is forensic pathology? What is an autopsy?’ See? Well, pathology is that part of the large field of medicine that deals with the diagnosis of disease. Most pathologists work in a hospital where they examine tissue removed in surgery — to diagnose, say, whether it’s cancer or not — and they perform autopsies on persons who die in the hospital of natural disease.

“Forensic pathology is a sub-specialty of that. And it deals very explicitly with the medical examiner’s office, where — utilizing autopsy techniques, laboratory techniques, X-ray, the history brought in by the investigators, the clinical chemistry of these different things — we bring them all together to determine the cause of a person’s death and the circumstances surrounding it. Because we also fill out the death certificate, and we’re the ones who specify the manner — whether that be homicide, suicide, accident, natural, or undetermined.

“Now, autopsy is an examination. Note: examination— it’s the key word — both external and internal examination of the body of a deceased person for the purpose of documenting natural disease, documenting injuries, and determining the cause of that person’s death. Now, notice that I’ve not used the term dissection, which is what lay people think: that ‘autopsy’ is a dissection. The dissection is incidental to our making the internal examination. And that is a major hurdle to understanding what an autopsy is. Lay people get hung up on the dissection and don’t see that this is a medical procedure. We’re examining the organs to see why this person died.”

As opposed to med students dissecting cadavers —

“— to learn anatomy. In doing the dissection, the ultimate purpose is to learn the anatomy. Right? Lay people think that’s fine. But a lot of lay people are hung up over autopsies. They think, ‘Oh, my mother’s suffered enough,’ you know, or, ‘No one in my family’s gonna be autopsied.’ They don’t say, ‘Nobody in my family’s ever gonna have an operation.’ So it’s not the dissection — it’s just ’cause they don’t understand the higher intellectual point of what an autopsy is. It’s a subtle point, but if you keep that in mind, you may actually help to educate some people.”


“This is a field which is not very popular among doctors — and you know why? It needs a very special type of personality to put up with this day in, day out.”

Dr. Jariwala speaks while sorting tissue samples taken from a child autopsied yesterday. Educated in India, her career settled in the United States years ago.

“It needs a lot more than public outside knows about. There’s a lot more. We have to be master of not only every branches of medicine, but as a human being. As a psychologist. As a group therapist. And you need to know how you talk to the family. You tell a mother, ‘Your 20-year-old son is dead,’ it’s not easy how you talk to them, how you relate to them. Sometimes, if the people go to the hospital, they anticipate. But not like here. When you know your son or daughter is in the hospital, you anticipate something is going to happen. Here you don’t know nothin’. Your son isn’t calling, all of the sudden he’s gone. And he’s gone forever. That’s hard when it is unexpected.

“People should be given special consideration who work in this place. If you should go by minutes and hours the county pays, none of us would be working here in this place. I, as a medical doctor, would be making three times more than I am now. Easy. But it’s something I chose to do. Everybody you talk to seems to worry about, you know, that we’re dealing with death. We never get any recognition,” she laughs, sort of. “Or, ‘Oh, you’re a doctor that’s diagnosed cancer!’ We don’t get any kind of that feedback. We’re talking about death. Nobody is going to say, ‘Outstanding autopsy on my son.’ That just doesn’t happen.

“Sometimes they even become hysterical and try to attack. Real cases here. Sometimes they come and they want to kill you for telling, for giving this news. Oh, yeah. You never anticipate how they gonna react. Even on the phone: ‘You cut his dead body! You cut my son! My three-month-old! We don’t want even a single scratch and you cut my baby! How could you do that?’ Because there is such a denial to accept that kid is dead. Very difficult for them to accept the death of this little kid.”

Is it difficult, I wonder, when little ones come in dead from abuse — scalded or whatever — to contain her own rage? “Here we very professional, very thick skin. Otherwise you can get emotionally lost. Especially with children. You do. You don’t wanna be, but psychologically you do. When you see so much trauma on the child, you wonder how did somebody — especially sexual assault with three-month and half-month — how possibly could somebody do this? What did he gain by doing this? How did he do it? Why did he do it? That bothers me more.

“And then, when you go and testify and they have a prime suspect, you would never believe: this is the person who did this? He doesn’t look any different than me and you. Yeah. That’s shocking. This guy did that? This type of people, you sit with them in the restaurant, you are in the movie next to this guy, you talk to them. You never know. That bothers me. We leave our kids with the baby sitter, you leave them in the school with the teachers. Who can you trust?

“So you can’t take anything home. If you do, you will never get married, never have children, you never drive,” she laughs. “Never work, never drink, never eat. I mean: hypertension, obesity, diabetes, suicides, homicides, drive-by shootings. You won’t do anything in this life. When I leave this place, I don’t take anything home except my paycheck.”


Three hours to catch a plane, I join the “whole crew” — doctors, chemists, technicians, investigators, secretaries — jammed (as many as possible) inside the Conference Room. The table is spread with an array of home cooking in honor of an office lady retiring. Even those on their day off — Mauger, for one — have dropped by to say their goodbyes. Except for one autopsy assistant still in his “blues,” this might be anybody’s melancholy reunion.

Due to the “lousy budget problem” (I’d heard quite a bit about that), retirements are no longer replaced. Office staff has reduced by two, one pathologist just packed his bags, supervisors Vine and Barnhart combined do the work of four, ‘the Back’ is now closed after midnight (in spite of San Diego County’s ever-increasing “unnatural” death count) — thus, the tone of this banquet seems less picnic than requiem. The “gone” are just that...gone.

Balancing a piled plate on my knees, a chicken drumstick in hand, I sit beside Investigator David B. Lodge and take a wild guess: “You Army or Navy?”

“Navy,” he says. “Hospital corpsman.”

Like Cal —

“— like Cal. Workin’ for Shootin’ Affairs in Vietnam. Yeah. Cal was tellin’ me about ya, said you were on his ship. Had some pretty serious injuries.”

Yeah.

“Well, war is very horrible. It’s no two ways about it. I’d seen a number of dead bodies before, you know, I ever had this job. So it wasn’t new. Although, to be honest with ya, there’s no comparison to between the wartime situation ’n’ what you see out in these streets. I mean, there’s some comparison, but usually you’re dealin’ with relatively fresh bodies in a combat situation. Since I been in this job, you see guys just basically shattered, their entire body just spread all over the highway. That’s really what it amounts to.”

I point to the picture-plaque of doomed PSA Flight 182 and ask Lodge if he was here for that.

“Oh, yeah. I’d only been here about six months.”

How was this small office able to handle all those bodies?

“Oh, we had a lot of help. Police department was on there, Red Cross, guys from the Navy, Explorer Scouts, prob’ly mortuaries pitched in and helped us out. All kinds o’ people from the inner city — manager and everybody else got involved. It certainly wasn’t just a one-shop operation. And o’ course had the fire department out there too. A lot of the job was basically gettin’ the junk and trash off the body so we could get to the body. Or the parts. Lot of it, ’course, just collecting pieces. They were — God — lot o’ pieces all over the place. I had to climb on roofs there to get the pieces they wanted. At first the fire department was helping us with that. Then I guess they decided they, well, couldn’t take it anymore. So...”

...you got to do it.

“So I got to do it.”

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