Once the autopsy is concluded, and while the attendant is busy sewing up one body and fetching another, the doctor dictates the findings or does other paperwork. When the next body is ready for autopsy, the doctor reappears in the autopsy room ready to start the process all over again.
Although the physical autopsy has ended, the OCME autopsy process is just beginning, because the doctor must then deal with the reports from the toxicology lab and do some first-hand tissue examination or microscopy. The entire process can take up to six weeks to finish and entails the doctor putting in, on average, about ten hours, what with the microscopy, paper reports, dealing with the family and family physician, and the like. But the bodies are not permitted to hang around with us for the full six weeks, and they are routinely released to families and their designated funeral directors within twenty-four hours of finishing the initial cutting and sewing-up part of the autopsy.
Physical findings from the autopsy are classified as A, B, or C. Class A are findings inconsistent with the continuation of life—they are conditions that if you have one or more of them, you can’t be alive, such as a bullet hole in the heart or brain. Class B are findings of advanced disease or trauma; any one of these could kill you but not necessarily; however, a combination of two or more certainly suffices for a cause of death. In this class are things like atherosclerosis—you can’t see it on the surface, and it is possible to have atherosclerosis and survive, but probably you won’t if you have it in combination with, say, a blood clot. A similar combination of Class B findings in a traumatic death might consist of a moderate-sized subdural hematoma (bleeding on the brain), combined with a bruise on the brain, accompanied by swelling.
Class C findings are signs of disease or mild trauma that by themselves would not cause a person’s death. If an autopsy turns up nothing at all aside from a few Class C findings, it is very likely that such a case will find its way to the “pending further studies” pile.
The more usual outcome of an autopsy, though, is that the findings will confirm the guess of the MLI, done at the death scene or during triage, about the cause and manner of death. Most of the time an autopsy simply dots the is and crosses the ts of the MLI’s on-the-spot investigation.
We once did a retrospective study of overdose deaths: Out of one hundred deaths that had been diagnosed at the scene as drug overdoses, the autopsy toxicology reports confirmed the opinion of the MLI at the death scene ninety-nine of the one hundred times as to the causative agent. This was an important finding because it gave MLIs in the field more confidence when voicing their opinions. If at the scene they suspected heroin, the statistics showed that they were likely correct. Knowing that your surmises are being validated in the autopsy and lab is a great help to an MLI.
One staple of crime dramas is the plotline in which the body is brought into the autopsy room with no outward signs of the cause of death. That’s fiction—it is rare that at autopsy we find a cause of death that has no outward sign, or gave no premonition. Most of the time, when a body is brought in because the precise cause of death was not obvious at the scene, it leaves the autopsy room with a finding that the death was from “natural” causes that were simply not visible on the surface.
Moreover, once we are armed with the information on the natural cause obtained at autopsy, we are usually able to go back to the family and elicit corroborative data. For example, a forty-five-year-old man dies suddenly at work, but we are told at the scene that he has “no history” of heart disease. The autopsy finds that he had severe atherosclerosis. Later, when we question the family again, they now remember how the decedent had “indigestion” for the two weeks preceding his death—a fact they simply had not thought to tell the MLI during the investigation of the death prior to autopsy.
Medicolegal investigators are not only good at predicting overdoses, in general we’re also good at predicting most causes and manners of death. If we say it’s a natural death, it usually is, and the autopsy almost always comes to the same conclusion. While a regular device used in crime fiction is to have a body come into autopsy labeled as a natural death and leave as a homicide to be solved by the hero detective, in reality, this almost never happens. Since MLIs began to be the first-line investigators at OCME, not a single body has had to be exhumed from its grave on the grounds that we missed the real cause of death at the scene, during an investigation.
FOUR
DURING MY TRAINING year as an MLI-I, it wasn’t only my supervisors and instructors who had to teach me. I learned lessons from cops and detectives, frequently when they weren’t even trying to be teachers.
Such was the case with my first homicide. The decedent was a prostitute found by a jogger at the northern edge of Manhattan, under the Madison Avenue Bridge, along the banks of the East River. The Harlem River Drive, a major highway, runs above the site, and while passing motorists on that highway couldn’t see the body, the Japanese tourists aboard the Circle Line sightseeing boat on the East River certainly could, and they nearly tipped the boat over when they all moved to one side with their Nikons to take a picture of a “typical” New York City scene.
It was clear to me, from my initial survey of the body and the location, that the woman had been killed elsewhere and dumped under the bridge. But as I continued working, the lead police detective went over to the decedent and stuck a handwritten note in her hand. It read, “I can’t take it any more so I’m jumping off the bridge.” And he accompanied the note with a grin at me and said, “Looks like a suicide.”
“I don’t get the joke,” I said later to my supervisor, as we were in the car on the way back to the office.
“Cops don’t like homicides,” he explained. “There is just too much involved for them in working one.” I expressed surprise; after all, like the rest of us in the United States, I had been brought up on a steady diet of popular culture crime stories in which characters like Kojak lived to catch killers. My supervisor shook his head at my naiveté.
Cops don’t like to work murders, he suggested, because homicides mean they’ll have to do too much paperwork. How much paperwork? Well, if the detectives were to fully fill out all the requisite “DD 5” forms—the basic report form of an NYPD gumshoe—on one single case, they would fill a book. Every witness to whom the detectives speak, every lead they follow, everything they do that is associated with their investigation of a homicide must be carefully documented. And even when the detectives are conscientious about doing their paperwork, another problem for them can arise—by filling out the forms they may have documented a misstep in their investigation, some small and insignificant thing, but one that a defense attorney could later blow up into a huge deal to make the detectives look like bungling amateurs. Consequently, among detectives there is a credo of paperwork avoidance.
A second set of problems for detectives who catch a homicide arises from the need to deal with a victim’s family, and to do so over a period of months. As time wears on, if no progress is made on an investigation, such families tend to get upset and to complain. Beyond these investigative headaches, there can be political ones. Police bosses are under enormous pressure from city hall to keep the “numbers” (of homicides) low, and to solve or “clear” the murders that do occur. This dual pressure then gets translated downward to the precinct detectives.
For all these reasons, cops, especially detectives, have a natural resistance to concluding that a death scene is a homicide. We MLIs, however, are not charged with preventing crime or directly with clearing cases and thus are immune to such pressures. We are taught instead to keep our “index of suspicion” high. I translated that edict into an internal directive to “treat each death as a homicide until it was proven otherwise,” and I repeated this mantra in my head at every death scene I walked into.
Slowly but surely, I was building in my mind a library of techniques, experiences, and tools that were making me into a better investigator. As my knowledge of the profession deepened, I used my own gut instinct
s and refused to rely solely on the cops’ side of the story. Years later, when I had become a more seasoned investigator, I was called to a “natural” death scene at an apartment in the Ninth Precinct, an apartment that had been illegally subdivided into smaller apartments. The action began as I stepped out of the elevator; a lone uniformed police officer, the only official person present, was standing guard at the apartment door. Walking around the hallway were quite a number of people, who I surmised were tenants of the illegal rooms, moving into and out of the apartment and just milling around. The cop didn’t stop anyone else, but he brusquely asked me what my business was there. Amused, I pointed out that both my driver and I were wearing distinctive OCME windbreakers and had our IDs prominently displayed. He grudgingly allowed me to enter the milling crowd and the apartment, and I soon discovered that his dismal powers of observation were a portent of things to come.
As I stood just inside the doorway, a tall, cadaverously thin black man drifted over to me. He vaguely introduced himself as the decedent’s husband. He seemed disoriented; I suspected he was high or had been using drugs for so many years that his brain had been fried. Slowly he led me to one of the many small rooms in the apartment, where a very emaciated black woman lay on a bed, dead. Though the small room was dimly lit, I could immediately see what I suspected were dried bloodstains on the bedding.
The cops, with their anti-homicide mind-set, had accepted the husband’s explanation of the blood on the bed, which was that his wife had been menstruating. So satisfied with this explanation were the detectives that they had even left the scene before my arrival. Employing the lesson that I learned at that crime scene so long ago, I glanced up and immediately noticed a “cast off” blood spatter on the ceiling. All my internal alarm bells started clanging. I ushered the husband out and, with my driver holding a flashlight, conducted a closer examination of the body. This revealed that the decedent had been beaten and then strangled to death. She had ligature marks around her neck, some of her teeth had been knocked out, and there were lacerations inside her mouth. She also had a scalp wound under her matted hair.
This case really drove home for me the power of mind-set. I told the cop on duty to have the detectives come back to the scene, on the double, and while he was at it to summon the precinct’s supervisors—and to detain the husband. When the detectives and their squad leader arrived, I told them I’d never heard of or seen projectile menstruation and pointed at the blood on the ceiling, which could not have gotten there from menstruation. That much was obvious, but even so, the cops—unbelievably stuck in their mind-set—tried to talk me out of my assessment that the woman had been murdered. Only after I had shown them her wounds, the real source of the blood spatter on the ceiling, did logic prevail, and they arrested the husband.
Keeping my index of suspicion high was a useful tool, but while I was developing it as an MLI-I, I had to learn to calibrate it. Early on, when entering a home, no matter how benign the scene within might appear to be, I viewed the decedent as a homicide victim and the family members present as potential suspects. Even if the decedent was a 101-year-old little lady lying on her bed, with a beatific smile on her face, and attended by loving, grieving family members, I saw a murder victim and a group of evil people who had knocked her off for the insurance money. During my first year, I slowly dialed back that inclination, until I was able to maintain a healthy amount of suspicion while not treating every family member like a mass murderer.
In fact, one of the most important understandings that I developed during my year of MLI-I training was that the families of decedents were really the clients of our office. Our first duty, of course, was to represent the people of the city in determining the circumstances of a death, but quickly I came to see that we also serve the family of the decedent in the processing of the death. Part of my task was therefore to enter a chaotic scene, in which a grieving family was confused and distraught, and to try to restore some semblance of order for them and guide them through the process of what happens to a body after death.
Dealing with the families at death scenes became an art form. I learned to consider relatives as suspects yet sympathize and empathize with them as well—since, after all, they just might turn out not to be killers. I was required to be firm yet gentle, tough yet kind, and in control of my emotions, yet not too cold or distant. Developing the tools to successfully navigate the often difficult waters of a family interaction took some time and came at the cost of some very painful lessons.
One was so painful that it shook me up for days, and reminded me, as no previous case had, that this was not a game, that my customers were very often people going through some of the worst tragedies imaginable, and that every day I had to immerse myself in this “grief soup.” I arrived at this particular scene, an apartment on Manhattan’s Upper East Side, early one morning, filled with trepidation because the case to which I had been dispatched was the type I always dreaded—a possible SIDS case. Preliminary information on my call-in sheet told me that a newborn had been found unresponsive early that morning and had been pronounced dead at the scene by emergency medical services (EMS).
I walked into an elegant building with a doorman and proceeded upstairs into a fabulous apartment—where I met two parents so consumed with grief and shock that they were almost unresponsive to my greeting. I stepped aside to obtain the story from a detective. It was unremittingly awful. For many years, the parents had tried to conceive a child, and finally with the help of a number of rounds of in vitro fertilization and other therapies, they had been able to birth this baby boy. Because the mother was exhausted by her difficult pregnancy and delivery, the couple decided to hire a baby nurse for their first night home from the hospital.
In the same room with them, also consumed by grief, was the nurse. She told the cops, and me, that some time before dawn she had lain down on the bed in the baby’s room, with the infant on her chest; a while later she woke up from a brief nap to find the baby still lying on her chest but gray in color and unresponsive. EMS was unable to resuscitate the child.
I interviewed the nurse for over an hour at the scene, and had her show me precisely how she had been lying on the bed during her nap and how she had positioned the baby. After she did, I immediately suspected that what had happened was a tragic accident. The nurse was a heavyset woman with large, pendulous breasts. She was wearing a thin T-shirt with no bra. From her demonstration, I suspected that during her nap one of her breasts had slipped over the baby’s face and smothered him.
For another hour and more, I shuttled back and forth between the nurse in the baby’s room and the family in the living room, learning all that I could about the case and at the same time laying the groundwork for a very difficult confrontation. The family was Jewish and was adamant that an autopsy not be performed. From the moment I walked into the apartment, I had known that there was no way this child was going to be buried without having first been autopsied, but I struggled to figure out how I could break the news to the already distraught parents that on top of everything else, I had to take their child away and cut it up. The task was not easy. That morning was one of the most painful of my professional life, but I had to take that child in. While I suspected that the death was accidental, there was no way that OCME or I would permit a dead infant to be buried without first having had a full autopsy to rule out the possibility of foul play.
It took a long time, but finally, with the help of the family’s rabbi, I gently convinced the parents that there really was no alternative to the autopsy. I had the baby brought in to the office, and we did the autopsy that day. The case was eventually signed out as an accident, as I suspected it would be, but that was of no comfort to the parents.
A few weeks later, I met with the nurse again, this time at our office. She was accompanied by her boyfriend. I felt as sorry for her as I did for the parents. She was distraught and felt like a murderer. At least I was able to tell her that she would not be indicted for the terri
ble accidental death of the baby boy. Still later, I was told that she had left the nanny business and the country.
In that terrible case, I had correctly assessed the scene, but in an earlier case, I hadn’t—and learned a valuable lesson by my error. My classroom for this lesson was a basement apartment in Harlem. I can still see it now: the cop on duty was outside the building because the apartment was so small that there wasn’t room for him to be comfortably inside. He jerked his thumb in the direction of the small kitchen to indicate that was where I’d find the surviving family member.
Entering that kitchen I saw, seated at the table, an older black man, perhaps ninety years old, wearing neat pants and a sweater-vest over a clean but age-yellowed white shirt; a thin man, of quiet dignity, crying silently, tears coursing down his crinkled face. He told me that it was his wife of seventy years who had died, and he was very eloquent about how wonderful she was, how much in love they had been. I sat and talked with him for a while, perhaps longer than my job required me to, because in my eyes this man was beautiful.
After a while, I left him sitting in the kitchen and went into the bedroom to examine and photograph the body, and when I pulled back the blanket on the bed, I was stunned: his dead wife was clearly a white woman, of Nordic extraction.
Dead Center Page 7
