by David Simon
Give that same doctor a knife wound and you’ll learn whether or not the blade had one edge or two, was serrated or straight. And if the stab wound is deep enough, a medical examiner can look at the markings made by the knife hilt and tell you the length and width of the murder weapon. Then there are the blunt trauma injuries: Was your victim hit by a car or a lead pipe? Did that infant fall in the bathtub or was he bludgeoned by his babysitter? In either case, an assistant medical examiner has the key to the corporeal vault.
But if a forensic pathologist can confirm that a murder has been committed, if he can further provide some basic information about how the crime was done, he is rarely if ever able to lead a homicide detective from the how of it to the who of it. Too often the dead man comes to the detective as little more than a vessel emptied of life by persons unknown in the presence of witnesses unknown. Then the pathologist can provide all the detail in the world: wound trajectories, the sequence of wounds, the distance between shooter and victim—and none of it means a thing. Without witnesses, autopsy results become filler for the office reports. Without a suspect to be interviewed, the medical facts can’t be used to contradict or confirm information gained in an interrogation room. And though a cutter may be an absolute pro at tracking wounds through a human body, though he may recover every piece of lead or copper jacketing left inside that body, it hardly matters when no gun has been recovered for a ballistics comparison.
At best, an autopsy provides information that can be used by an investigator to measure the veracity of his witnesses and suspects. An autopsy tells a detective a few things that definitely happened in the last moments of his victim’s life. It also tells him a few things that could not have happened. On a few blessed occasions in a detective’s career, those few somethings happen to matter.
A pathologist’s death investigation is therefore never an independent process; it exists in concert with everything the detective has already learned at the crime scene and in interviews. An assistant medical examiner who believes that cause and manner of death can be determined in all cases solely by the examination of the body is just asking for pain. The best pathologists begin by reading the police reports and looking at Instamatic photos taken by the ME’s attendants at the crime scene. Without that context, the postmortem examination is a meaningless exercise.
Context is also the reason that the homicide detective is generally required to be present in the autopsy room. Ideally, cutter and cop impart knowledge to each other, and both leave the autopsy room with a greater sum of information. Often, too, the relationship creates its own tension, with the doctors arguing science and the detectives arguing from the street. Example: A pathologist finds no semen or vaginal tearing and concludes that a victim found nude in Druid Hill Park was not raped. Yet a detective knows that many sex offenders never manage to ejaculate. Moreover, his victim was a part-time prostitute and mother of three. So what if there isn’t any tearing? Alternatively, a detective looking at a body with a contact gunshot wound to the chest, a second contact wound to the head and multiple bruises and contusions to the torso may think that he’s got to be dealing with a murder. But the two gunshot wounds are not inconsistent with a suicide attempt. Pathologists have documented cases in which a person taking his own life has fired a weapon repeatedly into his chest or head with inconclusive results—perhaps because he jerked his hand at the last second, perhaps because the initial shots were far from lethal. Likewise, the chest bruising—though it may seem to be the work of an assailant—could be from the efforts of family members who, on hearing the gunshots, rushed into the room and began performing cardiopulmonary resuscitation on the victim. No suicide note? The truth is that in 50 to 75 percent of all cases, suicide is never accompanied by a written note.
The relationship between the detective and the medical examiner is necessarily symbiotic, but the occasional tension between the two disciplines produces its own stereotypes. The detectives genuinely believe that every new pathologist comes out of medical school with a by-the-textbook mentality that bears only a casual resemblance to what occurs in the real world. A new doctor must therefore be broken in like a new shoulder holster. Likewise, the pathologists consider the vast majority of homicide detectives to be glorified beat cops, untrained and unscientific. The less experienced the detective, the more likely they are to be perceived as amateurs in the art of death investigation.
A year or two back, Donald Worden and Rich Garvey happened to be in the autopsy room on a shotgun murder just as John Smialek, Maryland’s chief medical examiner, was leading a group of medical residents on the day’s rounds. Smialek had only recently arrived in Baltimore, by way of Detroit and Albuquerque, and consequently Worden probably seemed to him no more or less knowledgeable than any other police investigator.
“Detective,” he asked Worden in front of the group, “can you tell me if those are entrance wounds or exit wounds?”
Worden looked down at the dead man’s chest. Small entrance-big exit is the rule of thumb for gunshot wounds, but with a 12-gauge, the entrances can also be pretty fearsome. At close range, it’s never easy to say for sure.
“Entrance wounds.”
“Those,” said Smialek, turning to the residents with proof of a police detective’s fallibility, “are exit wounds.”
Garvey watched the Big Man go into a slow boil. It was, after all, Smialek’s job to know any and all entrances from any and all exits, whereas it was Worden’s to find out who put the holes there in the first place. Given the divergence in perspectives, several months and a dozen or so bodies are often required before a detective and a pathologist can work well together. After that initial encounter, for example, it took quite a while before Worden could see Smialek as a good cutter and investigator. Likewise, it took that long before the doctor began to regard Worden as something more than a poor dumb white boy from Hampden.
Because a medical examiner’s report is required on any case in which murder is probable, the autopsy room has long been part of a Baltimore detective’s daily routine. On any given day, the morning rounds may bring to Penn Street a state trooper handling a Western Maryland drowning or a Prince George’s County detective with a drug murder from the D.C. suburbs. But the sheer volume of city violence has established the Baltimore cops as fixtures at the ME’s office, and as a result, the relationship between veteran detectives and the more experienced pathologists has grown close with time. Too close, to Smialek’s way of thinking.
Smialek arrived in Baltimore with the belief that the natural ties to the homicide unit had allowed the medical examiner’s office to sacrifice some of its status as an independent agency. Detectives, particularly those from the city, had too much influence over the manner-of-death rulings, too much say in whether something would be called a murder or a natural death.
Before Smialek’s arrival, the autopsy room was indeed a less formal place. Coffee and cigarettes were bartered and shared in the cutting room and a few detectives had been known to show up on Saturday mornings with a six-pack or two, treating the cutters to some early relief from the weekend rush that always began with Friday night’s violence. Those were the days when practical jokes and raw banter were an established part of morning rounds. Donald Steinhice, a detective on Stanton’s shift who long ago had learned to throw his voice, was responsible for some notable feats, and many an ME or assistant began an autopsy by pausing for what seemed to be a dead man’s complaint about cold hands.
Nonetheless, the casual ease of these years also had a down side. Worden, for one, could remember visiting the autopsy room and noticing the clutter and disorganization; sometimes, when the weekend rush used up all the metal gurneys, bodies were even laid out on the floor. Nor was it uncommon for evidence to get lost, and the integrity of trace evidence was often suspect, with the detectives unsure whether hairs and fibers found on the bodies were from the crime scene or from the ME’s own freezer. Most important, to Worden’s way of thinking, there had simply been a lot
less respect for the dead.
In a campaign for investigative independence and better conditions, Smialek ended all that, although he did so in a way that damaged the camaraderie of Penn Street and made the place a hell of a lot less fun in the process. As if to emphasize the professionalism of the office, he insisted on being addressed as a doctor and would not tolerate even a passing reference to his office as a “morgue.” To avoid acrimony, detectives learned to call the place—in Smialek’s presence, at least—the Office of the Chief Medical Examiner. Subordinates who were used to less formal arrangements, many of them talented pathologists, soon ran afoul of the new chief, as did those detectives who couldn’t sense the change in the weather.
Walking into the autopsy room on one occasion, Donald Waltemeyer made the mistake of wishing all the ghouls in the chopshop a fine good morning. Whereupon Smialek told other detectives that if Waltemeyer continued on that path, he would do so with a new and larger asshole. They were not ghouls, he declared, they were doctors; it was not a chopshop, it was the Office of the Chief Medical Examiner. And the sooner Waltemeyer learned these things, the happier a warrior he’d be. Ultimately, the detectives’ verdict on the Smialek regime was divided: the ME’s office certainly seemed to be better organized and more professional in some respects; on the other hand, it was a fine morning when you could share a cold one with Dr. Smyth while listening to Steinhice speak for the dead.
Of course, the application of criteria such as comfort and amusement to the autopsy room is—in and of itself—ample proof of a homicide man’s peculiar and sustaining psychology. But for the detectives, the most appalling visions have always demanded the greatest detachment, and Penn Street, even on a good day, was one hell of a vision. In fact, quite a few detectives came close to being ill the first couple times around, and two or three aren’t ashamed to say they still have a problem every now and then. Kincaid can handle anything unless it’s a decomp, in which case he’s the first one out the loading dock door. Bowman’s okay until they pop the skull to remove the brain; the sight doesn’t bother him so much as the clipped sound of the snapping bone. Rick James still gets a little unnerved when he sees a young child or an infant on the table.
But beyond those occasional hard moments, the daily routine at the ME’s office is, for a detective, exactly that. Any investigator with more than a year in the unit has witnessed the postmortem examination so often that it has become utterly familiar. If they absolutely had to do it, half the men on the shift could probably pick up a scalpel and break a corpse down to parts, even if they didn’t have any idea what, if anything, they were actually looking for.
The process begins with the external examination of the body, as important as the autopsy itself. Ideally, the cadavers are supposed to arrive at Penn Street in the same condition as they appeared on the scene. If the victim was dressed when found, he remains dressed, and the clothes themselves will be examined with great care. If there were indications of a struggle, the victim’s hands will have been encased at the scene in paper bags (plastic bags produce condensation when the body is later removed from the freezer) to preserve any hairs, fibers, blood or skin beneath the fingernails or between the fingers. Likewise, if the crime scene was in a house or some other location where trace evidence could be recovered, the ME’s attendants will wrap the body in a clean white sheet before removal, trapping any hairs, fibers or other trace material for later recovery.
At the beginning of the external examination, each body is removed from the walk-in freezer and weighed, then rolled on a metal gurney to the overhead camera that provides the photographs of record before the autopsy. Next, the body is rolled into the autopsy area, a long expanse of ceramic tile and metal that can accommodate as many as six examinations simultaneously. The Baltimore facility does not have, like many autopsy rooms, overhead microphones that allow the pathologists to record findings for later transcription. Instead, the doctors take notes periodically using clipboards and ball-points left on a nearby shelf.
If the victim was clothed, the pathologist will try to match the holes and tears in each item of clothing to the corresponding wounds: Not only does this help confirm that the victim was killed in the presumed manner—a good pathologist can spot a body that has been dressed after being shot or stabbed—but in the case of gunshot wounds, the clothes can then be checked visually or chemically tested for ballistic residue.
Once the victim’s clothes have received a preliminary examination, each article is then removed carefully to preserve any trace evidence. As with a crime scene, precision is preferable to speed. Bullets and bullet fragments, for example, often manage to leave the body only to lodge in the victim’s clothing, and often that evidence will be recovered as the body is slowly undressed.
In cases where sexual assault is suspected, the external examination includes a careful search for any internal trauma, as well as vaginal, oral or anal swabs for ejaculate, because semen recovered at the point of autopsy may be used later for comparison to link a suspect to the crime.
Other trace evidence can be extracted from the victim’s hands. In a murder that follows a struggle or sexual assault, fingernail clippings may produce fragments of skin, hair or even the blood of the assailant. If the struggle involved a knife, defense wounds—a pattern of straight incisions, often relatively small—may be visible on the victim’s hands. Likewise, if at any point the victim fired a weapon, particularly a large-caliber handgun, chemical tests for barium, antimony and lead deposits on the back of each hand might yield proof of that fact. The examination of a victim’s hands may also mean the difference between a ruling of homicide or suicide; in about 10 percent of all self-inflicted gunshot wounds, the shooting hand will be speckled by blood and tissue particles—“blowback” from the wound track.
Just as a detective stares at a crime scene and tries to see those things that are out of place or missing entirely, a pathologist conducts an autopsy with a similar eye. Any mark, any lesion, any unexplained trauma to the body is carefully noted and examined. For that reason, hospital trauma teams are told to leave catheters, shunts and other tools of medical intervention intact so that the pathologist can differentiate between physical alterations that occurred in the effort to save the victim and those that occurred prior to the emergency room.
Once the external examination is complete, the actual autopsy begins: the pathologist makes a Y-shaped incision across the chest with a scalpel, then uses an electric saw to cut through the ribs and remove the breastplate. In the case of penetrating wounds, the doctor will follow the wound track at each level of the body’s infrastructure, noting the trajectory of the bullet or the direction of the blade wound. The process continues until the full extent of the wound is known and, in the case of gunshot wounds, until either the entrance wounds are matched with exits or the spent projectile is recovered from the body.
The wounds are further evaluated in terms of their likely effect on the victim. A through-and-through wound to the head no doubt caused immediate collapse, but another wound, a chest shot that pierced a lung and the vena cava, might not have resulted in death for perhaps five to ten minutes, though it would have ultimately proven just as lethal. By this process, a pathologist can speculate about what actions may have been physiologically possible after a wound was inflicted. This is always a difficult guessing game, however, because shooting victims do not demonstrate the same reliable and consistent behavior depicted in television and film. Unfortunately for homicide detectives, a badly wounded person often refuses to limit the crime scene by simply falling down at the first wound and then waiting for the ambulance or morgue wagon.
The distortion of television and popular culture is nowhere more apparent than in the intimate relationship of bullets and bodies. Hollywood tells us that a Saturday Night Special can put a man on the pavement, yet ballistic experts know that no bullet short of an artillery shell is capable of knocking a human being off his feet. Regardless of a bullet’s weight, shape and ve
locity and regardless of the size of the handgun from which it was fired, it is too small a projectile to topple a person by the impact of its own mass. If bullets truly had such power, the laws of physics would require that the shooter would also be knocked off his feet in similar fashion when he discharged the weapon. Even with the largest firearms, this doesn’t occur.
In fact, a bullet stops a human being by doing one of two things: striking the brain, brain stem or spinal cord, causing immediate damage to the central nervous system; or damaging enough of the cardiovascular system to cause massive blood loss to the brain and eventual collapse. The first scenario has an immediate result, though the average shooter’s ability to intentionally strike the brain or spinal cord of a target is largely limited to luck. The second scenario takes longer to play out because there is an awful lot of blood for a human body to lose. Even a gunshot wound that effectively destroys the victim’s heart leaves enough blood to supply the brain with oxygen for ten to fifteen seconds. Although the popular belief that many people fall down upon being shot is generally accurate, experts have determined that this occurs not for physiological reasons, but as a learned response. People who have been shot believe they are supposed to fall immediately to the ground, so they do. Proof of the phenomenon is evident in its opposite: There are countless cases in which people—often people whose mental processes are impaired by drugs or alcohol—are shot repeatedly, sustaining lethal wounds; yet despite the severity of their injuries, they continue to flee or resist for long periods of time. An example is the 1986 shootout between FBI agents and two bank robbery suspects in Miami, a prolonged gun battle in which both suspects and two federal agents were killed and five other agents wounded. Pathologists later discovered that one of the gunmen sustained a lethal heart wound in the first minutes of the incident yet managed to remain ambulatory for close to fifteen minutes, firing at agents and attempting to escape by restarting two cars before finally collapsing. People with bullets in them, even a considerable number of bullets, do not always perform to expectations.
