Working Stiff

by Judy Melinek, Md

  Overdoses from illegal drugs usually make for easy work. The typical OD is young and otherwise healthy, so dissection is quick. If I find nothing out of the ordinary, I just wait for the toxicology report to come back identifying which chemicals did the killing. A straightforward OD is always a welcome autopsy on a busy day—unless, that is, the dysfunctional family dynamics that tend to accompany substance abuse come into play. Overdoses sometimes come with next of kin who will drive you bat-shit crazy.

  Robert Ward was a twenty-eight-year-old white man with a history of alcoholism and abuse of both prescription and illicit drugs. One day the week before Halloween 2001, he went out drinking with some friends. Ward went home alone to his apartment and was found dead there several hours later by one of his roommates.

  In the first phone call I got from his mother, Mrs. Ward expressed a strong personal objection to the autopsy. “Don’t you touch my baby!” she shrieked, of her six-foot-two, 243-pound son. Since this counted as a family objection, I put a hold on the autopsy until I could talk to Dr. Hirsch about it.

  At three o’clock rounds he backed me up fully. “If there wasn’t this history of drinking, and the guy was home all day with his mother and then woke up dead, I’d say sure you can do an external exam and be done with it. But I’ve seen that you can have fatal internal injuries without external sign of trauma. People who drink get into fights, and a man that young shouldn’t die even if he drinks. We have to perform an autopsy.”

  The autopsy was easy enough. Mrs. Ward’s baby had portal lymphadenopathy (enlarged lymph nodes from liver damage), visceral congestion (bloody organs caused by heart failure), and a one-inch pink cone of foam emanating from his mouth, from pulmonary edema. These three findings together are strongly suggestive of opiate poisoning. In an otherwise healthy young New Yorker, it’s dollars to doughnuts a heroin overdose.

  The toxicology report on Bobby Ward took four months to reach my desk. During those four months, Mrs. Ward called me twice a week or more. Some weeks she called every single day. She had many theories about Bobby’s death, none of them involving drugs. “He didn’t use drugs,” she kept insisting, despite my telling her, every time we spoke, that the physical findings I saw on the autopsy pointed, strongly, to an overdose. “What about the sushi?” she asked me during one call. “People die from bad sushi all the time. He had sushi that day. Did you test the sushi in his stomach?” I tried to assert my firm professional opinion that people do not die from bad sushi all the time. In my experience people never die from bad sushi. A huge load of heroin, yes; bad sushi, no.

  “What about the beer? He was drinking beer with the sushi—it could have been poisonous. Maybe the beer made the bad sushi more dangerous!” Most every day for four months Mrs. Ward had a new theory of what did Bobby in: misuse of a friend’s asthma medication, anthrax (he’d died around the time of the October 2001 anthrax-letters terrorist attacks, so this was a hot topic at the time), allergic alveolitis, dust mites, iterations of the bad sushi theory over and over again.

  Then, just after Christmas, the toxicology report finally arrived. It showed Robert Ward had taken a lethal concoction of heroin, cocaine, and the tranquilizer diazepam. I figured this evidence would finally convince grieving Mrs. Ward that the sushi hadn’t done it. Instead, the day after we discussed the toxicology report over the phone, Mrs. Ward appeared at the Office of Chief Medical Examiner.

  The security guard called to inform me she was waiting in the lobby, a bottle of NyQuil in her hand. She’d bought it from a drugstore and wanted to present it to me, because she had seen her son carrying a bottle like it a week before he died. Not this actual bottle of NyQuil, mind you—one that resembled it. She had a theory that the NyQuil had interacted with the friend’s asthma medication. I tried, as gently as I could, to explain to her that the drug levels in the toxicology report were definitive. Her son had died of an overdose.

  She balked. “My son didn’t do drugs,” Mrs. Ward repeated. I assured her that Bobby’s death would be certified as an accident—but this turned out to be precisely her greatest fear. An accident would make it his fault, or maybe her fault in raising him the way she did. “This was a homicide,” she said coolly, looking me right in the eye. “Somebody sold my son those drugs and they killed him. I’m following a lead to find out who it was, and then I’m going to get the police on him.”

  Following a lead? How much television did this woman watch? “How do you mean, following a lead?” I asked. Mrs. Ward told me there were rumors that an auto mechanic at a shop uptown on Broadway had been talking about Bobby’s death as a drug overdose. She figured this meant he was Bobby’s dealer. She was planning on going to his shop to “interrogate” the man.

  I was alarmed. “People who sell illegal drugs are unscrupulous,” I pointed out, choosing my words with care. “They may want to harm you, especially if they feel threatened. I strongly advise you against confronting this stranger.” I pictured myself trying to explain to Dr. Hirsch how the mother of one of my simpler cases ended up bobbing, hog-tied, in the East River.

  During the rest of our conversation in the lobby, Robert Ward’s mother grieved loudly, then expounded calmly her several overlapping theories of what she called “the crime.” She even proposed that her son’s death must have been a suicide—rather than face the inescapable fact, hammered home by the toxicology report, that he had been a recreational drug abuser, and it had killed him. I sat there, held her hand, and tried to be sympathetic. Mrs. Ward finally went home after about an hour, insisting that I keep the NyQuil “for analysis.”

  I filed the death certificate, officially closing the Robert Ward case, on February 19. Mrs. Ward called the very next day, thanked me for filing the paperwork, and asked that I save all her son’s tissue specimens “in secure storage,” so she could press ahead with her investigation.

  In March I started my monthlong rotation at the medical examiner’s Bronx office—where I immediately found myself knee-deep in drug deaths. The numbers in the Bronx were staggering. More than a third of the cases I autopsied there died of substance abuse. Nine out of twenty-three bodies. These had been young people, too. My first two Bronx cases were a forty-six-year-old woman who overdosed on a cocktail of cocaine, methadone, and over-the-counter antihistamines; and a forty-seven-year-old family man who was driving around with a prostitute when he had a cocaine-induced heart attack and crashed his car. A forty-year-old woman came in as a decomp with alcohol and cocaine on tox. Jerry wasn’t even forty when he went through that window fleeing a crack pipe fire.

  Mrs. Ward tracked me down in the Bronx and continued her call-a-week habit without abatement. When I returned to Manhattan in April, the calls started tapering off—and by the beginning of May there was radio silence. I thought perhaps she had finally come to terms with her son’s drug overdose. Then came the last day of May. When I got in, I had twelve voice mails. Six of them were somebody hanging up without a word—and I knew that meant it was Mrs. Ward. Before I could flee my office, the phone rang. I contemplated unplugging the damned thing from the wall but knew there was no point. I picked up.

  “Dr. Melinek, you have to rule Bobby’s death a homicide. The police say they won’t arrest the dealer, even though I’ve told them who he is! They say it wasn’t a homicide, so their hands are tied. It’s up to you to tell them it was a homicide. That’s your job!”

  “Mrs. Ward,” I said, striving to keep the exasperation out of my voice, “I have concluded the investigation into your son’s death. He died of an overdose of heroin, cocaine, and Valium. I have seen this type of death many times, and I can assure you that Bobby was never in any pain, and that his death was neither violent nor prolonged. This is classified as an accident because Bobby was just trying to get high—he didn’t mean to cause his own death.” I paused. There was silence on the other end of the line. “I really need you to understand that. My determination that the manner of death is an accident will remain unchanged unless I am provided wi
th incontrovertible evidence that Bobby was given the drugs against his will or without his knowledge. This is not a homicide, and I cannot rule it a homicide. I really hope you will find a way to accept your son’s death as accidental.”

  Mrs. Ward waited patiently for me to finish—and then continued as though I had never spoken. “I have all the paperwork together, but the police refuse to investigate,” she repeated, then launched into a diatribe about the ACLU’s refusal to take up her cause, given the failure of the NYPD to conduct a full investigation. They weren’t even trying to find the drug dealer who’d killed her son!

  That day I had been planning to finalize two old Bronx cases, both men, both shot twice. I was also hoping to finish the death certificate of a woman stabbed in a domestic dispute. She had defensive injuries to her hands, and I was able to tell the police that the location and angle of the fatal chest wound suggested an attacker approximately the same height as the victim. Open on my desk at the moment the phone rang were crime scene photos of an eighty-year-old woman lying dead in her bathtub, who had been beaten, raped, and strangled. On autopsy I had seen imprints on the strap muscles of her neck pointing to manual strangulation by a right-handed assailant. That case was all over the news. The police had a suspect in custody, and the DA was expecting me to deliver my report. Instead, I was on the phone again with Mrs. Ward, listening to her complain about police indifference.

  I was at the end of my rope, and had to fight the urge to scream into the phone, “Your son OD’d on a speedball! Please, please won’t you leave me alone so I can continue to investigate actual murders and stuff!” I didn’t, and she went on for twenty minutes more. We’d had the identical half-hour conversation once a week or more since Halloween time, and now Memorial Day was just behind us. Mrs. Ward and I had spent hours and passed seasons over the phone.

  Later, while I was on my way out to lunch, two administrators from our personnel department stopped me to talk. Apparently Mrs. Ward had called them the day before, asking how she could reach me, and what time I came into the office. She also wanted to know my home phone number so she could reach me there. They had declined her request but wanted to let me know about it. Mrs. Ward was stalking me. I suddenly didn’t feel like going out the door alone. I went back up to the fellows’ room and poked my head in. “Stuart, come be my bodyguard,” I said. “I’ll buy you lunch.”

  Mrs. Ward didn’t mean to torment me. She didn’t recognize that she was wasting my time and freezing herself in a protracted cycle of grief. She was outside my powers of persuasion as a doctor and skill as a grief counselor. No drug dealer had killed Robert Ward. Maybe he’d been an addict, maybe he’d needed help—but nobody put a gun to his head and told him to stick that needle in his arm. Speculation follows an overdose, more than any other type of accidental death. Mrs. Ward’s reaction was extreme but not unique. Denial is a powerful (and expected) reaction in the face of a sudden death, but entrenching that denial by piling doubt upon doubt can make healing impossible. During my time in New York, I saw families engage in this struggle many times, and I learned and developed strategies to help them work through it; to persuade them, as I had never succeeded in persuading Mrs. Ward, that their doubts were harming them.

  The phone calls from Robert Ward’s mother simply stopped. I was relieved—but also demoralized. There was never a breakthrough moment, never any closure. I knew it pained Mrs. Ward to imagine that Bobby was using those drugs recreationally, and it pained me to have to keep telling her so. She had brought Bobby into the world. Her baby was just trying to get high when he left it. No mother wants to believe that—and, as far as I knew, Mrs. Ward never did.

  6

  Stinks and Bones

  Curious strangers at cocktail parties love to ask how I deal with the rotting bodies, the stench of death, the maggots. The answer: You get used to it. Nobody enjoys examining decomposed bodies, but some of the cases are fascinating. Learning to handle human beings who have begun to return to the soil cycle has, more than any other aspect of the job, made me more comfortable with death—though it’s also made me much, much less comfortable with houseflies, and leery of cats.

  It was during the ride-along rotation with our death scene investigator Russell Dunn that I first saw those flies at work. That week with the MLI team showed me how much information I was missing when I considered the dead body on the autopsy table, out of context.

  The door to the old man’s spotless apartment was wide open when Russell and I arrived. Neighbors had called the police after ten days’ worth of mail piled up. Somebody had lit incense in the hallway, which infused an exotic nuance to the oppressive odor of decomposition. If you’ve ever had a mouse crawl into the dashboard of your car and die there, or if you’ve ever had a rat expire inside a wall of your home, you know its kind but not its force. A dead man stinks the same way—a sickly-sweet bacterial reek—but much stronger. It hits you—an assault, not a scent. You flinch, heave back in revulsion. It invades your throat, assails your taste buds, even stings your eyes.

  This corpse belonged to a small man, but the smell was powerful. We passed a patrolman in the next-door apartment, making coffee on the stove. “Oldest trick in the book, and a good one,” Russ explained. “Ask all the neighbors to boil some coffee and keep it boiling.”

  “Sounds like a way to keep them busy and out of your hair.”

  A world-weary smile dragged its way to Russell’s face. “You’ll see.”

  We donned plastic shoe covers and latex gloves, and Russ flipped through some envelopes in the pile of mail. “Errico Lavagnino,” he said, noting it on his clipboard. “But understand that this is a presumptive ID. All decomps come in as John or Jane Does until we can confirm the name by scientific means. Fingerprints, dental, radiology from hospital records, or DNA if all else fails.” Errico Lavagnino, our John Doe, lay facedown on the kitchen floor, a glass mason jar with something pickled, wax peppers maybe, still in his hand. On first glance I realized the awful smell wafting out to the hallway was the least of my worries. I’d never seen so many maggots.

  Carrion flies swarm around dead bodies not because they eat them, but because their offspring do. If the weather’s warm enough and not too dry, maggots will make a feast of a dead body. The female fly likes to lay her eggs in moist, warm areas: the angle of the mouth, the groin, the armpits. But she goes for the eyes first, where she lays hundreds of eggs, sometimes within an hour or two of the death, before rigor mortis even sets in. The eggs look like shredded Parmesan cheese sprinkled around the tear ducts. In less than a day the maggots hatch and start feeding. Most blowfly species reach reproductive maturity in a week to ten days, so two generations of flies had already gone to town on the corpse in front of me.

  I had done decomp cases in the morgue, but the morgue is a controlled environment. I wear a comprehensive suit of PPE, personal protective equipment, consisting of a nylon apron, plastic hospital booties, latex gloves, sleeve covers, and a full-length face shield. Here I had only the gloves and booties—no surgical mask, even. I felt naked. In the morgue, I can hose the maggots off the body and forget about them. Not so in this apartment.

  Maggots prefer vital organs, so they dig into the body. Some chew their way across the surface of the skin, while others head straight for orifices and defects in the dermis, favoring the squishy tissues over harder ones. These had skeletonized Mr. Lavagnino’s face, leaving only scraps of connective tissue. I could see them crawling in and out of his nose and ears to get to his brains. Mr. Lavagnino’s silky white hair had entirely sloughed off and was lying over his right ear like a jostled wig. Maggots don’t like hair and bone, so they eat their way underneath the scalp tissue, marching along a plane. They leave each hair follicle a dimple, the bald bone of the skull exposed in their wake.

  I held my breath and moved in for a closer look. There was a dry crunch when I put my foot down near the body, and I drew back in alarm. I’d stepped on a pile of pupal casings. They were each the size a
nd shape of a grain of puffed rice, littering the perimeter around the body. In the wild the maggot digs underground before it transforms into a pupa, but on this hard kitchen floor hundreds of them were scattered in all directions. Crouching there on the pile of pupae, I leaned in to examine the torso—and then jerked back. The dead man’s clothes were moving. A mass of maggots writhed beneath them, making the body quiver. My nausea grew more urgent.

  Maggots tend to stay away from the arms and legs because there’s not as much soft tissue there, so I turned my attention to the extremities in the hope they might be less gruesome. The visible skin had desiccated to a deep, leathery brown. I could see the outline of finger bones and knuckles grasping the pickle jar. A gold ring with a lovely emerald hung loosely on his third finger. Something about the sight of that bejeweled mummy hand grasping the mason jar with the peppers still floating there hit me in the gut worse than any of the maggoty action. I turned away and took a few deep breaths, fighting the urge to vomit.

  “Why don’t you examine his personal effects,” Russ suggested sympathetically. He had trained a lot of young medical examiners in scene investigation and recognized my queasy expression. “Tell me if you find anything.”

  “Okay,” I managed to say. Then it occurred to me I had no clue what I was doing. “What am I looking for, exactly?”

  “Anything that might inform this death investigation. Look for a suicide note, first of all. Go through the trash and see if you come across unpaid bills or personal letters. Might help us establish his state of mind before he died. Look in the fridge. If it’s empty, he might have been destitute. If it’s full of booze, he’s an alcoholic. Are there empty pill bottles in the medicine cabinet, and if so, could they have been used in a suicide? Trash, fridge, medicine cabinet,” Russell counted off on his gloved fingers. “You’ll be doing me a favor. I want to get him into the bag and get out of here.”