A Medical Examiner's Job

I'm in the middle of interviewing for residency positions. One of the standard questions I'm asked over and over again is if I have interest in any particular sub-specialties, or to describe any experiences with pathology I've had in the past. It's easy enough to talk about my fascination with gastrointestinal or neurological pathology, my time in the surgical pathology labs, or my excitement about blood banking and molecular genetics.

Talking about forensic pathology is a little harder.

When I started the residency application process, I was warned not to sound like I was married to any particular subs-specialty, but especially not forensics. Many medical students get no exposure to autopsy pathology, and fewer still ever see a forensic autopsy or a criminal case. Needless to say, it's nothing like what goes on television or movies.

Though I am considering forensics as a career, I don't have my heart completely set on it. Still, I am seriously considering it. Morbid as it sounds, I did enjoy my time at the medical examiner's office. I also don't have the option of glossing over the interest due to a quirk in the application process for forensic fellowships. Most pathology residents need to apply early, towards the end of their second year, but many residency programs schedule forensic training in the last year of residency. I have to ask about the possibility of altering the schedule so I can get my residency training in forensics earlier.

So over the last month, I've been asked why I'm interested in forensics. I've found that it's not the easiest question to answer. Saying I like to work with my hands feels shallow, true as it is. The most diplomatic answer would be to say that forensics is often essential for families looking for closure, but that's more about the result of the job rather than the job itself. Saying that death is fascinating is crass, but that's at least part of the appeal. Either way, it can get painfully draining.

(I will talk about my experiences at the ME's office under the cut even though I don't plan to get into gory details. Much. There are issues of confidentiality to consider.)

I spent four weeks at a busy ME's office. I got to assist in . . . I lost count. Definitely more than twenty autopsies. My degree of involvement was inversely proportional to the likelihood that the case would go to trial. Homicides, I was not allowed to touch to ensure that I didn't alter or damage any evidence. Confirmed suicides and overdoses I was allowed to eviscerate and dissect under supervision of an ME.

Four weeks is not a long time, certainly it wasn't long enough for me to decide for or against the profession. It was long enough for me to note some common patterns among decedents who end up at the ME's table. They tend to fall into groups.

Suspicious Hospital Deaths
Someone dies at the hospital. Did someone, somewhere mess up? There are places where any person who dies within twenty-four hours of hospital admission is immediately sent to the ME, barring a previously documented terminal diagnosis. Sometimes, MEs accede to family members who don't want an autopsy if the decedent was very old and frail. But most family members withdraw any objections to an autopsy once they're educated about the importance of accurate documentation of the cause of death for life insurance policies.

Suicides 
There isn't always a note. I'd go as far as saying there usually isn't a note. And sometimes the note is all but destroyed by blood and . . . other fluids.

Overdoses
Addicts are often isolated so they're very likely to be found at various stages of decomposition. A lot of time, it's not clear whether it was an overdose or a successful suicide.

Accidents
Mostly cars. The usual culprits are alcohol and/or carelessness. Less commonly, though still distressingly common, elderly drivers are a health hazard for pedestrians. People in general shouldn't turn left at red lights. It's hard to forget what a transected human spine looks like.

Decomps
You can get used to anything in life, including the scent of a rotting body. Though I was surprised to learn that bodies found on cold rivers don't smell like much of anything. Also, I don't have the eloquence to describe what it feels like when you have to stick your hand into liquefying human muscle (the femur is the best bone to recover for DNA analysis).

Homicides 
They're tedious. I could only observe these cases. The external examination alone took hours. The more bullets in the body, the worse it is. Police want every single bullet. The MEs were always dreading a floater. People rarely bludgeon or knife each other to death. When they do, it's gruesome. Husbands murder wives more often than wives murder husbands.

I was surprisingly calm throughout all this death. We use to do an autopsy in the morning, break for lunch, and come back for a second in the afternoon. Sometimes MEs performed three a day but I was always dismissed before the third one. Usually, the routine overdoses were leftover for the end of the day.

I wanted to go back at the end of my rotation, hence my thought that maybe forensic pathology would be a smart career choice.