Silent Siren, page 12
“You can get those back to us later, then.”
Numb, I drove to Station 65 to clean out my locker. I got back in my car, headed down Interstate 5 to the ferry terminal, still wearing my Shoreline Fire Department uniform. Traffic crawled as I crossed the Ship Canal bridge.
I wondered what the hell to do next.
III. Transitions
“Two roads diverged in a wood, and I—I took the road less traveled by.”
- Robert Frost
Re-Evaluation
In the years I had spent in the EMS field, I had seen a fair amount of death. I was used to it, and it didn’t bother me much. I had felt like such a fish out of water at Shoreline Fire Department that I wondered if another, somewhat related profession, might be a better use of my interest and abilities. I had graduated from Western Washington University with a bachelor’s degree in Biology—Human Emphasis and I had taught anatomy lab as well. I had graduated top of my class from both paramedic schools I attended, so I knew I had the requisite knowledge for either a career in mortuary science or forensics. I considered mortuary science as a career, but its heavy emphasis on business, the buying and selling of merchandise such as caskets and burial plots, didn’t appeal to me. I chose to pursue a second career in the medical examiner/coroner field.
In April of 2005, I applied for a position as a medico-legal death investigator for King County Medical Examiner’s Office in Seattle. The job required a bachelor’s degree in a scientific discipline and some experience, either in medicine or law enforcement. I had spent time poring through forensic manuals, so I did well in the interviews and was hired.
King County, like many Medical Examiner and Coroner systems, investigates all sudden and unexpected deaths within the county. Hospitals, nursing homes, police officers on death scenes, and hospice nurses would report deaths to the investigations division, on call twenty-four hours a day. As investigators, we asked follow-up questions to determine if the death fell within our jurisdiction. We responded to every suicide, homicide, accidental death, and sudden infant death in the county, completing extensive field reports, obtaining measurements, taking photographs, and transporting bodies back to our morgue for autopsy.
In addition, we responded to a number of natural deaths in which the decedent had not recently been under a doctor’s care, had no local doctor, had no family to make funeral arrangements, or were unrecognizable due to decomposition.
The Cooler
During the first two weeks of training, I was assigned to the Autopsy department. Housed in a windowless morgue with gleaming stainless steel tables and the ever-present odor of decomposition, the Autopsy suite adjoined a massive refrigeration unit that held, on average, thirty bodies held at a constant temperature of forty-two degrees Fahrenheit. Contained within the main cooler were two colder areas, the freezer and decomp cooler. The freezer held anatomical samples and the decomp cooler, kept at just above freezing, held “long-term residents,” mostly unidentified homicide victims or those whose cause of death was unknown and who died without relatives to claim them. At least two of the bodies had been held there for more than a year. The decomp cooler stunk. One of our duties at the start of the shift was to do a count and make sure every body was accounted for. I had to hold my breath when I entered the decomp cooler. Syrupy brown fluid continually leaked from one or two of the sheet-covered partially mummified bodies and dripped towards a sloping floor drain. Those decedents that had been identified but who had no living relatives able to pay for disposition of the body became part of the indigent remains program. They were held in the cooler for several weeks until arrangements could be made for them to be cremated at county expense.
At times, we brought in bodies thoroughly infested with maggots. Supposedly, some time spent in the freezer would slow down the maggots’ frenetic writhing, making autopsy more of an examination and less of a maggot rodeo. Of course, it was important to retrieve the bodies before they became “decompsicles,” hard as rocks, impossible to autopsy.
Checking the cooler was an adventure every day. I never knew what gruesome discoveries awaited me behind the heavy metal door.
On a wheeled tray lies the uncovered body of an elderly farmer, run over by his tractor, still wearing his work gloves. An old man with a long beard, found days after his apparent auto-erotic asphyxia, stares through eyeless sockets into the darkness, a parachute cord wrapped around his neck. A tiny stillborn baby no bigger than a rat, dressed in doll’s clothing, reposes in a metal container. I tick the numbers off my chart. Every body accounted for.
The Autopsy department and the Investigations division had a somewhat stormy relationship. The autopsy technicians spent their days in the windowless morgue under bright fluorescent lights, rapidly disassembling human bodies and analyzing their components. I saw it as tedious and rather gruesome. They saw our job as investigators as being undesirable as well; we responded to deaths in all weather and at all times of day and night, attempting to piece together accident scenes in driving rain and removing what remained of bodies from some of the most nonergonomic positions. We frequently received flack from Autopsy because they perceived a lack of quality in our photographs. Other times, the pathologists would be unhappy because we didn’t take a particular measurement they saw as crucial to their investigation.
I didn’t learn to perform autopsies in my two-week observation period, but I did observe the myriad of different insults that can occur to the human body. On Sundays, the autopsy staff was off duty so every death that came in after Saturday night would be on the table, ready to be examined on Monday.
Autopsy
My boots stick slightly to the linoleum morgue floor. An unidentifiable cola-colored substance is adhered to it, and it makes me somewhat ill to wonder what this substance might be. When I arrive back home at the end of the shift, these boots will come nowhere near the interior of my house.
It’s Monday, and about twenty bodies lie naked in a semicircle formed by cold steel autopsy trays, all from different walks of life, all with vastly different modes of demise. A fire victim lies on a tray near the entrance. Burned beyond recognition, she is simply a charred mass with no identifiable features.
A four hundred-pound man lies on another tray with his head caved in, the victim of a shotgun suicide. Dr. Brian Mazrim stands beside him, muttering into a tape recorder while autopsy technician Jaime Navarro turns the giant corpse onto its side to reveal a pattern of dark lividity on the man’s back. The ventilation system hums.
Dr. Mazrim puts down the tape recorder. “Hand me some paper towels,” he says.
The autopsy technician reaches to a nearby dispenser and grabs a hank of towels.
Dr. Mazrim wads them up and stuffs them into the dead man’s empty cranial vault. He pulls the flaps of scalp together over the paper towel wads and roughly approximates the way the man may have looked in life.
“Can’t be that much different from taxidermy,” he says, rather cheerfully.
An older man, down on his luck, found dead in his apartment after four days, rests on a nearby tray. He is partially mummified and steamed-broccoli green from head to toe as the result of decomposition. Two teenage girls, whose car had hit a tree, repose side-by-side on stainless steel beds. The odor is overpowering.
Investigators and autopsy staff crowd into the entrance of the morgue, arms folded against the cool air, and listen to Dr. Haruff present cases at morning rounds. Investigators offer their input if the case was theirs, and then they file back downstairs, leaving the autopsy technicians to begin incising and disassembling bodies.
Jaime approaches the green man, and, without a moment’s hesitation, slices a y-incision into his chest and continues it down to his pubis, his scalpel gliding effortlessly through skin, fat, and muscle. He reflects skin flaps to expose the sternum and then attacks the ribs with loppers, as though he is trimming a hedge. It’s indelicate, to say the least. The loppers make a chewing sound as they chomp through bone. The rib cage is opened and placed, like a loincloth, over the man’s genitals. A smell like that of gutted deer wafts from the remains.
Lungs, heart, intestines, liver, and spleen are removed in one block and placed on a plastic cutting board, awaiting Dr. Lacy’s more precise incision. The two work wordlessly. Dr. Lacy scribbles notes on a dry-erase board above the stainless steel sink into which the tray empties.
As it turns out, the man is green on the inside as well. Where there was once a chest and abdomen replete with organs, now there remains what resembles a dug-out canoe, with about an inch of blood and shimmering fat globules sloshing around in the bottom of the new cavity. The odor of decomposition temporarily takes my breath away. I turn to the side, breathe slightly less foul air through my paper mask for a few seconds, and then turn back to once again observe Canoe-making 101, by Jaime Navarro. As fast as Jaime is working, I’m surprised he doesn’t cut himself. Then again, why should I be surprised? He’s done this hundreds of times, his hands working on autopilot. The organs are diced, examined in fine detail, weighed, washed, and returned to the body after small samples have been obtained of each organ and placed in plastic tubs of formalin. It’s a mechanical process, conducted in assembly-line fashion (or in this case, disassembly-line fashion). The heart is large, too large for a man his size—an indication of long-standing high blood pressure. His coronary arteries are corroded with the results of nearly six decades of poor dietary choices.
As Dr. Lacy slices and dices, like a chef preparing a meal nobody wants to eat, Jaime turns his attention to the man’s head. He slices an incision between the man’s ears and then forcibly pulls his scalp down over his face, revealing the white gleam of his skull. Jaime wields a reciprocating saw over the newly exposed bone. The saw whines as bone powder puffs up from the blade, sprinkling the table and Jaime’s gloved hands like snow. With a sound like a boot being removed from mud—Thwuck!—as well as scraping overtones, Jaime removes the skull cap. A membrane that resembles burlap, the dura mater, covers the surface of the cerebral cortex. Jaime reflects it back. A gelatinous beige brain, hidden within its secure sanctuary of bone for fifty-nine years, now peeks out at a world illuminated by bright fluorescent lights. Gingerly, Jaime slices the brain from its spinal cord and hands the fragile object to Dr. Lacy.
The autopsy now complete, the body lies wrecked under the bright lights. It’s now up to me to put the pieces back together, so that the disaster before me more closely resembles a body. I place a red bag containing the dissected viscera into the open abdomino-pelvic cavity and loosely suture the flaps over it. It is far from an expert job. When the body arrives at a funeral home in a few days, the funeral director will embalm the viscera and then re-secure the flaps with a tight, leak-proof baseball stitch. I then replace the top of a brainless cranial cavity and flap the scalp back over it, suturing it loosely as well.
An hour of dissection and dictation distills down to two lines on the death certificate: Cause of death—atherosclerotic cardiovascular disease. Manner of death—natural.
Suicide
“Give my cigarettes to Crazy Mary.”—from the suicide note of an old man.
On a warm, sunny, spring day, investigator David Delgado and I are called to the Jefferson Terrace Apartments, across the street from Harborview Hospital. A sixty-year-old man hasn’t been seen in a week and now the apartment manager reports a smell emanating from his apartment. Police on scene report it to us as a suicide by gunshot—a very common method of self-annihilation, though some decedents I saw came up with much more creative ways to take themselves permanently out of circulation. Previously, I had seen two men who committed suicide by attaching themselves to helium tanks and breathing deeply. One used a painter’s mask to hook himself to the tank; another used a scuba mask and tubing. Another man used a vacuum cleaner cord (still attached to the vacuum) to strangle himself. The stand-up vacuum cleaner’s cord was knotted around a door knob and then passed over the top of the door to the other side, where the man had made a makeshift noose. He simply sat down in a chair and cut off the circulation to his carotid arteries. Lights out.
The dead man sits in a wheelchair in a cramped bathroom, his right hand on his lap, a handgun still contained in a grip loosened by death. Dark, congealed blood drips slowly from his mouth to a large stain on the front of his shirt. As I look closer, I notice a hole at the top of the man’s head, surrounded by small pieces of skull and gray matter. A mirror above him is shattered and tiny bits of tissue surround the shards. It appears the man had placed the gun in his mouth and fired. The bullet had then traveled straight through his brain, exited the top of his head, and then shattered the mirror. The spent round lies in the sink, surrounded by a faint corona of semi-clotted blood and residual sink water. Bloated with four days of body gas, he resembles the Michelin Man. His skin is green in places, black in others, and beginning to slough. He wears shorts. Giant blisters have formed on his lower legs where black decomposition fluid has leaked under the sloughing skin. The smell is indescribable.
Now the hard part—readying the dead man for transport back to the morgue. Since firearms are involved, we place paper bags over both hands, securing them with plastic ties. The autopsy staff will swab his hands for gunshot residue to confirm he was the one who shot the gun. There is always the possibility that a gun could have been placed in his hands after he had been murdered by another, making a homicide look like a suicide. I carefully remove the pistol from the man’s loosened grip and place it into an evidence bag.
David looks around the room. “I need a coat hanger,” he says.
“Dare I ask why?” I ask.
“We’ve got to drain those blisters or they’ll burst when we move him.”
The police officer looks ill. He keeps his distance in the kitchen, watching us perform our morbid examination. He wears a dual-filter canister mask and clutches a can of Glade air freshener, which he spritzes in the air every minute or so.
David and I don’t wear masks or use Vick’s under our noses. It’s really a matter of choking back the nausea as the stench hits your nose and for a couple of minutes afterward. In a short while, one’s olfactory circuit is overloaded and the smell becomes bearable.
David walks into the bedroom and then comes back empty-handed. No coat hanger. He grabs a knife from the kitchen and quickly slices through the largest of the blisters. Inky fluid splashes to a towel on the floor, staining it black.
The police officer heads towards the front door. “You guys are killing me,” he says. “I’ll be in my car if you need me.”
Police officers have a way of leaving about the time we need their help moving a body. I can’t blame them, though. Though their job description involved dealing with dead bodies, they are not paid to be amateur morticians. David and I will have to heft the two hundred-pound man into the body bag ourselves.
David lays an unzipped green body bag on the floor at the feet of the dead man. Together, we open a white plastic sheet that is closed at both ends, laying it inside the body bag. Since the green body bag is not impervious to fluid, the plastic sheet, also known as a “canoe” prevents body fluids escaping and soiling the stretcher and truck. David folds a hospital bedsheet lengthwise and slides it behind the man’s back, making a makeshift sling. I do the same with his legs.
Using the slings as handholds, we heft the man out of his wheelchair and onto the floor. He lands squarely in the middle of the double body-bag combination, exactly as planned. The body is securely wrapped and zipped into the body bag. We each grab an end and drag him inelegantly towards the front door, where the stretcher awaits.
Once we have the body loaded into the truck, we go back inside and attempt to find contact information for his family. Although he makes it clear from his suicide note that he doesn’t want his family involved, someone will need to be responsible for his funeral arrangements. I imagine that even if the man had a stormy relationship with his family, they would want to know what had happened to him.
Death certificates are one way of locating next-of-kin. Since they list the funeral home responsible for arrangements, we can call them up and see if they have contact information for living relatives, such as a spouse or other children. We find the man’s father’s death certificate and take it with us. Additionally, we find his ID card but an exhaustive search of the items on his desk and in drawers turn up little else, no address book, no letters from loved ones. This man did not want to be found.
The apartment manager speaks to David as we are preparing to leave the scene. He wants to know what he’ll have to do to get the apartment ready to rent out again.
“We’ve got him out of there,” David says. “That’ll take care of most of the smell, but everything in there will have to be replaced, the carpet, the curtains, even the TV. The smell gets into everything and it’s impossible to get it out.” The man signs some paperwork pertaining to identification, and we drive back to the office.
I am thankful that the truck’s cab is separate from the box, so I don’t have to smell the guy all the way back to the office.
David says, “I’m glad I had you along. That would have been hard for me to do that by myself. That cop was no help.”
Since the bullet exited the man’s skull, its path was well established and the pathologist determined that an autopsy was not necessary. He receives an external examination only and is then placed back in the cooler to await a member of his family to come forward and make funeral arrangements. Nobody does.
No family is found and, weeks later, the man is cremated with public funds, his urn placed in a Kent, Washington mortuary and listed as “permanent resident.”
Though the scene is gruesome and the work unpleasant, I find myself enjoying the pace, much slower than paramedicine, and more analytical. In the midst of dealing with a hidden side of life, I feel an odd sense of pride in doing work so few people would be able to do.
