If These Bodies Could Talk: True Tales of a Medical Examiner. Алексей Решетун
height, has a mustache. He is balding and a bit of a pervert."
"If he is a man, he is over thirty, and if she is a woman, she is at least forty-five, because otherwise the family and kids would not let her spend extra time at work. Either way, they are a cynic. They like to relax away from other people in nature, and are particular about drinking certain kinds of tea or coffee, or high-end alcohol and cigars. They are always obsessively washing their hands and cleaning off any surfaces and other things before using them."
"He is a man. He is forty-five to fifty-five years old. He is either a bachelor, widowed, or divorced. He does not have any kids, or maybe he does, but they have grown up and moved out of the house. He is very detail-oriented, to the point of being a bit pedantic. Maybe he is quite a perfectionist. He is always neatly dressed but nothing flashy. He has a couple of old friends he is close with, but who he only talks to every two or three months. He has a dog at home, a mutt named Fido. He likes reading. He has a television, but he has not turned it on in four years. He would rather take his dog for a walk in the woods than spend time at a noisy party, assuming the weather is right. He doesn't like people who are still alive because they make too much noise."
Do you see a pattern? It is almost terrifying – a bald man with hairy arms in a wrinkled suit, with sad eyes, who is possibly a pervert. To a certain extent a mad scientist. Movies and television have clearly made their mark.
Let us start with the fact that in recent years many women have begun working as medical examiners. I think this is part of a growing trend in career choices, as women become more emancipated, and men are becoming gentler and more sensitive, and more likely to prefer another, purer field of medicine other than forensic science. Women work side by side with their male colleagues, and often they work even harder. After all, they are just as capable.
Certainly, there are some remarkably tall male medical examiners, and some of them do have hairy arms, but probably not to the point of scaring children away. Medical examiners are also just as likely as anyone else to lose their hair.
Unfortunately, some medical examiners do smoke but not all of them, and the number of those who do is shrinking with every year. The fantastical image of an expert who happens to be a functional alcoholic is also a far cry from reality. Once upon a time, it might have been acceptable to drink in the workplace, but those days are long gone, and you will not find any drunk doctors or orderlies at the Moscow Forensic-Medical Bureau. Sixteen years ago, as an intern, from time to time, I did see a couple of the most intelligent, most competent and experienced experts step out of the forensic laboratory, make a beeline for the refrigerator, and take a few swigs of vodka. Unfortunately, most of these people have long since died, and those who have taken their place no longer behave like this.
In most cases, dingy basement laboratories are also a thing of the past. Employees at the Moscow Bureau enjoy brightly lit, sparkling offices on the third floor, a separate cafeteria, and strict sanitary and epidemiological regulations.
Medical examiners range from about twenty-four to seventy years of age. Just like any doctors, their chosen specialty is no accident. Occasionally, law students ask me, "Did it take long for you to get used to your job?" Medical examiners do not need to "get used" to their job any more than miners need to get used to working underground, cooks get used to working in a hot kitchen, or obstetricians get used to working on a maternity ward. By their third year, if not earlier, medical students already know if they are drawn to therapeutic or surgical specialties. To summarize, therapeutic specialties involve minimal blood, if any at all, while those who gravitate toward surgical fields can expect all kinds of blood and guts. Someone drawn to the therapeutic side of things will not specialize in surgery, and vice versa. No one is forced into any field. You definitely will not find young men and women beginning their internship in forensic medicine, only to suddenly be horrified upon learning – "Oh, heavens, we have to cut up bodies here!" – and running away screaming. Every student who chooses this or any other specialty is acutely aware of what they are getting themselves into.
Just like any other specialization, people choose forensic medicine because they are interested in it. Passion for your work means you are willing to overlook some of the negative aspects of your job and stay inspired enough to keep putting in long hours.
And, while it is true that sometimes our personal lives leave something to be desired, are medical examiners the only people who deal with this sort of problem?
3. PATHOLOGIST OR MEDICAL EXAMINER? WHAT IS SIMILAR, WHAT IS NOT
People, and sometimes even doctors, often use the terms "medical examiner" and "pathologist" interchangeably. If our colleagues have trouble telling us apart, how can we expect laypeople to manage this? At first glance, pathologists and medical examiners appear to be in the same line of work – but the differences between them are quite significant.
But first – the similarities. Both pathologists and medical examiners are doctors. They have both completed medical school before deciding to specialize in either pathology or forensic medicine. They both wear white coats, both work in a morgue, and they both examine dead bodies.
But that is where the similarities end. Pathologists work in a hospital and examine bodies at the request of the chief physician, who is their boss. Arthur Hailey did an excellent job capturing the relationship between pathologists and hospital staff in his book, The Final Diagnosis. Generally speaking, pathologists monitor treatments and diagnoses by examining the bodies of people who died in the hospital or of disease. For example, let us imagine someone who has a heart attack, known as an acute myocardial infarction. He is brought to the hospital in an ambulance, receives a diagnosis, and the doctors begin treating him. But sometimes, despite our most valiant efforts, people die. This is where the pathologist comes in to perform a postmortem exam to determine whether the doctors' diagnosis and course of treatment were correct. The pathologist will look at the histology of a dead body or examine biopsies from someone who is still alive. When performing an autopsy, he or she may choose not to examine the person's skull if there is no reason to do so.
Of course, pathologists do examine people who died at home, but only when they did so in front of witnesses (especially doctors), suffered from a long, chronic illness (confirmed by medical records), and the body did not present any sign of injury. In Russia, the number of people who die at home and are later examined by a pathologist varies among the regions – sometimes it is as high as eighty percent, and sometimes as low as ten percent.
The two most important words when describing the work of a pathologist are "disease" and "hospital." Pathologists do not examine people who died a violent death. If during a postmortem examination a pathologist sees signs of violent death, he or she must: (1) immediately stop the autopsy; and (2) contact law enforcement agencies to send the body to a medical examiner.
It is necessary to distinguish what exactly constitutes a "violent death." Most people assume that if someone is not found with an axe sticking out of their head, their death was not violent. In fact, things are not that simple. Any death that occurs due to factors in someone's external environment – cold temperatures, alcohol, carbon monoxide, or, yes, an axe wound – is considered violent. Intent does not matter here – if someone died from alcohol poisoning, whether he drank too much of his own free will, if someone poured vodka down his throat, or he drank it by accident is of little importance. In any case, the death will be considered violent.
In fact, only three types of death are considered non-violent: (1) death from disease (for example, our heart attack patient above, or someone who dies of pneumonia, a stroke, etc.); (2) death from old age (medical examiners will only see one of these cases every couple of years); and (3) death as the result of a stillbirth caused by congenital anomalies.
In short, pathologists do not examine violent deaths. That is the job of a medical examiner.
Medical examiners do not work in a hospital but in a specialized institution – in Russia's case, the Moscow Forensic-Medical Bureau. Though their offices may happen to be located in a hospital, they do not answer to the chief physician, and only examine bodies when directed to do so by law enforcement agencies. There, they handle all violent deaths (murder, suicide, accidental); sudden or unexpected deaths; deaths with no witnesses or with undetermined causes;