In the absence of methamphetamine, Cable Guy might have said to himself at this point, “This is a really bad plan.” Instead, he stepped over to the edge of the roof and began to lower himself down. He was going to rappel to his open apartment window, just one floor below. The coaxial cable frayed under his weight, slipped, and broke. Cable Guy managed to grab hold of a ledge for a few seconds. Witnesses reported cries of “Help me!” from high in the air somewhere. Then he lost his grip, fell eight stories, and landed on the sidewalk.
When the body reached my table the next morning, it was a mess. His skull had fractured so badly that shards of bone had torn up his brain. All his ribs were in pieces, and had slashed through his lungs, esophagus, aorta, and pulmonary artery. There was not a lot of vital reaction, which told me Cable Guy had died on impact. Tox came back positive. The dogs, the investigator assured me, were just fine. When the cops arrived, they were standing there, tails wagging, leashed to the apartment door, dutifully waiting for their master to return.
Few accidental deaths are as ridiculous as Cable Guy’s—even the ones that sound ridiculous. “Killed by an egg roll machine,” for instance. But that was no joke. It was the result of the grisliest industrial accident I saw in New York.
An egg roll factory has a combination shredder-mixer that fills an entire room. I learned this after one malfunctioned at Mak’s Noodle, a small wholesale producer on Broome Street in Chinatown. The shredder blew apart while spinning at high speed and sent the central drum and blade flying. The blade amputated one worker’s arm at the shoulder and shrapnel injured two other men. The gigantic metal cylinder landed on a fourth, Miguel Galindo, crushing his upper chest and neck and pinning him to the floor. His breastbone was cracked in half, his aorta and pulmonary arteries severed, both lungs punctured—but his spinal cord was intact, and he had no head injury at all. Galindo had suffered from these terribly painful crush injuries, fully conscious, until he died of suffocation. He wasn’t paralyzed or even immobilized. His undamaged heart continued to pump blood from severed arteries into his maimed chest. Galindo’s pleural cavity filled with blood and air until he could no longer draw breath, and he suffered air hunger while his brain used up whatever oxygen was left in the blood in his head. Then finally, mercifully, he blacked out and died.
Galindo was a hale man—no heart or lung disease, healthy liver. The toxicology report showed no drugs or alcohol, or even medications, in his bloodstream. The autopsy haunted me as I rattled home on the subway that evening. How long did Miguel survive after the drum landed on him? It could have been anywhere from a few seconds to a couple of minutes, but I knew for sure that his death was not instantaneous.
“Did he suffer?” I hate that question. Survivors of the deceased ask it all the time. If the answer is no, I’ll tell them the truth. If the answer is yes—sometimes I will lie. It’s been my experience that grieving families may not be thinking clearly. They think they want to know what happened—but then, some have later confided to me, they regret knowing. I lied to the widow of a truck driver whose eighteen-wheeler broke down on the Gowanus Expressway one rainy night. He violated the first rule of highway safety: Don’t get out of your vehicle. While he was peering under the hood, another truck rear-ended his, and he ended up pinned beneath his own rig. His torso was crushed and his spine broken in two places, but, like Miguel Galindo, his head was pristine. He was likely conscious for some time before he died. His wife, over the phone, asked me, “Did he suffer?”
“He died instantaneously,” I lied.
I had seen daily motor vehicle carnage during my medical training in Los Angeles, but in New York it was rare. The average speed of a motor vehicle in Manhattan is seven miles per hour, “no faster than a running possum,” as Dr. Hirsch put it. Our MVA cases tended to be pedestrian versus car or bus, and I saw relatively few of even these.
There was the elderly woman who died in a crosswalk when a delivery truck backed over her. The driver didn’t realize she was under the truck until people started screaming at him that he’d killed her. There was Yuliya Koroleva, run down by a van on my first week doing autopsies. At Christmastime in 2001, an elderly man confused the gas and brake pedals and plowed through a rush-hour mob of shoppers in Herald Square, killing seven people and injuring eight. I did the autopsy on the last fatality victim, a woman who held on to life for sixteen hours in the hospital despite a broken pelvis.
Melinda Hayne was in a car with her stone-drunk boyfriend when he blew through a red light at seventy miles an hour and hit a granite building. She died in the right rear passenger seat. Her best friend Katie died next to her. The owner of the Lexus sedan was Katie’s boyfriend, who was in the front passenger seat. He ended up with a lacerated spleen, but lived. Melinda’s boyfriend, Jason Dwyer, emerged from the crash with a few cuts and scratches—and felony charges of driving under the influence, vehicular manslaughter, and criminally negligent homicide.
I was struck by the girl’s beauty. Melinda died in the prime of life, and apart from a small contusion caused by the seat belt, there was not a scratch on her. My professional remove failed me at first while I stood over her perfect corpse. Some hair lay across her eyes and nose, and instinctively I smoothed it away, as though she were a sleeping child.
Inside her body I found the acceleration-deceleration injuries that often kill people in high-speed car crashes. Melinda’s spine was broken at the eleventh and twelfth thoracic vertebrae, right at her center of gravity in the seated position. Her aorta was shorn clean in half at the same spot. That ruptured vessel was the diameter of a garden hose, and most of her blood supply had poured into the muscles of her lower back and gathered there. The seat belt had stopped Melinda from flying out of the car, but at that speed it couldn’t prevent her death by acute intrathoracic aortic transection. She had no head injury, and so was conscious and probably in a good deal of pain from the violence of the event. She would also have been terrified. Her spine was broken, so she was paralyzed and could feel nothing from her waist down during the several seconds to couple of minutes it took her to die of internal bleeding.
Melinda Hayne’s death became a high-profile case. I was called to testify in the criminal trial of Jason Dwyer in March 2003, almost a year after I had performed Melinda’s autopsy. I was eight months pregnant with Leah, our second child, when I met with the assistant district attorney to prepare.
Though 99 percent of a New York City medical examiner’s job takes place at 520 First Avenue, the other 1 percent, an exciting, nerve-racking, and quite different type of work, takes place in the city’s courthouses. The assistant district attorneys who prosecute cases in New York subpoena us when they believe the death certificates and written autopsy reports we have filed can’t stand on their own. Going to court is considered an important part of the training of a medical examiner, and before each of my thirteen courtroom appearances I spent a lot of time reviewing my reports, photographs, and notes in preparation for sworn testimony.
The ADA prosecuting Jason Dwyer was seeking a manslaughter conviction. “Do you prosecute all drunk drivers this vigorously?” I asked him.
“No. In this case, the speeding and the running of a red light showed reckless disregard for human life.” Based on witness testimony, the degree of damage to the Lexus, and the damage to the building, it was easy to establish that Dwyer was operating the car at a lethally reckless speed. At thirty or even forty miles an hour, Melinda’s spine wouldn’t have been wrenched apart, her aorta wouldn’t have severed, and she would have lived. Not at seventy.
My testimony was straightforward. I described the abrasions across Melinda’s belly and on her right shoulder, consistent with a harnessed seat belt. On autopsy, I told the jury, I found intestinal tearing and a lacerated left ureter, injuries characteristic of a violent acceleration-deceleration event. “Her internal injuries, which were not survivable, were a consequence of coming to a complete stop from a high speed,” I said, demonstrating the transection of her s
pinal cord by stacking both my fists on top of one another, then wrenching them apart horizontally. “The aorta, the largest blood vessel in the body, lies in front of the spinal column. It too was torn, spilling blood into the muscles of her lower back.” I saw a juror flinch.
The prosecutor had an instinct for courtroom drama. “How old was Melinda Hayne?” he asked.
I paused and checked my report. “She was twenty-seven years old.”
That was my age when T.J. and I got engaged. We were married the next year. I was a mother to Danny when I was thirty. Now I was thirty-three and going to be a mother again in a month. Melinda never would. The terrible waste of it flooded back to me again and must have shown on my face. The prosecutor let the fact of the dead woman’s age sink in with the jury.
“I have no further questions,” he said.
At the end of the two-week trial, the defendant, who had no criminal record that dark morning when he got behind the wheel of his friend’s Lexus, was sentenced to two to six years in prison.
“Oh, so sad,” Monica Smiddy said in her soft-spoken way, after I told her about my testimony. “That’s such a sad story.” She repeated it under her breath as she leafed through the OCME intake sheets, the paperwork pile of deaths for the day. It was Monica’s task that morning to assign autopsies to each doctor. “This one too.” She flipped to the next case on the roster. “Look at this guy. And this one. So sad.”
I leaned a little closer to Dr. Smiddy and hushed myself to match her gentle tone. “Monica,” I said, “they’re all sad.”
5
Poison
“Don’t stand in front of the door when you knock,” warned Russell Dunn with an expression that betrayed personal experience. We were walking through a housing project foyer that smelled of equal parts takeout and urine. “The PD is required to secure the area, but they hate babysitting dead bodies. Half the time they just leave a beat cop outside the apartment door. He might neglect to tell you that the crazy girlfriend or the strungout next of kin is still inside.”
The veteran medicolegal investigator punched the elevator button for the seventh floor and continued his tutorial. “Once the door’s open, get everybody out of the room except for the PD. You don’t want the family there when you move the body. And make sure you have a cop right next to you, to witness that you didn’t steal any property off the body.” Then he looked me right in the eye and pronounced the unofficial motto of all forensics professionals: “Cover your ass.”
We reached our floor and left the stuffy little elevator. Sure enough, two policemen stood outside a door at the far end of the hallway. I could hear muffled sobbing from the same direction.
My first case on a ride-along with the medicolegal investigators was a dead heroin addict. Drugs kill a lot of young people, but sometimes you can live a long life with a chemical addiction. The dead man inside the apartment was in his early sixties. His elderly mother found his body and started to scream. The neighbors called the police, the police determined that it was a dead body (“poked it with a stick,” as Russ put it), and then called the Office of Chief Medical Examiner.
The place was dark and cramped but decently clean, not the sort of derelict squat I’d been expecting. Another patrol cop stood in surly reluctance in a corner of the tiny living room, and the dead addict’s mother was grieving in the kitchen, alone. Russell consoled her with a practiced professional calm while escorting her out to the hallway.
He returned wearing latex gloves and tucking a sheet of paper onto his clipboard. “We try to get the family to sign the ID while we’re on scene, so they don’t have to bring themselves down to the office later.” The woman had found her son exactly as he was, she’d told Russell, and hadn’t tried to move him. The body was slumped facedown over the living room sofa. Russell started patting down the dead man’s clothing. “Watch for needles, especially in the pockets—even if there’s still one sticking out of his arm. Make sure you document all personal property on the decedent and voucher it as medical examiner’s evidence.”
When Russ had finished assessing the scene and checking over the body, there wasn’t much left for him to do but remove it to the morgue van. For this he had the help of Dave, the hulking driver. Dead bodies are heavy. In addition to being sympathetic with the families, observant of their surroundings, and unafraid of dealing with death, our investigators have to be physically fit. They’re paid well, and for good reason—you want the guys collecting your corpse to be consummate professionals.
“Let gravity do the work,” said Russ, as he and Dave eased the decedent off the sofa and into a body bag draped on the floor. They zippered the heavy vinyl bag shut and heaved it the few inches onto the lowered gurney. Russ was already opening the door while Dave lifted the gurney to waist height on its scissor legs. “Once the body is in the bag, we like to get out as soon as we can,” Russell said, tucking his clipboard into a gym bag.
Out in the hall, the elderly mother was sitting, defeated, in a chair from the kitchen. Standing beside her was a newcomer to the scene, a glassy-eyed man who bore a strong resemblance to our dead addict. Both watched us in silence. When we reached the end of the corridor, Dave pushed a couple of levers and flipped the gurney upright, so that the body, strapped to the metal bed, could share the elevator with the three of us.
“You see the track marks on the brother’s forearms?” Russ asked me when we got outside in the blessedly fresh air. I admitted I hadn’t. He nodded grimly. “He looked pretty far gone. Poor mom.”
Dr. Hirsch had a policy that anyone with a history of substance abuse got an autopsy—and there’s plenty of drug and alcohol abuse in New York. “Alcoholics and drug addicts live at the margins of society and are more likely to die of trauma than non-users,” he taught us during fellows rounds. Chronic alcoholics are especially prone to dying of occult trauma—hidden injuries, invisible on external examination. “Drunks are fragile. Since internal injury is sometimes difficult to discern, we are bound to investigate the cause of death with a full autopsy before making a determination of manner. And remember, you can’t rely on the toxicology report alone. Toxicology serves as confirmation, not investigation.”
By the numbers, alcohol is the deadliest drug. It kills chronic alcoholics slowly, binge drinkers quick. On New Year’s Day 2002, four of our seven cases were due to alcohol. All in all, drinkers cause me a lot of work. One guy just shy of his fortieth birthday ended up dead at the bottom of his basement apartment stairs, a bag of Chinese takeout in his hand and something like eighteen shots of liquor in his veins. The investigator spoke to his roommate, who reported that Charlie got drunk three times a week. I spent a good deal of time on this autopsy documenting the man’s nearly continuous swirl of tattoos and his jingling collection of body piercings. I was glad to have the help of an experienced autopsy technician who liked to work fast, and a visiting pathology resident from NYU Medical School named Vinnie.
“Whoa!” I couldn’t help dropping my professional mien when I got Charlie’s trousers off. The collection of hardware he had clattering around his genitals was astonishing. “What the hell is that?”
“Oh, that’s a Prince Albert,” replied Vinnie, perfectly matter-of-fact. The tech and I both turned to him. The thing in question was a thick silver hoop with a gray metal ball piercing the tip of the penis. Even I, who have no penis and have seen plenty of weird things pierced where the sun don’t shine, considered the Prince Albert painful to behold.
“The little one too?” I asked Vinnie, pointing with my scalpel to a similar doodad threaded through the tissue connecting Charlie’s scrotum and anus.
Vinnie frowned. “I’ve never seen one there, but I guess it would be called the same. A Prince Albert of the taint. Fun.” I paused to write a careful description of this adornment in the margin of the body diagram. I had no way of rendering it in shorthand.
It’s part of the autopsy to remove all jewelry on the body and keep it in a sealed bag as the property of the f
amily, so after I had finished documenting Charlie’s collection of shiny baubles, I went to work taking them off him. When I got to the Prince Albert, I tried unscrewing the ball so I could unhook the perforating ring, but the damn thing wouldn’t budge. I picked up my scalpel. “Doc, you can’t—!” the autopsy technician said as, in one motion, I incised the tip of the penis down to the metal ring and pulled the Prince Albert right off. The big man’s eyes bulged, and he scooted a step backward while clutching his groin.
The sweetish smell of alcohol pushed aside the other morgue odors as soon as I cut into Charlie’s body. I found no natural disease and no hidden internal injuries to indicate he had been in a fight. His posture in the scene photos, curled at the bottom of the basement stairs, pointed to positional asphyxia. He had landed next to his closed apartment door, his chin pushing onto his chest, the unopened bag of Chinese food still in his grip. Monica Smiddy was working at the table next to me, so I asked for her assessment. Positional asphyxia occurs when you pass out in a pose that causes obstruction of your airway. There are usually telltale signs on the body, and Monica didn’t see any. “He’s got no plethora or petechiae,” she pointed out, peering into the dead man’s eyes. Plethora is the suffusion of blood in the face, and petechiae are broken blood vessels in the whites of the eyes, a signal of neck compression. “Jim, come here, will you?”
Dr. Jim Gill, another senior ME working a case in the Pit that day, joined us. “Yes,” he replied after Monica voiced her concern, “but lack of plethora and petechiae doesn’t rule out positional asphyxia unless there’s also no evidence of airway compression. Did you do a quick-tox?”
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