“I must have misspoken,” I countered. “I’m sure I put ‘stab wounds’ on the DC.” I was well aware the difference was not semantic. An incised wound is longer on the surface of the skin than it is deep, whereas a stab wound is deeper than it is long. A forensic pathologist who confuses one for the other in a trauma case has failed in her most basic job: properly identifying the injury.
“You’d better check that DC just in case, because I know what I heard.” With that, Stephany got up on her high horse and left.
I was royally pissed off. Who did she think she was? My slip of the tongue during the conference didn’t matter all that much. It was the death certificate, the official legal document that would be scrutinized by prosecutors, defense, judge, and jury, that mattered. I couldn’t wait to pull up the Brown DC so I could thank Stephany for her concern and advise her where she could stick it. Yes, I was going to tell her a thing or two. I was going to—until I looked at the death certificate. On the cause of death line it read “incised wounds of neck.”
Shit! I had fucked up the DC on my third homicide!
They already had the perp in hand, and I hoped like hell he would plea-bargain. I was going to have to amend the death certificate, and not because I had put in the wrong month under the decedent’s date of birth. I had the cause of death wrong! The defense attorney could shred me on cross-examination. How was I going to explain to a jury that I had changed my mind about the cause of death? Still, even that would be bushel loads better than my fate if I had gone into court with the original—wrong—DC. Stephany Fiore had saved my ass.
When I met with Jill Hoekster, the assistant district attorney on the case, she didn’t mention the amended death certificate at all. She was fuming that Birthday Suit wouldn’t take a deal. “I can’t believe this guy won’t plea down, but we are just too far away on how many years he needs to serve. I am willing to go to manslaughter, fifteen-to-life, but he doesn’t want to serve more than ten.” She perked up and opened a file. “Get a load of this.” Jill handed me a glossy eight-by-ten photograph of a naked man, uncircumcised, with pale white skin, thick body hair, and crystal-blue eyes. He was staring into the camera. There was blood all over him, especially on his hands. Yes, Birthday Suit had actual blood on his hands, and the ADA had the pictures to prove it. “CSU photographed him right there at the scene,” she told me. “Everybody at my office got a kick out of it.”
There was another eight-by-ten behind this full frontal shot. That one was a close-up of his neck, with tufts of chest hair visible in the left-hand corner. On the left lateral aspect of the neck were four scratch marks, some with curvilinear shape. “Look at that!” I said. “She scratched him.”
Jill leaned in to look. “Is that what you think it is?”
“Oh, yeah, it’s classic. No way this is from a knife. See the shape of the nail right here?” I pointed. “Hey, I clipped her nails for the rape kit. I’ll bet there’s usable DNA in there.”
“That’s okay,” Jill replied, as she scribbled a note on a legal pad. “We already got both his and her DNA off the knife. I would like to ask you on the stand if you think those are scratch marks, though. It speaks to intent.”
“Sure.”
Those scratch marks made it clear the victim was fighting for her life, and my wound interpretation testimony would have made it hard for the defense lawyers to argue the stabbing was an accident. Birthday Suit took the manslaughter plea deal and went down for fifteen years. I was relieved I didn’t have to take the stand on the case; though later, with experience, I came to realize that my panic over the death certificate error was unwarranted. Dr. Hirsch had taught us that juries understand we doctors are only human. “They only hold your mistakes against you if you don’t own up to them.”
Stuart, Doug, and I received a thorough education in bullet wounds from Dr. Hirsch. We spend a lot of time in gunshot homicides tracking down bullets and shotgun pellets, matching exit and entrance wounds. Everything’s got to add up, and the medical examiner’s description of what befell the body can help the police determine direction and distance of fire, sometimes even narrating the sequence of shots. Bullets recovered from a dead body can often be matched to the weapon, and they are powerful evidence at trial.
An entrance wound is typically a round hole punched into the skin, with scratched edges, or “abraded margins.” If the hole’s edges are torn up in “lacerated margins,” then it’s probably an exit wound. My autopsy tool kit contained four wound probes, straight metal rods a little thinner than a pencil, about a foot and a half long. “It is always easier to probe a wound from the exit to the entrance,” Hirsch instructed. “You need to describe the exact shape of the hole, the edges, and the amount of hemorrhage. If there’s less blood, the wound may have occurred later in a sequence of multiple shots, as arterial pressure dropped.”
Bullets are predictable. They don’t bounce around inside bodies. They travel more or less in a straight line. If a bullet hits bone, it might become lodged there, or it might carom off on a slightly different vector, but it’s not going to pinball around. Some types of ammunition are designed to blossom into sharp-edged petals once they enter the target. Surgeons and forensic pathologists absolutely hate these things. We have to remove bullets by hand, without any tools that might scratch up the surface and compromise ballistic evidence. I wear cotton gloves sandwiched between two layers of latex, but even this doesn’t guarantee protection. Fishing around inside a dead guy for a little chunk of jagged metal that can cut right through my gloves and skin is one workplace challenge I wish I didn’t face.
Forensic pathologists sometimes encounter ballistic head-scratchers. My favorite is the bullet embolus. A slug enters the beating heart at just the right spot and with precisely enough momentum to get flushed into the circulatory system, then surfs through smaller and smaller vessels until it gets stuck somewhere far removed from its point of entry. “The strangest bullet path I ever had,” Dr. Hirsch told us, was a man who was shot in the chest but ended up with a bullet deep inside his liver, which showed no sign of trauma. The lead slug had dropped into his inferior vena cava, and gravity pulled it all the way down to the hepatic vein.
If there is a gunshot entrance wound without an exit, you have to come up with the bullet. Failure to do so can sink a homicide conviction. At afternoon rounds one day, Dr. Hirsch told us the story of how this had once happened to him, many years before, in a multiple-wound gunshot case. After he finished counting up all the entrance and exit wounds and collecting the slugs, there was one bullet missing. He X-rayed the hell out of the body looking for the stray bit of metal, but no sign of it appeared. Finally, he told us, “in desperation I took the autopsy sink apart with a wrench.”
“Did you find it?” Stuart asked.
Dr. Hirsch unwound his signature half smile. “No. I never did. I’ve mulled it over for years. I think perhaps the bullet must have lodged in the thoracic vertebrae and was camouflaged in an overexposed X-ray.” We all groaned, and Hirsch’s smile crept to three-quarters. “Buried now. I’ll never know for sure.”
Guns leave distinct types of wounds at different ranges. A contact wound, with the gun touching or pressed into the skin, can sear a round scorch mark called a muzzle stamp. If the gun is near the target but not touching it, hot particulate debris leaves stippling, a confetti pattern of abrasions around the bullet hole. If the gun is fired from closer than six inches (a close-range wound) then there will also be soot around the wound. Anything more than six but fewer than thirty inches, with stippling but no soot, is called an intermediate-range wound. If a wound has none of these features—no soot and no stippling—then it’s a distant-range bullet wound. Whether the gun was fired from thirty inches or thirty yards away, it will leave a neat hole and nothing else.
I learned a lot about ballistics, and the specific clues a gunshot wound leaves, during a case that came to me in January 2003. Andre Jefferson was a twenty-two-year-old black man from the Wagner Houses in
East Harlem. The only witness to his death by a single gunshot wound to the left temple was a friend named Justin. Justin told the cops that he had brought Andre a handgun the two of them were planning on selling. According to Justin, Andre took the gun and aimed it out a window. “Don’t do that,” Justin told him.
“Hey, how about this?” Andre raised the gun, pointed it at his own head, and—bam!—it went off. The gun was sitting on the windowsill when the police arrived. They arrested Justin trying to leave the building.
Andre Jefferson had a single penetrating gunshot wound at the hairline, with fine stippling on his right ear, but no soot: intermediate range. The bullet had passed through Jefferson’s brain and stopped at the other side. When I lifted the brain out of the top of his head, the bullet slug was sitting in the subdural space, right up against the skull and directly opposite the entrance wound. It was small, consistent with a .22. I bagged the deformed piece of gray metal for evidence and wrote, “Small-caliber, unjacketed lead bullet” on my worksheet.
The stippling pattern told me Andre was shot from somewhere between six inches and three feet away, which meant it was plausible he had shot himself by accident as Justin said. Intermediate range included a distance short enough for self-infliction to be possible and a distance long enough for it to be impossible. Of course, at any distance it was also plausible that someone else had been holding the gun when it went off—which would make this shooting a homicide.
So, who done it? I sent the police a request for a range-of-fire analysis of the gun and had a pleasant surprise two and a half months later, when Detective Sean Hart of the New York Police Laboratory Ballistics Unit invited me down to watch the ballistics tests in person. I asked him if I could bring students along. “Sure,” he replied, “as many as you’d like.” This was in March 2003 and I was eight months pregnant with our second child. I beached myself in the passenger seat of a colleague’s car as we drove to Queens, with three lucky medical students crammed in the back.
Detective Hart was a round-faced man with intense green eyes, in blue jeans and an NYPD sweatshirt. He had been on the force seventeen years, the last eight in the Ballistics Unit—where, he made it clear, he was planning to stay until retirement. “I was a beat cop at Manhattan North for a few years, then on narcotics in two different precincts in Queens, including this one. I bought drugs for two years around here.”
“Only way you can say that legally and not get arrested,” I joked.
“I was arrested once.”
“Really?”
“Yeah. I was dressed as a construction worker. You know—low jeans, hard hat, beat-up work boots. Well, the precinct did a sweep and caught me with the drugs I had just bought.” Detective Sean Hart didn’t have the mien of a man who loved a tall tale, and that made the five of us lean in all the closer. “This patrolman was handcuffing me against his car. I started to whisper to him, ‘Hey, I’m a cop,’ because I was really nervous he would find my gun.”
“And shoot you?”
I kicked myself for blurting the question when he turned his detective’s eyes on me, trepanning right into my brain. “Yeah, well, you never know. I couldn’t say it too loud, or I’d blow my cover. Lucky for me the sergeant came over. He thought the patrolman was having trouble cuffing me. The sergeant recognized me from the precinct. So they got the handcuffs on, put me in the back of the car, drove a few blocks, and let me go.”
“Wow,” said one of the medical students. “What a story.”
“Yeah, good one to tell my kids someday.”
Sitting on a table in the firing range was a black wooden box with a piece of white canvas fastened to its front end. It looked like a homemade pet carrier. A metal yardstick lay flush against the box and stretched away from it on the table. Detective Hart explained this was the firing box. “What’s in it?” I wanted to know. He lifted up the canvas and showed us—sheets of cotton batting like you’d buy at a fabric store, packed tightly.
“Here’s your gun,” the detective said, opening a plastic evidence bag and lifting out an itty-bitty .22, silver with a brown inlaid grip. It looked like a toy. Hart made perfectly sure we were all standing behind him and that we had our blocky ear mufflers on, then he pressed the muzzle against the canvas sheet and squeezed the trigger. The gun made a pop, and barely twitched in his expert hand. It left a burnt black ring in the canvas, a tiny hole in the middle. “That’s a tight trigger, I can tell you already,” Hart said. “Exactly how tight I’ll tell you later.”
He put a fresh square of canvas onto the box, used the yardstick to line up the muzzle two inches away, and fired again. This time the gun bucked a bit more. The close-range gunshot left a wide, messy starburst of dark soot and debris around the bullet hole. Detective Hart repeated this ritual, slowly and methodically, at four, six, eight, twelve, eighteen, and twenty-four inches. Each time, the debris pattern on the white canvas became wider and more diffuse, until, at thirty inches, there was nothing on the cloth but a bullet hole. When he laid all the canvas sheets on the table, it seemed clear that the stippling pattern on Jefferson’s wound had been made when that gun was fired at him from more than twelve but less than eighteen inches away. I asked my medical examiner colleague his impression. He thought the same thing.
Shit, I said to myself. Twelve to eighteen inches was the gray area for an intermediate-range gunshot wound—far away for a self-inflicted wound, but not too far. It meant I couldn’t rule out an accident and call this a homicide, which I would have been able to do if the debris spread matched the gun at thirty inches away, or even twenty-four.
Next, as promised, Detective Hart tested the trigger pull. He checked that the gun was empty, then pointed it toward the ceiling and suspended a three-pound wire weight to the trigger. Nothing happened—it was too light. He went up to four pounds, then five. Still no click. He kept adding weight. By the time the detective finally tripped the pistol’s trigger, he had eleven and a quarter pounds loaded onto the end of the wire balance. “That’s sure no hair trigger,” he told us. “Most street guns measure out at five to seven pounds. This trigger is closer to the pull required on service weapons by NYPD. You’ve got to squeeze it like you mean it.”
Fascinating as it was, Detective Hart’s ballistics demonstration didn’t solve the Jefferson case. I still had to figure out who put a bullet into Andre’s brain with that little silver .22. I knew the gun was fired from twelve to eighteen inches away, and it didn’t have a hair trigger—but the only thing this established was that it was not impossible for the wound to be self-inflicted. I suspected Justin was trying to get the gun away from Andre when it went off by accident, at the far end of Andre’s reach. Maybe it was still in Andre’s hand, maybe in the grip of both of them at once. Or maybe Justin shot Andre over drugs, over a girl, over something else. As Dr. Hirsch reminded me when I presented this dispiriting amalgam of what-ifs at three o’clock rounds, “He who accuses must prove”—and I couldn’t prove a damned thing. Andre Jefferson’s shooting was filed as an undetermined manner of death.
A depressing number of young black men like Andre Jefferson die of gunshot wounds in New York City. Their autopsies were daily events during my monthlong rotation in the Bronx office. One Friday I autopsied Lamont Henderson, who had two perforating, large-caliber gunshot wounds to the torso, each an inch wide. The very next day my case was twenty-one-year-old Raynard Hall: two gunshot wounds to the face. Under Barbara Bollinger’s tutelage, I did a “face peel” to trace the paths of the bullets, dissecting the thin facial skin away from its underlying musculature all the way from the brow down to the neck. It wasn’t easy. The eyelids were the trickiest part. After I peeled the skin off his skull, I followed the bullets’ bloody tracks through Raynard Hall’s head. One went into his left cheek and ended up lodged in the back of his neck. The other entered at the left eyebrow but drilled straight downward and severed his cervical spinal cord at the fourth vertebra. It was only by placing the dead man’s chin against his chest t
hat I was able to thread my metal probe into the exit wound and coax it in a straight line along the bullet’s track to the entrance wound.
Together the two bullet tracks told a story. Hall had been shot in the cheek first, and then he ducked before the second shot hit him above the eye. His chin had to have been down in order for the trajectory to make sense. Plus, if the first bullet had been the one that hit his spine, he would have lost all muscle tone and collapsed—making the angle of the other shot through his cheek impossible.
“That is so cool!” I proclaimed to Barb and Renee, the tech, when I saw the point of my probe emerge from the dead man’s flayed brow. I had never been able to reconstruct such a sequentially detailed story from a gunshot wound before.
The homicide detective, a big white guy, came in to officially identify the body while I was in the middle of the autopsy, before Barb and I had started the face peel. He barely glanced at Raynard Hall’s face before he pronounced, “Yeah, that’s him,” and handed me a clipboard with a form to sign. “So it was two in the chest,” he added, just as my pen touched the signature line.
I looked at the name on the identification form: “Henderson, Lamont”—yesterday’s dead black man. “This isn’t your case,” I said. “This man has been shot in the face. Look.” The detective turned red. “You’re trying to sign out the wrong body. The one with the chest wounds, Lamont Henderson, is in the cooler. We did him yesterday.” I handed back the unsigned clipboard.
“Wonder how often that happens,” Barb mused as the detective passed her on his way out of the Bronx morgue. I wondered too.
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