Someone had set out framed prints, a portrait of my dad wearing a pained smile, all over my grandparents’ house. I had never seen the picture before, but it was a recent shot and I figured this martyred expression was his attempt to make himself look nice, knowing full well what it would be used for. He had planned his death. A week or two before he did it, he showed me where he kept his will, “just in case anything happens to me.” He had stashed it in a hallway closet that used to be part of a dumbwaiter shaft. You had to move a painting to open the closet door. When my mom and I opened it after his death, we didn’t find any will, just some other papers and a leather kit box with vials containing clear fluid. It looked like needle drugs to me. My mom threw it out.
Survivors of suicides come in two varieties: those who never speak of the event, and those who talk about it frankly and freely. I belong to the second variety. I really do believe that hushing up suicides enables more suicides. My medical school training cemented this belief with current scientific and sociological theory, and my job as a forensic pathologist has further reinforced it with experience in grief counseling.
You might expect that dealing with the families of suicides would be hard, but usually it isn’t. They are generally supportive, and even appreciative, of the job I have to do. Many of them accept the news right away and sometimes reveal that they had been expecting it—the final defeat in a years-long battle against mental illness. Other families never accept the medical examiner’s ruling that their loved one’s death was a suicide. Dr. Hirsch told us one woman had called him on every anniversary of her teenaged son’s suicide for fifteen years, begging him each time to change the manner on his death certificate to accident. The boy had hanged himself, and hanging is one of the most compelling scenes for the determination of suicide. Hanging yourself requires premeditation and planning. My dad had to tie the knots—he probably had to learn how to tie them, and practice first—secure the rope, put the noose around his neck, cinch it tight, and then put his weight into it. You don’t do that by accident. This bereaved woman’s boy hadn’t done it by accident either.
Autopsy findings in a hanging are straightforward. There’s a ligature mark that passes along the throat and elevates to the ears. Blood pooled in the arms and legs due to gravity leaves the extremities purple with “stocking and glove lividity.” If the victim’s face is paler than his torso, it was a tight noose, cutting off all blood supply to the head. He probably lost consciousness in a matter of seconds. If his face is flushed and purple, with pinpricks of blood in the whites of the eyes and in the gums, the noose was tight enough to stop blood return from the jugular veins but not tight enough to clamp off supply through the carotid arteries, which are deeper in the neck and harder to compress. He probably dangled there for a couple of minutes, the blood pressure rising in his head with each heartbeat, before he blacked out and then died. If somebody’s really botched a hanging, the noose obstructs no blood vessels at all but instead pushes the tongue up against the palate and causes a slow, choking death by air hunger. Suicides who manage to actually break their necks, the way a skilled hangman would, are rare. Those deaths are nearly instant. In my experience, electrical cords are the most common device used for a noose, followed by belts, and dog leashes.
“It doesn’t make sense.” That’s a statement I hear often from the families of suicides. By its nature suicide is a self-destructive act, hard for someone in a healthy frame of mind to fathom. I see people take their own lives this way all the time—a rash impulse that ends in an irrevocable, fatal action. “It’s okay that it doesn’t make sense,” I can reply in all honesty, and sometimes I tell the survivors about Menachem Melinek—a brilliant, professionally successful man and a doting father who decided to hang himself in his bathroom in 1983. Though I understand in the most intimate and clinical way how my father died, I will never know why. It’s a goddamned selfish act, suicide, if you ask me.
There are many ways people end their own lives in New York, but some scenes we returned to again and again. The atrium of the Marriott Marquis hotel in Times Square was a hideously popular place for suicides when I worked in New York from the summer of 2001 to 2003. An elevator shaft rises like a sequoia in the middle of the towering interior courtyard, with twelve glass cars climbing its trunk. The upper floors have hallways that hang over the atrium, with banisters for peering down, hundreds of feet below. Today, you can’t climb over; back then, you could.
I had one case, a thirty-six-year-old man named Kurt Bowers, who left a note next to the railing on the forty-third floor before he climbed over it. My autopsy report included the notation “complete transection of all four limbs,” which means none of them was still attached when he came to me. Bowers’s left leg and right arm ended up on the eleventh floor. His left arm and right leg were on the seventh, separated by several yards of hallway carpet. Part of his skull and scalp landed in the elevator shaft. Everything else came to rest on the fourth floor, except for his brain. His brain was still missing when I received the body bag; the scene investigators were collecting it floor by floor. On autopsy I found all of his remaining internal organs torn apart, indicating that Bowers must have bounced off several surfaces on the way down.
I got another suicide from the same place four months later. This man left a cryptic note that read, “Mary. The old man is eating me alive. I can’t do it anymore.” He went over the railing on the twenty-third floor. His left leg ended up on the tenth, his mangled torso on the ninth. I suspect these people imagine they are going to plummet gracefully down and land with a melodramatic thump in the lobby, but I never saw that result. The ones I saw had pinballed off a variety of jutting structures on the way, each impact causing damage to a different plane of the body. Not graceful at all. And traumatizing to all the guests who watched it happen, the police who secured the scene, and the hotel workers who had to clean up the carnage.
New York City has a lot of bridges with sidewalks, so most of the floaters I autopsied also turned out to be jumpers. I got a forty- to fifty-year-old John Doe found in the East River way uptown, whose body told a miserable story. I knew he died from drowning because there was water in his lungs, and though he had suffered a string of past traumas, none were recent. One of his legs had been surgically amputated at the hip, and the other was shriveled. His pelvis had been crushed but then healed, and his intestines were adhered with scar tissue from several surgeries. The X-ray for autopsy showed a bullet lodged in his mid-back even though he had no recent gunshot wound. Just scars, and plenty of them.
We hate old bullets. They confound us in gunshot homicides, and in other cases they’re a bitch to dig out from the scar tissue encasing them. This one, at the ninth thoracic vertebra, had rendered my John Doe a paraplegic a long time ago. “Somewhere out there is a wheelchair with a suicide note on it,” posited the autopsy photographer.
“Maybe, or maybe someone drowned him. Maybe he got drunk and wheeled off a pier by accident. Anyways, unless he gets ID’d, he’s going to be one big undetermined.”
“You think he’ll get identified?”
“Yes. Somebody’s missing him, I’ll bet.”
Ten days later, the medical director of a Bronx nursing home called. He told me my floater’s name was Howard Balmer, and he was a resident of their facility. “Howard was quiet but not depressed. I’m concerned someone harmed him. He used every day-pass he could get to go out to OTB parlors. I didn’t try to stop him, because he professed he was only gambling a little money, and he never seemed to be in trouble because of it. But now I don’t know.”
“Was he on any psych meds?”
“None.”
“Did he ever express suicidal ideations?”
“No. I asked around, the staff and other residents too. Nobody heard him talk about suicide.”
“And no known suicide attempts?”
“None.”
The doctor wasn’t lying to me, but he didn’t know the whole story. That came a few days later. D
etective Vasquez of the 25th Precinct in East Harlem told me over the phone that he’d interviewed Balmer’s close friends, and canvassed the waterfront for a wheelchair with no luck. He’d learned Howard was an alcoholic. He would come home intoxicated, falling out of his wheelchair. “His roomie at the nursing home, and everybody else I spoke to, had nothing but nice things to say about the guy. His only vices seemed to be drinking and light gambling. He would go out on a pass, get drunk, and gamble the rest of what he had on hand that week. Then he’d go home. That was it. He’d do that pretty regularly.”
“He never went to a loan shark?”
“No gambling debts. Everybody knew about his habits, and nobody worried much. Even the regulars at the OTB said they kept an eye out for him. They all recognized him when I showed the picture around.”
That didn’t sound like a suicide to me, and getting drunk enough to topple a wheelchair as a regular routine would argue for an accidental manner of death. But where some detectives would have stopped, Vasquez had dug deeper. Before Balmer went into that nursing home, he had lived with a roommate named Tom Parker—and Parker told Detective Vasquez a different story. “In 1997 Balmer overdosed on pills and alcohol, and they pumped his stomach in the ER. Then in the winter of ’98 he tried to starve himself. He was living alone then, but Parker came to check on him after he was missing a couple of days, and found him in the apartment with all the windows open, passed out and naked. Both those times Parker took him to the hospital.”
Parker also told the detective how his friend had ended up with that souvenir bullet. According to him, twenty-five years ago Balmer had attempted to rob someone at gunpoint. The victim got the gun away and shot Balmer in the spine, leaving him paralyzed. Tom Parker also told the detective he had been worried about Howard because he had told him he could keep his Social Security checks “if something happened—and Balmer told his roommate at the nursing home the same thing about his belongings there. Nobody thought he seemed depressed or anything, though. Everybody but Parker was surprised.” Detective Vasquez looked for a suicide note but couldn’t find one. He did a thorough, diligent piece of police work on that case, and I told him I appreciated it.
I appreciated it, but in the end it didn’t help me determine the manner of death. Balmer’s tox came back sky-high for alcohol. Even if he was a seasoned drinker, he must have been profoundly intoxicated at the time of his death. It’s not easy to fall into the East River if you’re confined to a wheelchair, but it’s not impossible either. No note and no wheelchair. I’d bet it was a suicide but couldn’t rule out an accident, and so I classified the death as undetermined. I asked my colleagues at afternoon conference and they agreed with my assessment. “The wheelchair’s probably down on the bottom of the river for good,” Doug said. He was probably right.
From a technical standpoint, autopsies of suicides are usually straightforward. Sometimes we come across a homicide that’s been dressed up to look like a suicide, but this is not an easy method for getting away with murder. People fight desperately for their lives, and homicide detectives are skilled at reading a tussled death scene. I will find signs of a struggle on the body. Poison your victim first and there will be a toxicology result. The determination of whether a death is a suicide or an accident, on the other hand, hinges on investigation of the death scene.
MEs spend a lot of time putting together the stories provided to us by the police and families. A suicide note is usually definitive for establishing intent. Anything that indicates a clearly deliberated effort—a locked, secured apartment; a well-tied noose; a chair used to climb over a wall and jump off a roof—rules out accident. This does not necessarily rule out homicide, of course. Impulsive suicides are the most challenging for me because these are the ones the families don’t want to accept. The circumstances never involve a note and often include a fight with a lover while the decedent is emboldened by some sort of intoxication.
Edward Burgess and his girlfriend, Laura, a volatile pair, got into a screaming fight in their apartment a few days before Halloween. He threatened to kill himself. There was a physical struggle, then Burgess wound one end of a rope around his neck and the other around a pipe—and headed out the kitchen window. The rope didn’t hold. He fell five stories to his death of multiple bone fractures, the skull among them, and visceral lacerations. His liver was torn to pieces and his kidneys were a mess; so was his colon. Burgess had a lot of blunt trauma, and all of it seemed consistent with a fall of fifty-odd feet, the height of the window. The body told a story consistent with the one the girlfriend gave our investigator, so I certified the case the same day as a suicide and moved on. I had another blunt trauma case that day, a construction worker who had died as an unrestrained passenger in a friend’s motor vehicle, and in the afternoon I was obliged to spend twenty minutes on the phone with Mrs. Ward again, explaining that bad sushi hadn’t killed her drug-overdosed son.
Several days later—when I was still elbow-deep in the Ward case, the postal bin homicide, a pile of old bones unearthed at a construction site, a premature baby, and a couple of heart disease cases—Burgess’s sister called me. She was certain his death couldn’t have been a suicide and tried to convince me that Laura, the girlfriend, had defenestrated Burgess. “If he was beaten and thrown out the window, wouldn’t you see the same thing on his body?”
“Not really,” I told her. “You’d see signs of a struggle, like bruises and fingernail scratches that are not consistent with the fall.”
“How can you know for sure she didn’t force him out the window?”
“Your brother outweighed her by fifty pounds.”
“She’s a big girl. She’s violent. And she may have had someone else there that we don’t know about. There was this friend the police didn’t talk to. I forget his name. How do you know he didn’t kill Ed and then throw his body out the window to cover it up?”
“It is possible to try to disguise a homicide by throwing the body out a window,” I told Edward Burgess’s sister, “but that didn’t happen in this case.”
“But how can you know for sure?” she insisted.
I paused, and chose my words with clinical precision. “There were findings at the autopsy which indicated to me definitively that Ed did not die in the apartment.” I hoped she would hear and heed the subtext, which was, “You don’t want to know how I know for sure.”
She did not take the hint. “What ‘findings,’ exactly?” Burgess’s sister pressed, forcing me to go into literally gory detail.
“Your brother’s broken ribs lacerated several of his internal organs, and I found bleeding around these organs. That means his heart was still beating after he hit the ground.”
Silence from the other end of the line. For that long moment, I really hated my job. But Edward Burgess’s sister was undeterred—to her, in the denial phase of grief, it simply meant Laura and the mysterious friend had forced Ed out the window while he was still alive. “Laura’s story keeps changing,” she reported. Apparently Laura got drunk and told some mutual friends that a couple of days before Ed’s death, the two of them had been in a bad fight and she hit him in the face, bloodying his nose. “I remember Ed calling me that same evening. He said his nose was bleeding, and he thought it was broken. She hit him with a guitar and stormed out.” I replied that I had examined the bones of her brother’s face during the autopsy, and his nose had not been broken.
As we talked on the phone, I reviewed the body diagrams I had made during the autopsy. Burgess’s wounds were predominantly planar, indicating only one direction of force when he hit the ground. If he’d been in a fight first, I would have seen other planes of injury. “Did Ed ever attempt suicide before?” I asked his sister. There was a pause.
“Well, once another ex-girlfriend told me that they had a fight, and he tied a rope around his neck and threatened to hang himself . . .”
That removed all doubt from my mind. This was a suicide. Burgess’s sister hadn’t read the crime scene re
port as I had, and didn’t know he had tied a rope around his neck before he went out the window. Now that the details of his death coincided with an earlier suicidal ideation using the same method under identical circumstances, I decided she had the right to know why I was sure this was an impulsive suicide. I tried to emphasize that I wasn’t discounting her doubts, and that I was sure drugs must have played a role in the death. A couple of months later when the tox came back, it did, in fact, show alcohol, cocaine, and ketamine, a party drug. The cops like to say, “Once a suicide, always a suicide.” It’s callous and cynical, and very often true.
I visited the scene of only one suicide while doing my on-scene training with our medicolegal investigators. It was the day after I visited Errico Lavagnino’s stinking apartment, in late August. I was tagging along with an investigator named Joe when we got a call to a high-rise apartment building in the middle of Manhattan. A businessman in a Japanese firm had used a pocketknife to slit his wrists and the right side of his neck in his windowed office. It was a beautiful place, everything brand-new and expensive-looking, a sliver of the Hudson River visible between the neighboring skyscrapers.
The man was lying in a heap on the floor, next to a garbage can by his desk. He looked to be in his midthirties, in an expensive pair of dress slacks and a button-down shirt with the collar open and the sleeves rolled up. A jacket and tie hung neatly on the back of his desk chair and an empty bottle of the antidepressant Zoloft lay in the garbage, along with about three quarts of clotted blood. There wasn’t much blood on him or on the floor. Even if he hit an artery, it had still probably taken him several minutes, kneeling there, bleeding into the garbage can, to die.
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