“We don’t do that,” I told him over the phone.
“Why not? I saw it on the news.”
“Because you only swab living people, and even in that case there is no guarantee that just because you find an anthrax spore, the person is infected,” I explained. The media had been touting nasal swabs as some sort of definitive diagnostic test, when in reality they are only a first-round screening tool—and a poor one. “When I perform the autopsy, I will look inside your uncle’s organs. If he died of anthrax, I will immediately see its effects on his body.”
On autopsy, I found the postal worker did not have an anthrax infection. He had a garden-variety pneumonia due to AIDS. I pended the case until I got tox back, hoping to give the family some time to get over their immediate grief, turn away from the newsroom hysterics, and gain some perspective. “Yup. A white powder,” I said to Stuart across our desk in the fellows’ room, when I opened the man’s toxicology report a month later and found it positive for cocaine.
All of us had to spend time on the phone in similar conversations about anthrax. At Hirsch rounds one afternoon, one of the doctors presented the case of an eighty-nine-year-old man notable for his longevity as a chronic intravenous drug user, who was found dead at home with white powder on a mirror by his bedside. “Did you test it for anthrax?” Jonathan Hayes joked.
We found out on October 30, however, that not all the anthrax calls to our office were false alarms. During morning rounds that day, Dr. Hirsch informed us that sixty-one-year-old Kathy Nguyen, the first known case of inhalational anthrax in New York City, was doing very poorly at Lenox Hill Hospital and was not expected to live. She had arrived at the hospital on a Sunday, with chest pain, achy muscles, and a bad cough. Her condition deteriorated alarmingly on Monday, and a blood culture came up positive for anthrax. By Tuesday, in the midnight hour of Halloween, she was dead.
I had been scheduled to do autopsies that morning. Jim Gill was assigned the Nguyen case, and I was going to do the day’s two others—an alcoholic woman and an infant boy who died of organ failure immediately after birth. I went into the Pit as usual at eight o’clock to start the two autopsies before morning Hirsch rounds and was surprised to find no one at all in there except Dr. Gill—and the body of anthrax victim Kathy Nguyen.
“Where are the techs?” I asked Jim.
“They’re afraid to come in here. They don’t want anything to do with this case, so we’re on our own.”
“What?”
“Their union rep is square in their corner. They brought the body in here, put it on the table, and left.” I was floored. I had never seen the OCME morgue technicians spooked by any disease—not HIV or hepatitis, not tuberculosis, not even West Nile virus. They dealt with those threats every single day doing “routine” autopsies, but now had retreated, united in fear. Even more alarming, Jim was standing over the body of a woman who had been killed by an airborne biological weapon, but he was gowned as usual in latex gloves and plastic apron, with an ordinary N-95 surgical mask. I expected him to be doing this autopsy in our positive-pressure room behind the biovestibule airlock, suited up as for an emerging pathogen such as Ebola or hantavirus: in Tyvek coveralls and a fit-tested, powered air-purifying respirator face mask. Instead, Jim was dressed for a regular day at the office, if your office is the morgue.
“Is there any risk of contagion?” I asked nervously from behind my own flimsy paper mask.
“No. Anthrax in the body is no more infectious than other blood- and respiratory-borne pathogens, and she was treated aggressively with antibiotics. It is unlikely that there is any viable organism in her body.”
“Promise?”
“Get started on your cases, will you? With no tech I’m going to need some help over here.”
So I did. With just me and Jim working in the Pit, it was spooky as . . . well, spooky as a morgue on Halloween. Dr. Hirsch came in at nine thirty, as always. Accompanying him was an NYU clinical pathologist who was an expert on anthrax, and half a dozen residents and medical students. The visitors hovered around the table and watched for most of the forty-five minutes it took Jim Gill to perform the autopsy of Kathy Nguyen while I assisted. Dr. Hirsch stood there in his tweed suit and face mask, quiet but intensely watchful.
The autopsy was terrifying and fascinating. We worked carefully, without chatter. When Jim reflected the breastbone and front ribs, he paused so we could all see in the thorax the textbook effect of inhalational anthrax—hemorrhage of the mediastinum. The pericardial sac and the entire space between the lungs was swimming in bright red gore. Anthrax travels through the lymphatic system and then the bloodstream, and Nguyen’s lymph nodes were swollen bags of blood. Some were black and blue from necrosis—especially around the central airway. It was clear that the anthrax had entered Kathy Nguyen’s body through her lungs, and the infection had spread from there.
The lungs were frothy and filled with bloody fluid. We expected to see hemorrhagic meningitis too, but after Jim sawed open the skull we found the brain surface perfectly clean and normal. “It’s a testament to the potency of the antibiotics,” the NYU pathologist said, and he was exactly right. Our microbiology lab would tell us the next day that the bloody mess of tissues had almost no bacteria present. Kathy Nguyen’s doctors at Lenox Hill had arrested her bacterial infection using the most powerful antibiotics known to modern medicine, but the onslaught of their toxins was already in motion, and nothing could halt it.
None of us—not the NYU anthrax expert, not Dr. Charles Hirsch—had ever witnessed anything like that autopsy. No more than fifty living doctors have seen a case of anthrax in the United States, and I don’t know if a single one of those had done the postmortem examination of a fulminant inhalational infection. It is a milestone I wish had never been placed before us at the New York OCME.
Yes, that was one hell of a Halloween. The week leading up to it started with Michael Donohue—poisoned with heroin, dumped and rotting with the garbage in that Hell’s Kitchen postal bin. The next day Robert Ward came my way, inaugurating the “bad sushi” phone calls, and I also autopsied a middle-aged woman who had died of a therapeutic complication after last-ditch heart surgery. Wednesday featured the pulpified remains of a suicidal jumper and the preventable death of a motor vehicle passenger who hadn’t buckled his seat belt. Some construction workers in the heart of Harlem uncovered a scattering of human remains at a building site, and these—the dumpster bones—became three new cases for me. Two messy continuing investigations, five new postmortems, and an anthrax assist—that was October 31, 2001. To top it all off, I got a phone call from the district attorney’s office that afternoon, warning me to prepare my grand jury testimony in the strangling of Sylvia Allen, whose autopsy I had been doing on September 14 when the bomb scare sent our whole office outside in the rain.
“When?” I asked.
“Friday,” came the answer.
“This Friday?”
“Yes. That’s when the grand jury convenes. Is that a problem?”
“No,” I said, wondering what kind of jail time I could get for lying to a district attorney. I had never been called before a grand jury before, and that case was sitting far on my back burner. “No problem.”
As it turned out, I was right. My appearance at the grand jury went smoothly, and was the first step in a long legal process that eventually put Sylvia’s murderer into Shawangunk maximum security prison for life without the possibility of parole. He was, as the ADA put it, “a repeat customer,” a true sociopath with two prior convictions for homicide and seven for rape. None of us knew it at the time, but this man would later confess from prison to the unsolved 1997 murder of a sixteen-year-old girl in Queens. Sylvia Allen had been the fourth and last victim of a serial killer.
November 2001 could only improve on September and October. For one thing, I was obliged to take a break from New York City for a week, to attend a mandated conference-style professional course at the Armed Forces Institute of Pathology
in Washington, D.C. Danny and T.J. came with me on the train—to Danny’s scampering, babbling delight—and we planned to turn it into a much-needed family vacation.
Doug, Stuart, and I were the only conference attendees from New York. Between lectures on the first day, people from all over the country kept seeking us out to hear about the 9/11 recovery effort, which at that point had been going for exactly a month. The three of us bumped into the course director during the lunch break. He seemed surprised to see us. “So. Are you going to be staying?” he asked.
“Of course!” I said, with honest enthusiasm—I was delighted to be unleashed from work, meeting new colleagues, eating free food. “We’re here for the whole week!”
We were waiting for the elevator when a fat conventioneer in fatigues sidled up to us. “You’re the New Yorkers, right?” he said. “So, have you heard about the plane crash in Queens?”
“What?” Stuart and I yelled.
“Yeah, a jet crashed on takeoff this morning, wiped out a whole neighborhood. Two hundred–something dead. It’s all over the news. Surprised you don’t know about it.” The fat man was so nonchalant, breaking the news of tragedy heaped upon atrocity in our city. I felt like Stuart and Doug looked: ready to punch him.
We sprinted to Stuart’s room and turned on the news. American Airlines Flight 587, we learned, had crashed eighty-one seconds after takeoff from JFK, en route to the Dominican Republic. The plane, a popular direct flight and a pipeline home for the city’s Dominican community, had been full. All 260 people aboard had died, and an unknown number on the ground as well. The Airbus A300 generated a fierce fire when it crashed into a residential neighborhood in the Rockaways. The cable news cameras showed firefighters running toward the blazing wreckage and burning houses with axes, chain saws, and hoses. I had seen so many of those FDNY jackets shrouding mangled remains—and there they were again, the men and women wearing them fighting another jet-fueled fire, marching right up to those bright orange flames.
“We’re doing full autopsies in these cases,” Dr. Flomenbaum told the three of us when we arrived back in New York. He was putting together the day’s list, as usual—because, despite another mass-casualty disaster, New Yorkers kept stubbornly dying of regular things. Flome was putting us on the line for the DQ01 recovery effort. “Disaster Queens 2001” had joined “Disaster Manhattan 2001” in the case files of the New York OCME.
“We don’t know what caused this crash,” he said. “It could be terrorism or it could be many other things, so we need to autopsy and do full toxicology, including carboxyhemoglobin, on everyone, to figure out the cause of death.” The ID room seemed to be even busier than usual, a dozen voices talking on the phone at once. “It’s important to figure out if the passengers died of blunt trauma, and what their patterns of injury are, so fill out your body charts. We also want to know if they were alive in the fire. That’s where the carboxyhemoglobin level comes in. Got it?”
When I arrived at the Pit, I found seven tables running side by side, all doing DQ01 cases. Like in the World Trade Center recovery, we were each assigned a scribe and a detective. Again FBI agents were circling the tables.
I autopsied four individuals that first day I worked the Queens disaster, two men and two women. They were all badly mangled, extensively charred, missing the upper portions of the face and skull, and most if not all of their brains. The stench of jet fuel was dizzying, as bad as the first day handling World Trade Center remains, or maybe even worse. And again, as I had seen working the WTC line, there were surreal and horrifying demonstrations of Newton’s laws. One passenger’s wallet had been impaled by the sharp end of someone else’s broken rib, leaving a nickel-size hole through all the pictures and currency and credit cards inside. A woman’s uterus had come out of her body through a hole in the pelvis, and inside the charred organ I found a one-inch-long cooked fetus. In two different people the heart was dangling outside the chest, having torn right through the breastbone. At least we would be able to tell the families that none of the victims had suffered.
The detective helped me weigh the organs, and I rattled off dictation at breakneck speed. A DMORT guy working at my table told us how impressed he had been with our office’s quick response on the day of the Queens crash. “The crash was at nine fifteen, and by ten thirty I saw OCME people down there. By five o’clock the first bodies were triaged and ready to be autopsied. You guys are something else.” If I hadn’t been so heartsick and fatigued I might have been glad for the praise.
There were so many partial remains from the crash of Flight 587 that we moved the DQ01 operation outside to the loading dock, displacing the processing of DM01 cases—one disaster shouldering aside another. It was a lot like the first week of the World Trade Center work. The partial remains were mauled and twisted, but this time there was a lot more charring, less ash, no concrete dust. The smell of kerosene permeated the air even under the tents.
I was assisted by two detectives, and a DMORT forensic pathologist served as scribe. We were working along at a good clip and had finished documenting a couple of the body bags labeled PARTS by the police at the staging area in Queens, when the DMORT doctor unzipped a new bag—and froze. “These aren’t parts,” she said, without taking her eyes from the body bag.
“What are they?” I asked, and moved toward her to look. “Oh no.”
It was full of the whole bodies of small children. I couldn’t tell how many were in the bag, but I could see it was bulging.
Doug Freeman was working the table next to us and had overheard. He asked what it was, and I told him. Doug looked at me, and without pause, he said, “I’ll do them.”
I will always be grateful to him. Until that moment, I had thought that autumn’s work had forced me to confront every horror that exploding airplanes could bring. I was wrong. As the mother of a two-year-old child, I could not face this one.
The crash of American Airlines Flight 587 took 265 lives on November 12, 2001. Passengers made up 251 of those, crew 9, and 5 people died on the ground. The cause was pilot error. Pilot training, the retirement of that particular type of jet, and changes to air traffic control protocols have made another such crash unlikely. The news that this disaster was not another act of terrorism came as a great relief to me and all my colleagues.
* * *
For a long time after the fall of 2001, the smell of jet fuel or the sound of an airplane’s whip-roar overhead sent a jolt of fear through me. But to my young son, Daniel, the low, loud approach of an airliner was always an occasion for running, yelling, pointing skyward, and staring in wonder. After we moved to California, T.J. and I used to take him and his infant sister, Leah, out to a weed-strewn, blustery park on the periphery of the airport, to watch planes take off and land. Only after sitting in the patchy grass with T.J. for hours on end, playing with the baby and watching Danny’s joyful reaction to each new flight rumbling over his head, did I stop dreading that sound.
12
Final Disposition
When I went into the field of forensic pathology I knew that it would be an excellent specialty for Dr. Mom. After a year working as a medical examiner—even with the procession of calamities following September 11—I remained convinced it was. I finished my fellowship in forensic pathology at the end of June 2002 and immediately started a yearlong fellowship in neuropathology with Dr. Vernon Armbrustmacher, the OCME’s brain specialist. By August, morning sickness had arrived.
You might imagine cutting up human brains all day long would exacerbate this condition, but it was sure better than working in the autopsy suite. Dr. A is easily six and a half feet tall, low-key, gentle—and madly in love with the human brain. He employs an easygoing teaching style coupled with a remarkable amount of patience. His antiseptic little laboratory has buckets of pickled brains and spinal cords lining shelves all along the walls. It’s quite a sight for the uninitiated. For a pregnant doctor, however, a year spent with the soothing Dr. A in the sanitized quiet of a room
smelling only of chemical preservatives was the perfect workplace.
Not all autopsy brains go to Dr. A’s lab for a neuropathology analysis. Brain cutting is limited to decedents who had suffered some sort of head trauma (including bullets) or who exhibited signs of neurological impairment. And although brain cutting was a learning opportunity for me, teaching was not Dr. Armbrustmacher’s primary role. As a board-certified neuropathologist, he was uniquely qualified to observe and diagnose brain injuries, diseases, and defects. His professional analysis made it less likely we, as a death-investigation team, would miss a subtle medical finding that could have major forensic implications. When Dr. Armbrustmacher finished bread-slicing a brain and laid the slabs on the table in front of us, we could assess its internal substructures together and see areas of injury with the naked eye. That most mysterious of organs surrendered its mysteries—right there, at my fingertips. For a girl who had wanted all her life to be a scientist and a practitioner of medicine, brain cutting was a thrill.
During my neuropathology fellowship year, I continued working in the autopsy suite on weekends, even after my bulging belly made it a challenge to do so. Autopsy is physical labor performed at navel height, and I became adept at cutting into the human torso with my own twisted sideways. My baby, Leah, was a big kicker. Feeling that new human life growing inside my body while I explored the body of another life just extinguished was a paradoxically uplifting and unsettling experience.
We were outgrowing our one-bedroom apartment, and two years in New York had been enough for both T.J. and me. I put together my résumé, and he started researching cities with forensic pathology positions available. There was a job opening in San Jose, California, so we flew out there to look around and interview. It seemed a pleasant enough place. Plenty of sunshine. Mellow citizenry. I noticed that the downtown area had no real skyscrapers, and asked about it. The Santa Clara County chief medical examiner told me that because their airport is so close to downtown, the building codes don’t allow for anything higher than twenty-two stories. A plane could still hit one of those buildings, of course, but it would be by accident. There could be an earthquake any day, naturally, but the office had a mass-casualty disaster protocol in place and ran regular drills. After my experience with man-made catastrophe in New York, I was eager to move someplace that feared only an act of God.
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