The Coroner Series

by Thomas T. Noguchi

  Later I discovered what had happened. The patient was suffering from a strep throat and my father had swabbed it with Lugol solution, which contains iodine—the standard practice at the time. But the young man had begun to gasp and had fallen to the floor. Almost at once, he had gone into an irreversible coma.

  What followed was to be the most harrowing period of my father’s life, for the parents of the young man immediately accused him of medical malpractice, claiming their son had choked to death on the cotton swab my father had used to apply the iodine solution. The district attorney’s office took up the case, and my father was charged with carelessly using loose cotton and thus causing his patient to choke and die. Under the Japanese Penal Code, he could be sent to prison if convicted.

  One can imagine the turmoil and despair in our family. My father, so upright all his life, faced disgrace and imprisonment. It seemed to us that the DA’s office had already convicted him without a shred of evidence.

  Japan, like the United States in the 1930s, was backward in forensic medicine. Only in very rare cases was an autopsy performed, and that occurred almost always at the request of the family of the decedent. There were no coroners’ or medical examiners’ offices in Japan then. That’s why my father created a sensation when he demanded an autopsy even though the young man’s parents had requested none. He told the authorities he would accept the results of such an autopsy, even if it meant prison.

  The autopsy was performed by one of Yokosuka’s most distinguished physicians. And the examination of the young man’s throat and lungs showed not one trace of cotton from the swab. In fact, the autopsy determined that the man had died of an allergic reaction to iodine, with no previous history of such an allergy. My father was cleared. And a thirteen-year-old boy received a first—and enduring—impression of the role of forensic medicine.

  I learned another important lesson during the closing months of the war with America. In March of 1945 I was eighteen, a sophomore in college, when the sound of air raid sirens split the air over Tokyo. Then the distant chatter of antiaircraft guns was heard, and our professor quickly ran to the door, gesturing for us to follow.

  Sitting in that classroom, I could look up directly into the sky, for the roof had been blown off the school building in a previous raid. Since then our classes had convened in the rubble, where the students, as well as the professor, wore helmets and shoulder pads. The professor lectured and we took notes until, almost every day, the air raid sirens sounded.

  That day I followed after the professor, who was running toward the trenches we had dug for shelter around the perimeter of the school grounds. And as thunderous explosions struck closer and closer, I jumped into a trench along with the august professor himself. I’ve never forgotten that man, because of his courage and composure. In the middle of the detonations, he sat against the dirt wall of the trench and proceeded to mark examination papers as calmly as if he were in his study at home.

  The war ended with the horrifying destruction of Hiroshima and Nagasaki by nuclear bombs. And then we were “invaded” by the American army of occupation. Japanese propaganda films during the war had depicted Americans as “apes” and “monsters,” but the ones I met were friendly, open and often laughing—a strange warrior tribe indeed. I discovered that I liked these laughing people who somehow possessed so much scientific greatness that they had easily overpowered Japan, with all her brave soldiers.

  After the war, still determined to become a doctor, I enrolled in Nippon Medical School. But remembering what had happened to my father, I knew that I wanted to learn law as well as medicine. So I took an almost unprecedented step: the year after I enrolled in medical school in 1947, I also enrolled in law school. It was a hectic time, studying medicine during the day and law at night. I wonder now how I was able to do it. In 1951 I graduated from Nippon Medical School and interned at Tokyo University Hospital. But all the while a new dream was forming in my mind. I wanted to go to America.

  Why did I decide to effect that startling transformation in my future life? I could have inherited my father’s substantial practice and become a wealthy physician in Japan. But it was not his success that inspired my decision. Rather it was my subconscious desire to superachieve as my father had done. He had broken through barriers when he left the family to become first an artist, then a doctor. I wanted to break new ground myself. And, from the first, I had been fascinated with the wonders of science—and there was no doubt that the United States, in 1952, was the world leader in technology.

  My parents were startled, and I’m sure my father was distressed that I would not carry on the practice he had spent so many years developing. But once my mind was made up, they made no attempt to dissuade me. Discouragement came from another quarter when I applied to two hundred American hospitals for an internship. My record showed excellent grades, and yet I received only one reply—from Orange County General Hospital, in California. They accepted me, and in 1952 I flew to this great country, America, for the first time.

  I have never really regretted my decision to make America my home, even though I quickly found that the U.S. government had not been just to its Japanese-American citizens during the war. One of those citizens, a pretty girl named Hisako Nishihara, was a freshman at the University of California at Los Angeles when she and her family were uprooted from their home in Los Angeles and placed in detention camps, where they remained throughout the war.

  Hisako and I fell in love and were married on December 31, 1960. At that time I was studying clinical and anatomic pathology, because I had discovered another instinct within myself: a love for scientific detective work, which is an integral part of a pathologist’s profession. Normally I would have elected to pursue a private practice in pathology. But since my father’s brush with legal disaster my sights were set on another goal: the practice of forensic medicine.

  The trouble was, as my peers quickly warned me, there was no money in it. Most practitioners in forensic medicine were in government service, and I would have to resign myself to a lifetime of low income if I opted for that as a career. Yet it was the very fact that forensic medicine was held in such low regard that attracted me to it. Here was a field in which one man could make a difference. In fact, it desperately needed good men to elevate its standards and fulfill its mission.

  So I applied to the Los Angeles coroner’s office in 1960 and went to work there as a deputy medical examiner. Despite the drab quarters and the low pay, I quickly realized I had made the proper choice. For I was fascinated with forensic medicine, perhaps the most colorful of the medical disciplines, with a picturesque history that harked back to the days of Robin Hood.

  Forensic medicine came into being with a crime that shook Europe in 1192, and because of that crime a new title was established for certain knights of the English realm: coroner.

  King Richard the Lion-Hearted, on his way home from the Crusades, was kidnapped by Leopold of Austria, and an enormous ransom was demanded from England for his return. But the King’s treasury wasn’t large enough to pay the ransom. And it seemed that Richard, lion heart and all, was doomed.

  In that crisis, the savior was not the legendary Robin Hood, as folk tradition has it, but a man more prosaically named Hubert Walter, the Justiciar of England. Desperately, Walter searched for ways to raise the ransom money—and came up with a novel source: corpses. In those days almost all convicted felons were hanged or otherwise disposed of in an unpleasant manner. Walter appointed a knight in each shire to take custody of felons’ property for the royal treasury, and gave him the title “coroner,” derived from the Latin custos placitorum coronae, “guardian of the pleas [claims] of the crown.” Sometimes the coroner even sold the death weapon, if it had value. But another method by which coroners raised money from the dead was more important to medical historians, because, in effect, it began the profession of forensic medicine as it is known today.

  England was a mixture of Norman and Saxon citizenry. The Saxons were
English, but the invading Normans were the ruling class. It was perfectly legal for a Norman to murder a Saxon, as far as the rulers were concerned. But if you killed a Norman, you were in trouble. In fact, you had to produce the killer or prove that the dead man was not a Norman or the entire village would be required to pay a heavy fine. The fine was called a “murdrum.” And to determine if it could be levied, coroners held inquests into the facts of every suspicious death, investigations which were the genesis of our profession today. Over the years, other agencies gradually assumed the tasks of levying and collecting taxes, but the coroner’s function of investigating mysterious deaths remained.

  The growth of forensic medicine as a medical discipline occurred on the European Continent, where, in 1621, the “Father of Legal Medicine,” Paulo Zacchias, who had been appointed the Pope’s physician in the Vatican, published a textbook entitled Questiones medico legales which analyzed various medically related cases heard by the papal court. His book became the standard text in its field for centuries. But still in England forensic medicine was not accepted by the medical establishment. Instead, laymen were appointed as coroners and they performed bureaucratic duties, not medical.

  This system of laymen coroners traveled to the new continent called America. In fact, for hundreds of years in this country the only qualification to run for the office of coroner was that you had no prison record. But America kept growing. Cities of ten thousand became metropolitan areas of millions, and the unexplained deaths, homicides, suicides and accidents multiplied rapidly. Finally, in 1912, Massachusetts became the first state in the Union to pass a statute establishing a medical examiner’s system, with physicians, not laymen, as coroners.

  Gradually the same laws were promulgated in almost all states of the Union, including California in 1956. By then, forensic science had come a long way from the time of Norman rule and from theories in the mind of a Vatican physician. Modern forensic science can be defined as the scientific investigation of the cause of death in unexplained circumstances, particularly when criminal activity is suspected. And today the field has grown to encompass several areas of expertise.

  Forensic pathologists determine the cause of death by directing the examination of the body, its tissues and biological fluids. Under the forensic pathologist’s supervision, other experts engage in various disciplines:

  1. Criminalistics, the branch of science which deals with trace evidence such as paint chips, soil, hair, clothing, as well as firearms and other weapons.

  2. Toxicology, which deals with determination and interpretation of poisons, drugs and toxic chemicals found in the tissues, blood and other biological fluids.

  3. Histology, which studies structural changes in human tissue caused by disease or violence.

  4. Forensic dentistry and anthropology, which assist in the identification of bodies through teeth or skeletal remains.

  Those are the major disciplines which come under the purview of the modern medical examiner. In addition, in some medical examiners’ offices, there are experts in forensic psychiatry, forensic microscopy, questioned-document examination, forensic engineering, medical jurisprudence and other forensic disciplines.

  Nowadays medical-examiner offices in large urban areas include numerous departments with skilled investigators and/or medical examiners who visit the scene of the crime and search for forensic clues, and a staff of forensic pathologists who perform the autopsies to obtain and interpret medical evidence and conduct a medicolegal investigation, coordinating with toxicologists, histologists and other technicians who examine and analyze samples of tissue and fluid, searching for clues.

  Thus we attack each unexplained death from many scientific directions, with skilled experts and laboratory equipment. And we can learn—and educate everyone—about dangers ranging from the existence of poisoned Tylenol capsules to the identity of a murderer who may think he has committed the “perfect crime.” But when I joined the Los Angeles Medical Examiner’s staff, we did not have this large modern organization. Instead, the office employed only three full-time pathologists, a handful of laboratory technicians and some young part-time residents studying to be pathologists.

  And into this small complex came the most famous decedent in the world.

  3

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  Medical Examiner’s Case No. 81128

  * * *

  Marilyn Monroe

  It was incredible. On November 4, 1982, I was on my way by car to the Los Angeles District Attorney’s Office to be interviewed about a possible murder. The unbelievable factor was that the “murder” had occurred no less than twenty years earlier. But here in Los Angeles they were still officially investigating the questions which surrounded Marilyn Monroe’s death two decades before.

  On that date in 1982 I was no longer the Chief Medical Examiner of Los Angeles, because I had been demoted and was in the midst of my appeal to be reinstated. But still the DA wanted to see me. For I was the pathologist who had performed the autopsy on Marilyn Monroe, and, as it happened, the facts revealed in my autopsy report had become the basis for all of the claims of murder. My autopsy, private investigators said, proved that Marilyn Monroe was the victim of foul play, even though Theodore J. Curphey, M.D., the Chief Medical Examiner/Coroner in 1962, had concluded on the basis of that same autopsy, plus other evidence, that Marilyn Monroe died from an overdose of Nembutal and chloral hydrate pills. Never in my experience had a coroner’s conclusion been so hotly disputed for so long a time.

  Over a period of twenty years, I had been questioned by investigative reporters so many times that I had lost count. Many of them were convinced that Senator Robert F. Kennedy was Monroe’s lover and had ordered her to be murdered—by injection. They cited evidence of an official cover-up and claimed that a diary Monroe kept had mysteriously disappeared. Finally, public pressure had grown so great that the Los Angeles County District Attorney’s Office had been forced to reopen the case, and I was summoned to the Criminal Courts Building and found myself sitting in an office across the desk from two assistant district attorneys. Their questions went right to the points that had bothered investigators for years, beginning with “If Marilyn Monroe swallowed dozens of sleeping pills, why was there no evidence of pills in her digestive tract?”

  As I answered that question my mind wandered back to 1962 when I, a young and impressionable medical examiner, first viewed the body of Marilyn Monroe. Later I would be asked, “How did she appear in death?” And I could reply only with words from the Latin poet Petrarch:

  It’s folly to shrink in fear, if this is dying,

  For death looked lovely in her lovely face.

  The assistant DAs brought me back to the present with another question: “It’s said that the yellow dye on the Nembutal she swallowed should have stained her stomach. And yet you found no evidence of staining. How can that be?”

  Again I answered the question, but in the back of my mind I wondered what was there about this beautiful actress that caused such fascination with her life, and such mourning over her death. Why, so many years later, does she still tug on American heartstrings? Her beauty? Her vulnerability? Her talent?

  Or the strange unresolved mystery of her relationship with the glamorous Kennedys?

  Balloons floated to the ceiling of huge Madison Square Garden. Bands played, elephants trumpeted; the handsome young President of the United States and his dazzling wife looked down on the scene of celebration from a box. It was May 29, 1962, Kennedy’s forty-fifth birthday. But the focus of the evening was not the young President. The hundred of guests eagerly awaited the appearance of the real star of the celebration, perhaps the most talked-about phenomenon in modern motion picture history, the luminous actress Marilyn Monroe.

  Earlier that year, President Kennedy had met Monroe in Las Vegas, Nevada, through their mutual friend Frank Sinatra. She had happily agreed to appear at his birthday party and to sing a song for the President. But all the guests knew—as did almost all Am
ericans—that Marilyn Monroe was perpetually, even rudely, late. Would she keep the President of the United States waiting? Would she embarrass him?

  Then suddenly a “pin” light hit a corner of the arena, and Marilyn Monroe entered on an elephant, riding sidesaddle. Dressed in a form-fitting sequin-studded gown, she made her way to a microphone on a platform in the middle of the huge arena, and the audience roared as she began singing in her inimitable baby voice, with heavy sensuous breathing on every syllable:

  “Happy … birthday … to you

  Happy birthday to … you

  Happy birthday … dear Mr. President

  Happy birthday to yoooou!”

  The tumultuous applause that followed was the climax of the President’s birthday party. But, for Monroe, the real summit of the evening may have been reached later at a private party hosted by a Democratic financial supporter, Arthur Krim of United Artists. For there she met Robert F. Kennedy, the President’s brother, for the first time.

  Adlai Stevenson described the scene at that party in a letter he wrote to Mary Lasker:

  Let me tell you about my perilous encounters last night with Marilyn Monroe. She was dressed in what she calls “skin and beads.” I didn’t see the beads! My encounters, however, were only after breaking through the strong defenses established by Robert Kennedy, who was dodging around her like a moth around the flame

  Also present and hovering, as it happened, was the historian Arthur Schlesinger, who wrote in his diary:

  I do not think that I have seen anyone so beautiful; I was enchanted by her manner and her wit, at once so masked, so ingenuous and so penetrating. But one felt a terrible unreality about her—as if talking to someone under water. Bobby and I engaged in mock competition for her; she was most agreeable to him and pleasant to me—but then she receded into her own glittering mist.