Morgue

by Dr. Vincent DiMaio

  My classmates were fascinating, too. There was Barbara Delano, who loved to argue politics with me in those heady days of the mid-1960s, as America tilted toward the worst days of Vietnam, racial strife, and campus revolt in a tectonic shift of our cultural plates. Once she accused me of holding thirteenth-century political notions. “No,” I corrected her brusquely, “they’re definitely tenth-century.” (She later chaired Downstate’s School of Public Health.)

  And there was Chester Chin, who was so thin that the campus nurses tried to fatten him up with daily chocolate shakes. It didn’t work, and he came to detest medical school (and probably chocolate shakes). After graduation, he became an orthopedic surgeon and refused to ever return, even for reunions.

  But the first of us to become famous—infamous, really—was Stephen H. Kessler. A brilliant but troubled guy, he’d graduated from Harvard and entered medical school at Downstate with me. Before long, he started behaving erratically. One day he was caught tossing scalpels like darts at the cadavers in the anatomy lab. The dean forced him to take a leave of absence after his first year, and he checked into a mental hospital.

  Kessler eventually returned to medical school but was kicked out again when he was caught giving LSD to patients.

  Rumors circulated that Kessler was due to return for a third try when startling news broke in April 1966: Kessler had viciously slashed his fifty-seven-year-old mother-in-law to death in her Brooklyn apartment. (Coincidentally, my father did her autopsy and counted 105 separate wounds.) Kessler claimed he’d been tripping on LSD at the time, so the media dubbed him the “LSD Killer.” It turned out he was high on lab alcohol and pills and suffered from paranoid schizophrenia, so he was eventually found not guilty by reason of insanity. He disappeared into the asylum at Bellevue and was never heard from again.

  During those frantic med-school days, I often visited my father in the Brooklyn morgue. I’d seen dead bodies before, but these weren’t the slides in my father’s closet, or pictures in a medical textbook, or even the cleaned-up cadavers we poked and prodded in anatomy class. These were freshly dead, real people, pale or blue, with real bullet wounds, knife gashes, or no visible injuries at all.

  I was fascinated mostly by the mobsters who seemed to come through my father’s morgue doors with regularity in the late 1960s. The New York mob wars came and went, but the hits never stopped. The Mafia dead were always well-dressed, with alligator shoes, silk underwear, manicured hands. I’d never seen a man wearing clear fingernail polish until I examined those dead wiseguys on my father’s slab.

  As the end of medical school approached, I had to choose my specialty. What were the choices? There was an adage to consider: “Internists know everything but do nothing; surgeons know nothing but do everything; psychiatrists know nothing and do nothing; and pathologists know everything and do everything, but it is too late.”

  There was more. I had learned in medical school that (like my father) I had no bedside manner and that I couldn’t master the complex knots a surgeon must know. I realized I’d be better with patients who didn’t require reassurance and operations that didn’t require lifesaving knots. Pathology was perfect. Pathologists were doctors’ doctors.

  After my one-year pathology internship at Duke University Hospital in Durham, North Carolina—where I finally decided to pursue forensic pathology—I started my three-year residency at the Kings County Medical Center in Brooklyn. During that time, I started performing autopsies for the Chief Medical Examiner’s Office in Brooklyn under my father’s watchful eye. By the time I finished my residency, I had already done more than a hundred autopsies before I worked a single day as a certified forensic pathologist.

  My residency changed my life in another, more significant way when one of my supervisors introduced me to her secretary, Theresa Richberg, who at the moment was bent over her typewriter, her long blond hair obscuring her face. When she looked up, I was thunderstruck. She was beautiful. I guessed her to be in her mid-twenties, and when she spoke, I heard an articulate woman who seemed to be as smart as she was pretty. And among the first things she told me in that confident voice, scented with just a tantalizing whiff of Brooklyn, was that she was engaged to be married. She flashed a diamond ring to prove it.

  I was deflated but not defeated. Over the next few days, I made a point of speaking to Theresa any time I passed her office. In our water-cooler chats, I learned that she sewed her own clothes, which looked to me to be the height of New York fashion. She laughed at my dry humor, which not everybody did. She was bright, strong-willed, opinionated, and sometimes argumentative—my kind of woman.

  And when I told her I was just twenty-six, her jaw dropped. She’d thought I was just another bespectacled, distinguished, gray-haired old gent in his forties, nothing like the cocky, crude Italian boys on her block. I had class, she said.

  A few weeks after we met, she came to work without her ring. She told me she’d broken off her engagement. (In fact, the ring was in her purse and she hadn’t yet revealed to her fiancé that he’d been booted.) The next day I asked her out.

  She also dropped another bombshell: She was just eighteen, albeit a very intelligent and sophisticated eighteen. Apparently neither of us looked our ages.

  On one of our first dates, I picked up Theresa to go to the movies. She spied a big jar in the backseat. It was the stripped skin of a human hand floating in formaldehyde.

  Another time, we had arranged to meet at the Brooklyn morgue before our date, but Theresa refused to go inside. So I told her to wait at the back door for me. While she stood there, a morgue wagon pulled up. Two attendants pulled a dead body from the back and placed it on a gurney—then placed the dead man’s head on his chest.

  After that, I wouldn’t have blamed her if she fled screaming and never saw me again, but within a few weeks, she officially broke off her engagement to the other fellow.

  A year after we started dating, Theresa and I were married at the venerable St. Blaise Catholic Church in Brooklyn’s East Flatbush neighborhood. It rained right up to Theresa’s arrival, then stopped, supposedly an omen of good luck. All our Italian relatives were there, there was lots of food, and the reception looked like a scene from the movie Goodfellas.

  Back then, we were just a happy couple on the brink of our careers, but I had married a Renaissance woman. In many ways, her future was even brighter than mine: She would eventually leave her secretarial job and go to college, where she’d get a bachelor’s degree in fine arts, become an in-store designer for Neiman Marcus, work as an interior designer, and sell her custom-made jewelry to Saks Fifth Avenue. She raised two children who grew up to become a doctor and a prosecutor. Incredibly, in years to come, she’d return to college for a bachelor’s degree in nursing, work as a psychiatric nurse, be trained as a forensic nurse, and coauthor a book, Excited Delirium Syndrome, about a complex cocktail of mental and physical conditions that have proven suddenly fatal in many police arrests. Her work shed new light on the syndrome and led, in part, to its adoption as an accepted diagnosis by the American College of Emergency Physicians and the National Institute of Justice.

  And, oh, she’s an excellent cook, too.

  Sadly, we divorced briefly in later years. I married another woman who, in a fit of anger, fired four shots at me. I very nearly became a customer at the morgue. She missed, thankfully. It’s a very interesting experience, being shot at (and missed). I highly recommend it as a way to clarify your mind. You don’t hear the gun going off. I saw it, but I couldn’t hear it.

  Anyway, we quickly divorced, and I immediately reconnected with Theresa, with whom I’d never really fallen out of love. We remarried after an almost ten-year estrangement, and I am blessed to have her again at my side.

  I learned a lot during that middle period of my life. Most significant, maybe, is that when a woman pulls a gun on you, never say, “You wouldn’t dare shoot.”

  But back in those early days, before those troubles, Theresa and I were just happy
to have each other. I was locked in the rigors of becoming a doctor and she was finding herself, but we had each other, and we made a good team.

  We still do.

  * * *

  Doctors have been solving crimes for a long time, even if medicine had no name for them until the mid-twentieth century.

  Two thousand years ago, in 44 BC, Julius Caesar was stabbed to death by Roman senators in history’s highest profile murder. A doctor named Antistius was summoned to examine the emperor’s corpse. He reported that Caesar had been stabbed twenty-three times in the face, belly, groin, and arms, but only one wound—an upward thrust under his left shoulder blade that probably pierced his heart—had been fatal. The attack was so frenzied that many of the would-be assassins were cut, too. Antistius believed that if Caesar had not died from a sliced heart, he would have bled out in a few minutes as he lay unattended on the Senate floor at the foot of Pompey’s statue.

  It was history’s first recorded autopsy.

  A thousand years later in medieval England, the king appointed local cronies without any medical training to represent his financial interest in all criminal cases (as well as hear confessions, investigate shipwrecks, pardon criminals, and confiscate royal fishes). Also among these clerks’ duties was to inspect the corpses in all unnatural deaths and record their observations in an “inquest.” The appointee’s duty to “keep the pleas of the crown”—in Latin, custos placitorum coronae—naturally led to his title as “crowner” or “coroner.”

  Leonardo da Vinci and Michelangelo dissected corpses to improve their art, but they also became fascinated by the irregularities they saw. Pope Clement VI ordered that corpses of plague victims be opened to see what was inside.

  By the 1600s, the Age of Enlightenment, scientific advances and a fresh social conscience breathed new life into death and crime investigations. And in the late 1800s, fingerprinting revolutionized forensics.

  In 1890, Baltimore gave two doctors the title of medical examiner and assigned them to perform all autopsies ordered by the county coroner. Many big American cities followed suit and eventually gave the responsibility for all death investigations to physicians, although our system of elected coroners, who often have no medical training at all, remains firmly entrenched in America today.

  The first true medical examiner system was established in New York City in 1918 when the city abandoned its coroner system.

  So we have two types of medicolegal systems in America: the coroner and the medical examiner. The coroner system, which dates back to tenth-century England, still prevails in about 40 percent of America’s 3,144 counties, with 2,366 offices. In those places, the coroner is virtually always elected and almost never a physician. Even when the elected coroner is a doctor, he (or she) is not usually a forensic pathologist.

  The job requirements? Oh, have a local address, not be a felon, be at least eighteen years old. That’s about it. But that’s no problem. Once elected, the car-salesman-turned-coroner magically acquires the necessary medical and forensic knowledge he needs to solve extraordinarily complicated deaths. And that leaves time for the most important job any politician has: getting reelected.

  Elected coroners are often small-town morticians or cemetery workers whose daily contact with death makes it easy for voters to assume (incorrectly) that they are perfectly suited to the grim tasks of autopsies, blood work, body handling, and the occasional exhumation. Later in this book, I will tell a story about a backwater undertaker who boasted that his primary qualification to be the coroner was that he was the only guy in town who had a car big enough to properly haul a dead body.

  Most coroner systems produce poor, inconsistent work; most medical examiners good, consistent work. In a 2009 book entitled Strengthening Forensic Science in the United States: A Path Forward, the National Research Council advocated eliminating the coroner system entirely, an idea that had been bandied about since 1924.

  To date, nothing has been done. What was good for the tenth century is apparently still good for the twenty-first. And even in America today, when we have far more forensic tools than my father had when he became a doctor in 1940, the chances of a smart killer getting away with murder are higher in an elected coroner’s jurisdiction than any jurisdiction with a medical examiner.

  Despite the imperfection and inadequacy of the old coroner system, autopsies had solved thousands of American crimes by 1959, when forensic pathology was first recognized as a distinct discipline by the American Board of Pathology. In a huge moment when forensic pathology was finally legitimized, my father—then the Chief Deputy Medical Examiner for New York City—was among the first eighteen certified forensic pathologists in America.

  That first class of medical detectives comprised some of forensic medicine’s lions.

  Dr. Milton Helpern, my father’s boss in New York City from 1954 to 1973, was only the third medical examiner since the city scrapped its coroner system in 1918. He once said, “There are no perfect crimes. There are only untrained and blundering investigators, slipshod medical examiners.” His name still graces the award given to the highest honor for any medical examiner, the Milton Helpern Laureate Award, which I received in 2006.

  Dr. Russell Fisher was the Chief Medical Examiner for Maryland and built America’s best forensic team and facility in Baltimore. Such was his reputation that in 1968, just before I worked for him in my first job out of medical school, he led the so-called Clark Panel in concluding that the autopsy on the slain John F. Kennedy—the autopsy of the century—was so badly done that it “left doubt where there should only have been absolute certainty.”

  Dr. Angelo Lapi had been Denver’s first medical examiner and then moved to the Kansas City morgue. Blessed with a photographic memory, he was part of an elite team that listened to survivors of Nazi death camps and POW stalags describe wanton slaughter, dug up the decayed bodies, and collected evidence against their killers for the Nuremberg war crimes trials.

  As the chief pathologist for the Cleveland coroner, Dr. Lester Adelson was a key witness against Dr. Sam Sheppard, an osteopath accused of murdering his pregnant wife. Convicted in his first trial and acquitted ten years later in his second, Sheppard’s case was a media phenomenon that inspired countless articles, books, The Fugitive TV show, and several movies. After a thirty-seven-year career and more than eight thousand murder autopsies, Adelson retired to teach and write The Pathology of Homicide, one of the standard texts for forensic pathologists.

  All these men had stories to tell. They’d seen death in all its violent colors. They were the best and brightest in a new discipline.

  But forensic pathology wasn’t then and isn’t now perfect, either.

  My father’s and my career encompass the entire modern era of forensics, from a time when fingerprints and basic blood typing were the most “high-tech” forensic tools available, to today’s DNA profiling and massive computer databases. But I believe with all my heart that if we could magically drop a 1940s medical examiner into a modern morgue with an afternoon’s training on the new science, he’d function quite nicely. Why? Because a good forensic pathologist’s best tools are still his eyes, his brain, and his scalpel. Without those, all the science in the universe doesn’t help.

  Today, there are only about 500 working, board-certified forensic pathologists in the United States—about the same number as twenty years ago. Problem is, we need as many as 1,500 to keep up with the steadily increasing parade of unexplained deaths.

  Why, at the height of the profession’s popularity, thanks to TV shows such as CSI and NCIS, is there a shortage of forensic pathologists?

  Because it ain’t as glamorous as TV makes it. One in five new forensic pathologists drops out right after training, and over a ten-year period, we lose 10 percent more of these new doctor-detectives.

  The reasons are simple. For one, the job is complicated. To become a forensic pathologist requires four years of college, four years of medical school, and as many as five years of extr
a training after medical school. One must train first as an anatomical pathologist, at a minimum, before becoming a forensic pathologist.

  But hospital pathologists earn twice the money in a job that’s far less messy. A young doctor with $200,000 in student loans is easily seduced by a bigger paycheck (and needn’t explain a lower salary to a befuddled spouse). To make matters worse, some forensic pathologists accept government salaries that are lousy even for underpaid FPs.

  And the ultimate reality is that the job isn’t nearly as glamorous as TV makes it.

  They never mention how you can wake up to smell the stench of a decomposing body on your clothes or in your hair the next morning. They don’t show the maggots falling on you. They certainly never show autopsies that fail to find a cause of death.

  TV isn’t interested in the scientific truth, only a world it can imagine might possibly be true … maybe. But that’s understandable because viewers aren’t interested in scientific truth, either. Nobody really wants to see in prime time the pulverized innards of a baby who’s been beaten to death, or a head that’s been halved like a squash by a shotgun.

  So it goes. You go home and you just forget about it. You can’t live expecting everyone to be a sociopath or psychopath—they aren’t. Only 1 or 2 percent of us are. You get mad, maybe, that people do such things. You just shake your head and go on with your life. Another mystery will roll through the morgue door any minute.

  * * *

  When the time came to do my one-year fellowship—a final year of training after residency—my father discouraged me from doing it in New York City. Once the paradigm of forensic excellence when my father started there in the 1940s, the New York City Chief Medical Examiner’s Office had decayed. Even in the great Milton Helpern’s last years as the chief, the biggest medical examiner’s office in the world lacked state-of-the-art equipment, morale was funereal, it had become hard to fire some entrenched workers, and corruption had seeped in around the edges.

  Baltimore, my father said, was the best. Dr. Russell Fisher had recruited the nation’s best team of medical examiners and was in the process of building the most cutting-edge forensic facility ever conceived.