Gruesome perhaps, but necessary and worthwhile

One of the goals of our retirement community is to encourage people to continue as life-long learners. Retirement doesn’t mean turning off the brain. On the contrary, having more time opens up opportunities to explore new areas of knowledge. Curiosity gives life to old bones. And old brains.

In this retirement center, opportunities for learning abound. A resident committee dedicates itself to finding interesting speakers and workshops; this week a professor from the university across the street is speaking on “Civility in Polarized Times.” A few weeks ago, a Vietnam vet (and resident of this community) talked from personal experience on the ongoing emotional trauma war veterans face. The art committee frequently invites artists to demonstrate their craft. The community life department organizes outside excursions; in a few weeks those who want can ride the bus to the Rice Museum of Rocks and Minerals of the Pacific Northwest. And on and on.

And, of course, learning takes place through books. I’ve been a reader all my life, and retirement gives more time to read all kinds of books. The retirement community has its own well-used library. Belonging to a book-discussion group helps with processing what we read.

This past week I’ve been inhabiting another world, learning about a line of work I only experienced watching detective/murder movies on TV (not my favorite kind of show—and apparently full of misinformation). It’s the world of forensic investigative medicine. The world of autopsies, something I’ve not been interested in. Until now.

The book is a memoir by Judy Melinek, M.D., assisted by her husband, T.J. Mitchell. It’s called Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner (2014). The author tells the story of her two-year internship (2001-2003) in New York City, working in the Office of the Chief Medical Examiner (OCME), the office that investigates homicides, suicides, drug overdoses, and disasters. She describes her role as follows:

A forensic pathologist is a specialist in the branch of medicine who investigates sudden, unexpected, or violent deaths by visiting the scene, reviewing medical records, and performing an autopsy—all while collecting evidence that might be used in court. Like a clinical pathologist, she has to recognize what everything in the body looks like, but the forensic pathologist also has to understand how it all works…. The forensic pathologist is the medical profession’s eyewitness to death—answering all the questions, settling all the arguments, revealing al the mysteries contained in the human vessel. “One day too late,” my clinical friends like to joke.

At the beginning of the book, Melinek assures the reader that, “I’m not a ghoulish person. I’m a guileless, sunny optimist, in fact.” Part of the book is the story of how she journeyed from surgery to general pathology, finally realizing that forensic pathology challenged her and gave her the most personal satisfaction. She writes with humor that, “I didn’t start off wanting to be a forensic pathologist. You don’t say to yourself in second grade, ‘When I grow up, I want to cut up dead people.’ It’s not what you think a doctor should do.” But in the end of her professional search this very role become her calling.

Melinek’s story demonstrates a combination of objectivity and compassion. Concerning objectivity, she writes that “You have to suppress your emotional responses or you wouldn’t be able to do your job. In some ways it’s easier for me, because a dead body really is an object, no longer a person at all. More important, that dead body is not my only patient. The survivors are the ones who really matter. I work for them too.”

She demonstrates compassion through the stories of the people that death put on her operating table. The book is full of stories. The different chapters deal with deaths by poisoning, violent accidents, homicides, suicides, natural disaster, and man-made disaster. A chapter is given each, with stories of the people and details of how she went about her investigations, including details about the autopsies and how she discovered the secrets the bodies revealed.

It was disturbing reading and I had to steel myself in parts, practicing objectivity. This was possible because of Melinek’s obvious love of and respect for the human body and her fascination with its intricacies, even in a state of decomposition. That combined with compassion for the subjects of her investigations and their families helped me read my way through the book.

The longest chapter in the book is titled, “DM01.” That stands for “Disaster Manhattan 2001.” 9/ll. All cases for identification would be coded DM01-1, DM01-2, and so on. The workers at the OCME were in shock that day, as was the whole nation, and it soon became clear the dauting task ahead for the forensic pathologists. OCME headquarters became the center for the identification of remains from the disaster. Tents were set up in the street around the building, much like we witnessed during the recent pandemic. Thirty medical examiners joined the team and they worked 12-hour shifts around the clock. The work went on for 8 months, with remains being discovered even after the investigation was officially closed. Melinek estimates that she had 598 DM01 cases assigned to her. A year after the disaster, the team had issued 1,389 death certificates, the other 1,344 missing persons declared dead by judicial decree. The author noted that, “Many families expressed their gratitude that our office, and the funeral directors who acted as intermediaries, had helped them to mourn even in the absence of remains to bury.”

This gave me an entirely new perspective on 9/11, just as the whole memoir gave me a new understanding of forensic pathology.

Since 2004, Dr. Melinek has carried on her work in San Francisco where she lives with her husband and two children. Looking at her life’s work, she writes that

Every day I learn something new about the human body. I love the work, the science, the medicine. But I also love the nonmedical aspects of the job—counseling families, collaborating with detectives, testifying in court. I find I work hardest at these roles, at speaking for the dead. Every doctor has to cultivate compassion, to learn it and then practice it. To confront death every day, to see it for yourself, you have to love the living.

      As I wrote above, this book was like a walk through another planet. I learned something new about the world, about the value of work. I gained a stronger appreciation for people called into roles that most of us might find repulsive, but which are a necessary part of our living together in society. And I was reminded that any job can be carried out with integrity and compassion.