Dirty Work: The Social Construction of Taint

10. The Death Doctors

10 The Death Doctors Bob M. Gassaway 195 Introduction The dead human bodies arrive at the back door of the New Mexico Office of the Medical Investigator day and night, about 3,000 times a year, each one a puzzle with medical, social, and legal ramifications that need the careful analysis of a forensic pathologist. The Office of the Medical Investigator—better known to police officers as OMI— has jurisdiction by state law over any death that is “unattended,” meaning OMI investigates any death that is sudden, violent, untimely, and unexpected; or where a person is found dead and the cause of death is unknown. A lot of the cases reported to OMI—almost 2,000 a year—come as no real surprise. A local physician who has been caring for the person in recent months may conclude that the circumstances of the death are what might be expected in this situation, and that physician will agree to sign the death certificate. So these cases can be handled locally if an OMI investigator finds nothing to suggest that a more detailed investigation should be conducted. But the 3,000 dead bodies that arrive at the back door of OMI reflect the cases in which the police, family members, or physicians call on forensic pathologists to make sense of the unexpected, usually sudden, death of a human being. I undertook an ethnographic study of forensic pathologists’ work over a three-month period in 2005, during which I observed portions of about 30 autopsies. I wanted to try to understand the work of forensic pathologists. I was interested in how they handled daily contact with dead bodies. Merely being in contact with dead bodies often establishes some level of social, physical, or moral taint among people in a variety of occupations (Ashforth & Kreiner, 1999; Hughes, 1951). The Background The forensic pathologist is trained to deal with dead bodies. Other pathologists may examine samples of blood or urine or other body fluids or bits of tissue removed from surgical patients or removed for biopsy, but the forensic pathologist is trained to examine whole, dead bodies and answer two vital questions: 1) What was the cause of death? and 2) What was the manner of death? For example, a gunshot may be the cause of death. But how was the gunshot inflicted? The forensic pathologist must try to determine from the available evidence whether the gunshot was self-inflicted or inflicted by someone else and whether the shooting was suicide, murder, accidental , or not known. These specialists spend four years becoming medical doctors, three to five years in residency programs in pathology, and an additional year in a fellowship where they focus on the legal implications of their work and how to present their findings in court—the aspect of their training that qualifies them to put the word forensic in front of pathologist. Some of the people I observed were experienced forensic pathologists working at OMI where they also were members of the faculty of the adjacent School of Medicine of the University of New Mexico; others were fellows studying with the experienced pathologists at OMI. When they examine a body, forensic pathologists work at two levels. They begin with a gross examination. At OMI, each body usually is presented naked, lying on its back in a stainless steel tray that is placed atop a wheeled cart called a gurney. A field investigator who is not a physician briefs the pathologists on each case and points out injuries or other problems that were noted where the body was found. The body often is rolled onto its side so the back can be examined, then it again is placed on its back. The half-dozen or so pathologists on duty on a given day choose the cases that interest them; any leftover cases are assigned by the 196 Bob M. Gassaway pathologist who is the “attending” physician for the day. One or two morphology technicians, called “morph techs” around OMI, work with each pathologist. They move each body from its gurney to an autopsy table. The primary autopsy suite at OMI has four autopsy tables. Each table is L-shaped and made of stainless steel. Each has a 2 1/2-footdeep stainless steel sink in the corner of the table where the long and short legs of the “L” meet. The body to be examined is placed on the long leg...