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Body of Evidence: 7 Questions with a Forensic Pathologist

Published: May 8, 2017

What do you know about post-mortem examinations? The reality of this specialized medical field differs from T.V. crime dramas. Dr. Brandon Reilly discussed the declining numbers of autopsies in the U.S. in the May/June article Secrets of the Dead. We spoke with forensic pathology fellow Grace Dukes, MD of the Cook County Medical Examiner’s Office about the ins and outs of performing autopsies for a living.

Did you always want to be a medical examiner?

I did not. I knew it would be something based in the science world. I sort of landed on medicine. I went to medical school, and I didn’t actually know about pathology until I got there. During my first year a pathologist spoke with us about the practice in general. I did a summer internship in forensic pathology, and I got to see forensic autopsies. That’s where it got started.

How does a typical day go? Do you often perform autopsies? 

Yes, often. Not every day. Multiple people in our office will perform autopsies every day, and I’ll cut every couple of days.

A normal day — if I’m doing autopsies that day — I’ll come in in the morning, and I’ll read about my cases and try to learn everything about the medical histories and circumstances surrounding the death. Then I’ll go into the morgue and do the autopsy. After that, I’ll be dictating my findings, trying to wrap up loose ends, requesting things from investigators — additional pieces that I need.

When I’m not doing autopsies I’ll be writing reports, working with investigators to get additional pieces of the puzzle, interpreting toxicology findings, viewing microscopic slides. All of it is to come to a conclusion about the cause of death.

How long does an autopsy typically take?

It depends on the case. A relatively straightforward autopsy — with few anatomic findings — will take probably 45 minutes to an hour. If there are more complicated things we need to do — special dissections or retrieving bullets — that could take hours.

If we get a homicide, for example, with lots of injuries, we have to document those injuries both on our charts and photographically. If there are gunshot wounds we have to document the pathways of the bullets, the organs injured. If the person is holding a projectile from the gunshot that has to be retrieved. That can take a lot of time.

Are all autopsies the same? 

We will do the same procedures in each case, if it’s a full autopsy. They vary by injuries and anatomic findings, but we examine the body in the same way. We do an external exam and an internal exam, looking at all of the organs. That process is the same for every case.

Would you say it differs from a typical Hollywood portrayal of a medical examiner?

It’s different.

I have seen some of the T.V. shows that portray medical examiners, but I did not grow up watching them. That’s not what got me interested in pathology, but since I’ve started I have gotten into it.

The biggest difference is probably the turnaround time for results. D.N.A. testing is a big one. That actually takes months usually. Toxicology testing can take weeks. A lot of that takes much longer than is portrayed on T.V.

Another big difference is within the morgue when you’re doing an autopsy. At our facility there are four different autopsy tables functioning at the same time. When you see it on T.V. it’s usually in an isolated, dark room, usually quiet. When we do our procedures it’s actually not quiet at all. There’s a lot going on.

Usually it’s for dramatic effect. Everyone’s focus is this one body and this one cause of death, and they can just look at the body and tell something immediately. That’s not usually the case when we’re actually doing an autopsy.

Have you ever faced a scenario on the job that shocked you? 

We see things every day that the general public might describe as shocking.

We’re trained professionals. We’re trained to handle the things we see. When we’re here the focus is more on the job and cause of death determination and less on the fact that it’s shocking.

There’s a lot you could be unprepared for in that every case is so different, and the things you could see on a daily basis are always a surprise. You could get used to doing multiple gunshot wound cases, and there’s an aspect of it that becomes routine, but then there’s always a case where the circumstances are surprising. Nothing changes about what I would do during my work.

How does problem solving enter into your work?

Our job is to determine cause of death. Every case we encounter is — a problem is not the word — but it’s similar to a physician in a hospital with a patient with several pieces of the puzzle that may or may not add up. They have to use the information they’re given to come to a conclusion about the diagnosis. We really do that exact same thing. It just happens to be after the person has died.

 

Check out Secrets of the Dead from the May/June issue about autopsies in the U.S.

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