ME day 2

My first two days at the ME's have been accompanied by mysterious crippling nausea of unknown origin, blunting my initial desire to blog ravenously about my experiences. I'm hoping that the nausea is not of the existential variety, as it will subsequently be a long month. Nonetheless, a few thoughts:

Things that happened that I expected:
1. The bodies have generally been the apparent "usual" first-of-the-month old people that have died alone in their residences -- called "solitaries" by the MEs. Apparently there's a bunch of these cases at the beginning of every month when landlords come in to check on tenants that haven't paid their rent.
2. I did indeed learn on my first day how to collect vitreous humor, that is, to stick a long needle into both eyes to collect fluid for electrolyte and toxicology analysis. Sticking a needle into the eye was only gross for the initial puncture - once in the eye, it didn't seem as gross. Plus, the eyes looked pretty dead, so it wasn't as freaky as I had suspected.
3. The medical examiners have awesome big black jackets with "Medical Examiner" in yellow on the back. They look very bad ass.
4. I saw my first forensic case yesterday - a 20-something woman who died in her car after a late night car crash. She had a bunch of blunt force injuries -- "pulpified" liver (a new term for me), a huge gash on her forehead, a bruise from her(only partially worn) seatbelt, a huge scalp bruise, many broken ribs, and bruises around the heart. The cause of death was massive bleeding from her internal injuries due to blunt force trauma. We treated the case like a homicide, and collected a million things for testing -- vitreous fluid, spinal fluid, blood, bile, stomach contents, hair, small pieces of organs -- and then labeled them all in a complicated color-coded labeling system where multiple labels are applied, with the last labels wrapped around the side and tops of the samples and signed for chain of custody purposes.
5. Today, I got to go to court and watch the chief ME testify in a case that sounded like a hit-and-run. It was cool to watch how she phrased her testimony -- a lot of semantics and restating questions and over-stating the obvious. Lots of hedge-y words like "could be consistent with". There was a long discussion over the definition of what a pole is, exactly, and also what an abrasion was. Everyone was wearing pinstriped suits.

Things that I learned that I didn't expect:
1. That we evaluate something called "rodent activity".
2. That my bookshelf would contain a radiologic atlas of torture.
3. That I would get homework that involved extensive practice in writing the cause and manner of death.
4. That the MEs here make $250+ a year!
5. That the MEs also get to wear big firemen hats that say "Medical Examiner".

I'm "on call" tonight, meaning that the ME on call will call me if she gets called to any crime scenes. Crime scenes!

Medical Examiner's Eve

Tomorrow morning, I head out to the medical examiner's office. I have been asked to bring my own medical protective wear, shown here in two giant bags. Included are giant Tyvek suits, and N95 respirator masks. I'm not even sure what else is in the bags, as they were packaged for me and I was instructed to take them, and that they contained everything I will need.

I approach this rotation with the common medical school/residency combination emotion of excitement and dread. I felt this way with my first autopsy, my first Whipple specimen, the first time someone told me "you have a toxic megacolon waiting for you in the fridge".

I spoke with one of the assistant medical examiners last week and she told me which alleys I needed to drive into to find the back entrance of the ME's office. Apparently, I'm supposed to travel from one alley into another, then go into a parking lot that says, "Ambulances Only", then press a button that has a musical note on it, and wait for someone to let me in. I like how these instructions seem vaguely out of a spy movie, or, are strangely reminiscent of this old Macintosh game Deja Vu, where you have lost your memory and have to do all these crazy things to try to figure out who you are, or who you used to be.

That game kind of enmeshes, in reverse, with this feeling in medicine, where you are changed by random events you can't control, like watching a child die in the ICU, or doing an autopsy on a man while his watch, removed, is audibly ticking on the table beside you, or you hold a "dead" man's heart, still beating, in your hands, after the trauma team has pronounced him dead -- these events that you can't predict, and didn't think you would see, but then, all of a sudden, because you happened to be there, you've seen them, and you can't go back to the person you used to be. Then, you have to try and figure out who you've become.

It's strange to know this will happen this month - that I will see things that I don't want to see, cannot predict, and will not forget. Things that will change the way I see people and the way I think about life. I sometimes obsess about the last moment I remember before something big changes -- like the day before school starts, the day before you meet someone and fall in love, how I was watching War Games the night before September 11th. I think that people don't spend enough time thinking about the end of an era, so to speak, before an era is over. But perhaps my definition of era is quite loose. But, to me, memorializing these moments is part of figuring out who I'm about to become, and who I was right before I became someone else.

My above conversation with the medical examiner also included recommendations and advice:
"Eat a good breakfast. The smells in the there are easier to take on a full stomach."
"If you don't want to do the decomps, that's fine. If you don't want to see the decapitations, that's fine."
(In response to my subsequent necessary question "ARE THERE A LOT OF DECAPITATIONS?!?!?"): "No, but this week has been burn victim week. I'm not sure why."
The medical examiner also mentioned that I might be labeling evidence. I am also apparently not allowed to talk to local newspapers about any of the cases I see. Other residents have mentioned having to pick out maggots and put them in a jar, and having to measure the length of maggots to determine the time of death. I have heard many colorful accounts of what the smell of decomposing bodies smells like. Other residents have told me how great it is that you learn how to withdraw vitreous fluid from dead bodies (that's EYE fluid, people).

All these things are why I seem to be spending the night not diligently reading my Forensic Pathology textbook, but rather nursing a Bass and playing a seriously pathologic amount of Super Mario Galaxy.