The Morgue

Even though it was a lifetime ago, I'll not forget how I felt the first time I had to take a patient to the hospital morgue: creeped out.  I've gotten over that-though I'd never make a trip to the bowels of the hospital alone.  You can go alone because most places have hydraulic lifts that guide the tray into the cooler and all the nurse does is hook the straps to the morgue tray and push the buttons. I don't recommend it because of the spooky factor.

That said, I spent 3 hours with the Wayne County Medical Examiner Thursday.  This is one of the busiest morgues in the country with 8 full time forensic pathologists, performing about about 12 autopsies per day. To put that in perspective, there are only 1,400 board certified forensic pathologists in the entire country.  We have 8 of them.  I thought this lecture  was to learn how to pronounce death.  Duh.  Nope.  It was more about how to identify monkey business and extract yourself quickly, before you are lying next to granny on the bed and looking just as dead as her.

Walking into the morgue, the visitor is greeted with a long aisle of glass enclosed artifacts from death scenes.  It was fascinating.  I found myself thinking, I could work in a place like this.  I walked very slowly down that hall looking at everything.  There were tools from the drug trade including tourniquets, syringes and spoon with drug residue.  There were envelopes and stamps for LSD and cocaine scale kits.  All very interesting.  I was standing and looking at the human remains section when I saw a full thickness piece of skin from a human foot.  Degloved.  It was pretty startling to look at.  I later learned that about 4 days or so after death, the unpreserved body will shed its skin.  The degloved hand will still give up information like fingerprints once it's dried.  

The medical examiner lectured us about drug overdoses. There was talk about the fentanyl laced heroin that made the rounds about 2 years ago. We'd had at least one patient who'd died from that in our ICU in suburban Detroit. All told, about 200 people died then of accidental heroin overdose. Recently, the ME says the new thing is to lace heroin with benadryl. Again, people are dying. We were told 8 had died in Detroit in as many hours-most of them in one hospital's emergency room in the downtown area.  All had bought their drugs from the same dealer.  Interesting.   The dealer was busted within hours due to the forensic sleuthing skills of the ME's office.  If I were a cop, I'd want to have a job investigating suspicious deaths.  Most of the investigators working for the ME are former cops.

During the lecture, I learned to always roll the patient to look for knives stuck inside people.  I understand the ME will be miffed if they get a call from the funeral home about a murder after I've pronounced a natural hospice death.  There was talk of livor mortis and rigor mortis and the timing of death.  I'd learned this stuff ages ago but more or less filed it away in a vault in my brain.  I didn't need to think about this information then.  A hospital setting is about the only time a patient dies where time of death is definitely known by officials. In a home setting, the time of death is the time I get there and pronounce it. If a caregiver tells me granny just took her last breath one hour ago, but I find she is in full rigor mortis, the caregiver speaks with forked tongue.  Granny has been dead about 12 hours.  If granny's skin is marbled looking, the livor mortis is breaking down and she took her last breath about 36 hours ago.  She'll no longer be in rigor.

There were lots of slides of fishy deaths with particular attention to poisoning, strangulation and smothering. It seems, there are people out there who, for whatever purpose, try to help granny to St. Peter's gate.  Sometimes it's because they don't want to see granny suffer anymore and sometimes it's because all that's between them and financial freedom, is granny's funeral.  It takes all kinds.  If you give in to granny's pleas for relief and help her into the next world, you're committing a crime.  Murder.  In Michigan, we are particularly sensitive to the topic of assisted suicides.  Jack Kervorkian made certain Michigan would be forever associated with assisted suicide. 

Jack's way was not particularly helpful for the hospice movement.  Ours is a field where we try with all of our skill to make a patient comfortable, in their own home, in the days, weeks or months preceding death.  It is a mission, a talent and an art form.  Jack's way was a crusade and I think he was a very sick man.  I don't believe he wanted to ease suffering-I think he wanted a name for himself.  We saw multiple slides from the death scenes of his victims, they were devoid of signs of compassion.  These were places like dirty motel rooms with no comforts of home.  There were suicide notes of a sort that just said, "call my lawyer, Geoffrey Feiger."  Not suicide notes like the ones I saw in the morgue's hall of death artifacts that were more like letters of apology, talk of horrific pain, fear, mental illness, love or unrequited love.  The Kervorkian suicide notes were pretty matter of fact. There was no dignity in this type of death.  None.  In certain counties where I pronounce death, I'm required to call the police to the home of a deceased patient.  The police will investigate this death to be sure it isn't a homicide.  They'll call the medical examiner to report and he or she will decide to release the body or investigate the death-all of this because of Jack and his legacy.  Not surprisingly, these counties are where Jack wreaked most of his havoc.  Some counties have done away with this and trust the hospice nurses out there to make their own decisions about the circumstances of death.  In those counties, we call the medical examiners ourselves.  We're given the responsibility to report findings inconsistent with a natural death-we are entrusted by the ME to do this.  Woe to the nurse who lets a knife in the back slip past her skillful gaze.

Late Thursday night, about 10 hours after my day began, I got to put my newly learned forensic skills to work.  I walked into the home of a patient who, while gone from this world, looked well tended and cared for.  All around her were the comforts of her home and people who loved her.  She'd been freshly bathed and looked at peace.  Thankfully, it was not at all like the slides I'd seen earlier in the day.