Last time I wrote, it was about fingerprinting old school. I promised to write about processing in the lab.
No. No. No. I am old and female, giving me the right, no, two rights… to change my mind. We are talking a bit about blood and guts today. The autopsy. This is for writers who want more realism (not CSI — fake, not NCIS, fake) in their fiction.
So … you may ask. Go ahead. Fine by me. ‘Where do you get off thinking you are an expert?’ Well… okay, cool, be rude. Oh wait, that was my question, ahem. I’ve amassed over time search/rescue techniques useful; volunteer forensics with sheriff’s department, webinars, seminars, anatomy classes with gross dissection classes, and thorough training & bucks (and I mean a lot–spent a gazillion clams for FBI and National Forensic Science Training Institute).
In the medical field for 30+ years, I know the lingo, and writing about procedures in the hospital/trauma/office, I also have down. But, yes I was a CSI / NCIS junkie… but found out they had a lot of fakery going on in their shenanigans, and since I write fiction … I turned to the real world.
This information will give you a full autopsy — not you personally, but the lowdown. You’ll see procedures here that are real.
So, let’s begin … My main character, Catherine Cade (amnesiac) in How to Steal a Romance works as a volunteer (long story) and finds she has skills (again, long story). The first visit to the morgue (here, called the Dead Room), she performs an autopsy under the strict supervision of the medical examiner for legal reasons. Prior to this autopsy, he asked her to direct his every move on a Jane Doe. I left names and character interactions out:
I started. “Who have we here?”
“Unknown Hispanic male, found off the parkway, no ID. No tattoos.”
“In the big homeless campground?” I pointed at his hair and fingers. “He’s clean cut. Did you scrub under his nails?”
“Of course not.”
“His crew cut and clean nails don’t scream homeless to me. Who found him, and where?”
“Under the bridge by another homeless man. His clothes were filthy, torn up.”
I checked his hands. “It’s not conclusive. Callouses on his hands, some arthritic changes, consistent with manual labor. Musculature to upper and lower extremities are well-developed. What about trace evidence? Any dirt or grass from a different area under the bridge?”
“Tech is going over clothing and particulates. We obtained samples from the scene to compare.”
“X-rays? Did you get prints to send to IAFIS, swab for DNA?”
“All done.” He pointed to the films.
I stood at the old-fashioned x-ray box. “He’s had dental work.” I pointed. “Here’s a fracture of the nasal bone, some tissue swelling here, suggests fall or altercation.” I stepped to another light box and viewed the vertebrae. “Cervical fracture, thoracic and lumbar fractures. What’s this?” I examined an image of his leg. “Spiral fracture.”
“Not for this poor guy. Grab the mic and turn it on when I tell you to. Lower the table a bit, if you would.”
“Comin’ down.” He lowered the table and winked.
Gonna be a long autopsy.
He held the mic.
I turned to face my patient. “Talk to me John Doe. Tell me why you died. Okay, turn the microphone on. Adult, well-nourished Hispanic male, appears to be in his mid-thirties. External exam shows multiple bruising, over right posterior to anterior neck, right. Multiple abrasions right lower leg. Mic off.” I took more pictures and my eyes drifted past the medical examiner as I contemplated what I found.
“What?” He asked.
“I’ve seen this before. The fracture with the abrasion. I could be wrong, but I think he caught his leg in something like a chair or ladder, fell, causing a spiral fracture and fractures to his back and neck.”
“You’ve seen this before?”
I didn’t know when and hesitated. “Sometime back. Here’s the x-ray—fractured nose and the surrounding tissue engorged with blood visible even on plain film. Cervical fracture is different. Any wood, plant particulates I want collected.”
“What do you think?”
Silent, except for recording the procedure, I made an incision from the mastoid process behind the ear, extending coronally to the opposite mastoid, reflecting skin and muscle away, one centimeter above the eyebrows. After evaluating, I exposed the occipital protuberance, and used the vibrating bone saw to cut horizontally on both sides from the center of the forehead to the base of the mastoid process. Further cuts and notches allowed me to remove the cranium, evaluate, and lift out the brain for closer inspection.
“Mic on. No traumatic injury noted to base of skull, despite fracture to cervical vertebrae three and four. Absence of bleeding to the brain and interstitial tissues are inconsistent with a fall. Bruising to neck, lateral, sternocleidomastoid to posterior. Mic off.”
“Well? Any ideas?”
“Yeah, music would drown out your voice.”
“Wow. Boss lady is snippy.”
I didn’t miss a beat. “Gee, wonder how many times I’ve heard that one. Mic on.”
I made the Y-incision from collarbone left to right, past the sternum to the pelvis. “Clip the sternum for me. I need you to grab the enterome above you, hand it to me when I ask.”
I snapped my gloved fingers, held my hand out, and weighed the organs. I used the enterome to shear them open. “Taking samples for biopsy of mouth, esophagus, stomach, colon, liver, trachea, lungs, heart, bladder, spleen. Mic off.” I handed the samples to the medical examiner after I weighed the organs and he put the samples in paraffin wax.
I asked, “What did homicide say about the scene?”
We both put a new pair of gloves on. “They wait for me to tell them.”
“What do you think?”
“Undetermined. Possible scuffle out of hand.”
“Microphone on. John Doe’s liver normal. No sign of cirrhosis, no enlargement.” I added what the m.e. told me. “Alcohol negative, awaiting other toxicology. Mic off.”
“Mic on. He has a postmortem fracture to the base of his skull. Bruising on his neck, premortem. Blunt force trauma after death. Mic off. Why? Maybe a chokehold. Spit balling. It’s possible John Doe fell from a ladder and caught his leg, or someone helped him fall. Someone busted his nose and held him in a chokehold until he died. Then, a killer fractured his neck—but after death, there’s no blood associated with the trauma.” I hesitated. “We deal with the evidence, but my gut says this man was murdered.”
“You think the victim knew his killer, if you’re right?”
I paused. “Impossible to say. The fractured neck could mean anything.”
“We’ll toss it back to homicide.
I tossed my gloves into the hazardous waste trash, left the Dead Room and showered.
That, without the interactions and names is an authentic autopsy. Remember, a dissection is far different than autopsy, so if you are going for what a med student deals with, let me know. Got that, too.
From my second novel, Nobody Girl, I introduce my main character who as a cop, has never had a dead body in her rural town, nor seen a autopsy just like this. I’ve left names out at this point. This is with my agent:
The coroner unlocked the door to the cold morgue room, and pulled one of the three refrigerated body boxes toward us on a wheeled rack, revealing the victim’s remains. The putrefaction almost overwhelmed me. I gagged, and he handed me the peppermint. Tempted to stick the bottle up my nose, I instead put a small dot under my nostrils.
“Take a look at the x-rays. No other fracture except her right occipital lobe—and whatever tore through her.” (The coroner) pointed. “Let me show you what I found—beside the obvious.”
He walked to the table and uncovered the body.
Oh, no, I could have gone the rest of my life without seeing this. He had cut through the skin and skull and pulled her face and skin down over her neck. My knees wobbled. (My partner) stepped behind me and grasped me by the back of my jeans. He pushed his right knee between my legs. No doubt he’d bend his knees if a human chair became a necessity, or if I slid down and fainted.
(He) whispered, “Are you okay with me keeping you upright? I can let you drop, if you want. Toss you outside?”
“Whatever you do, do not let go.”
I prayed, hoping (my new detective’s) professionalism would carry me through this awkward and uncomfortable autopsy evaluation.
(The coroner) said, “I took the liberty of removing the connective tissue to show you this. I found small pieces of wood imbedded in the skin, not the bone, consistent with where we found her. More for my practice than needed. This happened premortem or perimortem, but I am sure that’s not the reason she is dead.”
“No?” I wanted to leave. I averted my eyes. The victim’s feet were visible, and if I could just keep my eyes there …. Her toenails, painted an off-white French nail-style, had otherwise clear glitter. The dirt cleaned away, her feet were something I would expect of her—perfect, but very dead—and thanks to our coroner, she was faceless. I shouldn’t have compared her feet to mine, but she didn’t have funky-looking runner’s feet. This mental exercise did keep me from looking at the degloved head.
(The coroner) pulled the sheet down to her torso. “This puncture wound. Perforated her saline breast implant. Whatever did this spiraled and decompressed and tore tissue, coring through. Nothing else except some tiny bits of metal. Didn’t see them until I re-examined the x-ray. I’ll let Duluth handle that. Looking at the entrance wound, I’m guessing a diameter of 6 inches.”
“What’s the ammo that could produce this?”
(The homicide detective) crossed his arms. “The JDJ .950 can produce an entry hole that large. Has a two-hundred pound kick. Small cannon. Largest rifle caliber out there. If that was the rifle used, it would leave bruises on the killer’s chest.”
(The coroner) shook his head. “The other conundrum is the wound tract, it has a pattern, just an uneven pattern. After the fatal wound, she fell, hit her head and fractured it, the tissue swelling said she didn’t die instantly. Someone took a rock to her face as she bled out. Poor girl suffered.” He glanced at me. “Check the edges of this wound, here. There was no surviving this. I estimated the exit wound is much smaller.”
(Detective) shifted. “Have you seen this before?”
(Coroner) removed his gloves, washed his hands, and rubbed his balding dome. “Son, I’m a family doctor and volunteer coroner. First time to deglove a head, too. So, no, I haven’t. It’ll take me some time to figure this one out.”
Next up … a visit to the Body Farm, including some scenes from How to Steal a Romance. Which will be disgusting.
Aren’t you excited?
And as always, please visit Kristen Lamb’s blog for writers: 13 Ways Writers are Mistaken for Serial Killers — Kristen Lamb’s Blog http://authorkristenlamb.com/