Russian Roulette Hastens One’s Mortal Departure—Medical Examiner

Nothing in medical school or interneship—except for the tiny part of actually learning how to officially “pronounce” someone “dead”—had prepared me for taking on the role of County Medical Examiner—the ways people find themselves dead are as varied as the personalities they were in life. Being the Medical Examiner required me to physically go to each scene in the county where a dead body had been discovered—as close as possible to the time of the discovery—to make a determination that the person was 1) actually dead, 2) to do a preliminary exam of the body and scene to try to find out why they were dead, and 3) to collaborate with the police agencies and pathologists for a final official report and death certificate.

In the Spring of 1982, for a bit of family change of routine and venue, my wife and I and all our kids decided to get together with friends—another couple who also had several children. At their house, the other Dad, Dave, presented a short spiritual message to the combined families, then handed everyone a treat as the kids all tornadoed off to play throughout their house while we four adults anticipated a relaxing chat at the kitchen table.

Instantly, as the kids dispersed, my pager beeped six shrill chirps—I borrowed the phone to call the number—it was police dispatch—she said I was immediately needed for a Medical Examiner case. Rolling my eyes, I explained the intrusion to my wife and friends. The case was only a couple of miles from our present location, so I stood to leave, knowing that ME cases usually didn’t require much time on the front-end exam.

ME calls were always attached to a bit of urgency, however, since there were usually several investigating police officers standing around waiting for the Medical Examiner to arrive to “pronounce” the body (dead) so they could release it to the on-call mortuary and get off-scene and back to routine. Most police officers, even though they confront it often, are not very comfortable with death—especially babysitting a dead body till the ME arrives.

In this case, that was especially poignant, since the victim was a 16-year-old who had been shot in the head.

As I got up to leave for the call, knowing I’d be back soon, turned and asked Dave if he wanted to go along. “Sure!” This was outside anything he’d ever been involved with before, and it sounded lots more interesting than staying behind listening to the mothers brag about their kids.

The flashing red-and-blue lights from a half-dozen city police cruisers made it easy to spot the location in an older fairly-dark neighborhood—I had trouble finding a place to park—there were cars everywhere—weeping and distressed friends, neighbors, and every family member from a ten-mile radius had already converged, filling the house and spilling out the front door and down the sidewalk. I didn’t relish the idea of trying to joggle my way between the nearly-hysterical mourning folks outside the front of the house, but I didn’t see other options. Recognizing my car and anticipating the dilemma as I exited my door, one of the police officers came up to us and told us that the easiest approach was through the back door, since the victim was in a back room anyway. He offered to lead the way.

I made a cursory introduction between the officer and Dave as we threaded our way toward the dimly-lit back door amongst police cars with flashing lights and crackling radios—passing through the wooden gate barely-hanging by its hinges into the backyard. The gauntlet continued down a dark dusty path from the gate to the door—I gingerly followed the uniformed officer, Dave following my footsteps. Three large German Shepherd dogs stood just off the shadowy path—one on the right, two on the left—this was THEIR domain, it was clear. None of them appeared overtly-aggressive, but with the numbers of agitated people and all their weeping and wailing, with the flashing police lights, and the enveloping pervasive spirit of gloom, the hair was bristling on the dogs’ necks. I was thinking that I sure hoped we could get past them unchomped. The policeman indicated that the dogs had—up till then—been docile. One second later, however, as Dave was passing by the last of the three, the dog’s head and neck shot out, his teeth grabbing Dave’s pantleg and thigh. The officer jumped, the dog retreated.

It was too dark on the path to examine Dave’s bite, even with the officer’s police-issue flashlight —Dave assured us he didn’t think it was serious, so we pressed on. Once the dog had established his position with his teeth, he retired off the path a few feet. Why he picked Dave to demonstrate that position was an unanswerable question.

The wooden back steps were barely illuminated by a single, dim, bare light bulb hanging over the door frame of the clapboard-covered back porch. The officer and his light led us through a narrow walkway between stacks of cardboard boxes, turning left into a bedroom near the back of the house—the hallways, living room, and kitchen were filled with sorrowing, grieving family and friends—many openly sobbing for this dead child—the wailing volume diminished a bit as they saw us enter the back of the house.

Seeing this young man sprawled lifelessly across the blood-spattered bed immediately forced my thoughts to my own daughter near his age, and I momentarily empathized a twinge of the agony his parents must be experiencing at that moment, knowing how I’d feel if circumstances were reversed. The officer filled in the details he had been given: this 16 year/old boy was hanging out with his friends; someone produced an “unloaded” pistol; he began spinning the cylinder, playing Russian Roulette—and LOST—when the .38 discharged into his left temple.

Because of my strong religious background, and having been raised on a ranch witnessing numerous animal deaths, I have never had much of a problem viewing deceased individuals and doing the ME investigations. However, children’s deaths have always been harder for me than adults’. And the proximity of the multitude of nearby grieving grownups and youth made this one even more difficult.

Even though it had already been over an hour since the incident, in the dim room I obligatorily checked for signs of life—carotid pulses (none), skin pale—no capillary refill, apical heart sounds (likewise none), and pupillary reflexes—both pupils dilated and fixed, the corneas now dryish. Trying to take it all in and make sense of the whole circumstance, I stood for a few moments and just gazed at the lifeless body that an hour before had been full of vitality and happiness—now joy was not to be found anywhere in this place. Gloom was oppressive. Dave was also lost in thought.

Another police officer entered the room and told us the mortician had arrived. We stayed to help them load and zip the body into the heavy black plastic body bag, covering it with a red fuzzy velour funeral blanket on the gurney for the return trip through the back porch-door/backyard gauntlet. Dave, the officers and I wordlessly plodded behind. The dogs were nowhere to be seen.

As we drove in silence back to Dave’s house, he interrupted the quiet asking, “I hope you’re writing these things down, Carlin?”

“No”, I said matter-of-factly, “This is an everyday occurrence for me.”

“But it’s not for folks like me. You should write these experiences down.”

I’d never entertained that perspective before, so I told him I would.

Back with our own healthy, happy, vibrant families, Dave and I were still somber—the contrast to the scene we’d just left was humbling and filled me with gratitude as our families prayed together before our return home. We prayed for the mourning folks we’d just left. Dave’s leg was contused, but the skin unbroken—the pants were torn.

I reflected on Dave’s admonition and resolved to do better—in recording my unusual life and at being a Dad

Pap Smears and Tools of the Trade—Dr-Patient Relationship

Subtitle: Blurry Bottoms—Hand Me a Screwdriver (1987)

For two years Maryann, an attractive mid-30s brunette, had been putting off getting a Pap smear because she didn’t particularly like the OB/GYN doctor she had seen in the past—he was somewhat cold and distant—made her feel uncomfortable, so she put off going. Finally, fear and guilt took over, so she asked her friend for a new doctor recommendation.

Over the years, because of my wife’s hypersensitivity (at least from a male’s standpoint) to being over-exposed “in the position” for a pelvic exam, I had become very conscious of and sensitive to the feelings that most women harbor about being “in the position” with a man doing the examining (notwithstanding Jane, my nurse always standing nearby). Because of my kindly and non-patronizing demeanor and my gift to be able to assist women in feeling a bit of security in an uncomfortable situation, I had gained a reputation as a safe, caring gynecologist. However, my personal or family female friends either came to see me BECAUSE I was gentle and sensitive, OR, they would NEVER in a thousand years come to me for a pelvic exam, because they imagined that if I run into them at the store or church, I’d remember what their bottom looked like (in actuality, for medical providers all the bottoms become sort of a blur, anyway).

So, following her friend’s recommendation, Maryann sheepishly presented at our office. Taking a brief new-patient history, Jane showed her into the exam room and handed her a folded paper (“maximum exposure/minimal coverage”) gown with instructions to take off all her clothes, don the gown with the opening in the front and sit on the end of the table. Moments later, I joined them.

I glanced at the history form—Maryann was essentially healthy, although it was apparent that because of “new doctor/Pap smear” complex—she was understandably jittery, so we made some small talk to help her be more comfortable for the assessment, and with Jane holding her hand, I began with a breast exam—all went well.

Then, with my back to them, I slid on my latex gloves while Jane assisted Maryann to lie down and put her legs up in the stirrups. Over the years, I found that if the patient can’t see my face because of the drapes and position, they are less uncomfortable—kinda like “if I can’t see you, you can’t see me” sort of disconnect. I sat on a stool facing the bottom end (no pun intended) of the exam table, where, just in front of my knees, were two instrument drawers storing the exam speculae (the “duckbill exam thingies” as they were known to many female patients). Maryann was fully-positioned ready for the instrument exam. I applied KY gel to her and reached to open the drawer to pull out a sterile speculum. The chrome drawer handle fell off in my hand! I was unable to open the drawer to get the exam instrument!

Then, in one of those moments you’d like to go back and relive so you can phrase something differently, I unconsciously said, “Jane, hand me a screwdriver!”

I’ll never know exactly what went on in Maryann’s mind that moment, but instantaneously she was sitting straight up on the table with one arm covering her breasts and her thighs pressed together—I just barely got out of the way of flying feet as she screeched, “What are you going to do with THAT?”

Too late to rethink my phrasing, I immediately realized that I had done a massive faux pas, worsening an already bad situation.

Jane promptly grasped Maryann’s hand again and patted it as I displayed the errant loose drawer handle, apologizing for my poor choice of wording/timing. After a short, very quiet pause, we all had a hearty laugh—it broke the ice and the remainder of the exam was quickly completed without incident.

Maryann ended up coming back for her Pap smear year-after-year, but each year before she’d lie down on the exam table, she made me prove the drawer handle was functioning and that no screwdriver would be needed.