05 March, 2012

My Exorcism, Chapter 11, Part I ~ "Creatures Running Underground"

"He was quiet... kept to himself."
"I never really knew her, but she gave me a weird feeling."

How many of us really know our neighbors?  Personal observation and experience, along with anecdotal accounts tell me that the closer our quarters, the less likely we may be to know the people surrounding us.  In a quiet suburban neighborhood, the homes are spaced apart by yards, fences, and trees, yet connections, shared activities, and friendships frequently exist.  I grew up in a rural setting, and what few "neighbors" my family had, we knew quite well, even when distanced by many acres.  Yet, look at apartment living:  dwellings in which walls are shared, and where one person's floor is another's ceiling.  Who are these people below, above, and next to us?  Who really knows all of these neighbors well?

If you have been following these stories sequentially, you know that when I was well into my fourth year at the Delaware County Medical Examiner's Office, a new pathologist was hired to oversee the office. Dr. Fredric Hellman began his position as the Delaware County Medical Examiner in April of 2000.

No time was wasted indoctrinating him into this new position.  On the afternoon of April 4, 2000, the investigator's line rang.  I answered and took a report of a male reported dead in his home in Upper Darby.  His death appeared to be a homicide.

As with many death reports received by our office, detail was initially lacking.  In this instance, it was enough to know basic information about location and probable manner of death.  Dr. Hellman and one of our college interns (who became and still is a dear friend) accompanied me to the scene.

The area of Upper Darby in which the death occurred is, in many ways, a typical urban, east-coast blue collar neighborhood.  The row homes are generally well maintained with small, neat front yards and well-kept fences.  Off-street parking is nonexistent.  When we arrived, the street was blocked by parked cars and emergency vehicles. We were not able to park our transport vehicle anywhere close, but we found a suitable place nearby, carried our gear toward the scene, and connected with the police and paramedics to begin the fact-finding part of the investigation.  As we spoke to Upper Darby detectives, we learned that the decedent was a 22 year old male who lived in the house with his family.  His mother last saw him alive when she left the residence for work early that morning. When she returned home that afternoon, she found the house in a state of disarray and her son deceased in an upstairs room.

It took awhile before we were able to enter the scene, as is customary with cases where police must carefully gather evidence and document surroundings.  Tension was running high among us all; so many unknown factors were present.  No one waiting outside knew what to expect to find inside.  No one really knew what to expect from our brand new and somewhat youthful Medical Examiner.  I imagine he did not know what to expect from any of us, either.

We waited.   The temperature was mildly chilly with some intermittent spring drizzle, but it was not unpleasant.  We continued to wait.  Family, friends, and curious observers lingered around the perimeter of the house.  Neighbors came and went.  Eventually, Dr. Hellman expressed the need for bladder relief, so he knocked on the next-door neighbors' door.  He wasn't gone long, and when he returned, he reported that they seemed like a nice family, graciously allowing him the use of their facilites.  They had an infant who he played with briefly.  The doctor clearly missed his family, who had not yet moved from Georgia to Pennsylvania.

Eventually, we were able to enter the premises of the crime scene, which was the house where the decedent, Constantine Polites, lived. To me, the house appeared neat, save for some rather obvious messes that instantly struck me as contrived.  So many things I saw made no sense, even during a cursory scan.  But my focus - my obligation - was primarily to observe, document, and preserve the integrity of the decedent in his current state, then to collaborate with colleagues and detectives to investigate the circumstances surrounding all of these factors.

Although the young, deceased man on the floor of an upstairs bedroom was certainly quiet, his injuries screamed out to us.  He was bound with cords, and had a pillow secured over his face.  He had been shot.  He had been stabbed repeatedly, and had a rather redundant incised wound to the neck.  In a word, it was overkill.  And my gut instantly wrenched up in the way that it only does when an act or event feels deeply personal.

There is no need for scene minutia to be described here.  It did not take long for Upper Darby detectives to assemble the facts and suspicions in this case, and to conclude who perpetrated the act.  And it did not take long for our brand new pathologist to feel the chill of having been unsuspectingly inside the home of those who participated in the murder he was investigating.

I refrain from disclosing any private details discussed with a decedent's loved ones, but I feel compelled to mention that Constantine Polites's family members were among the kindest, most genuine people I have ever talked to under such sorrowful circumstances.   I truly felt their grief, and I hope they are doing well in life, despite such a tragic loss.  And I hope that somehow they are able to process not only the loss, but the betrayal and horror that two of the three perpetrators who killed Constantine were teens who lived next door.

How well do you know your neighbors?

The Murder of Constantine Polites. (link)

The Conviction. (link)

04 December, 2011

My Exorcism, Chapter 10 ~ "Nightmare Running Races Skyward"

There are good reasons why I have not contributed anything to this blog for more than five years. Incredibly enough, other chapters are close to being ready for publication, and have been for some time. The "investigating suicides" blog has pertinaciously refused to write itself, and somehow I have not been able to bring myself to finish and post any of the others until winning the battle against that refusal.  

It is a tough one, my friends.  While all discussions of death are difficult for many on some level, in this one, I'm going to discuss a manner of death that is unique to all others, and it is the one death topic most avoided.   No one wants to talk about, read about, hear about, or think about suicide, yet it is probably the most important to contemplate.  And I'm not going to address physician-assisted, Hemlock Society, or any other terminally ill patient suicide.  This blog is about the decisions of persons in emotional despair choosing to end their lives.

It is the one we control the most.  The definitions of suicide include "the action of killing one's self intentionally; self-murder; self-destruction; the taking of one's own life."  Among the most interesting I found, however, is "to make away with one's self."  While this last one almost reads as an absurdly comical description of a complex, sorrowful act, it also communicates something greater to me than simply ending one's life with intent; it is indicative of deliberate removal of one's self from others, permanently.

I was astounded at the number of suicides reported to the Delaware County Medical Examiner's Office.   Suddenly, as an intern in training and then a full-time investigator, a paradigm shift became necessary.  Why?  Here are some of the suicide "facts" we are taught in Western culture:
  • suicide rates are highest during holidays like Christmas,
  • suicide rates are higher among teens than any other age group,
  • most people who commit suicide leave notes,
  • people exhibit despondent behavior immediately prior to committing suicide
Not one of those statements is accurate.

I will share what I observed anecdotally, backed up by some statistical research.  Readers should bear in mind that my direct observational experience occurred between ten and fifteen years ago. 

First of all, there are certainly depressed, lonely people who find the winter holidays unbearable and choose that time to end their lives, but this is not the time period when suicide rates trend upward - in fact, they drop.  Rather, spring and fall tend to be far higher.  What sense does this make, one might wonder?   I am not formally trained in psychology, but my thoughts are that with the emergence of spring, there is a natural renewal of hope, and this often does not leave a place for someone who feels hopeless.  As for fall, perhaps it's similar to spring in that it perpetuates a feeling of change.  Or did Dylan Thomas express it best in his "rage, rage against the dying of the light" phrase - only in a literal sense (and in direct contrast to the poem's meaning)?  I don't know the answers.  I do know that Christmas was pretty slow for suicides when I worked as an investigator.  Perhaps it is more difficult to remove one's life from others when more people are around, as they tend to be during holidays. 

As for teen suicide, I don't have much investigative experience with this, fortunately.   Not that suicide in any age group is easy to handle, but there is something especially heart-wrenching about a person that age giving up his or her life.  The recently launched "It Gets Better" campaign comes to mind; often, life really does get better - or has the capacity to - but during the teen years, it is all too easy to feel that despair is the norm.  I remember this well.   I do recall the youngest suicide victim to come through our office while I was there.  It was not a case I investigated.  It was a boy who hanged himself, purportedly because a girl he liked did not share his feelings.  

He was twelve.

I think about all of the child and teen bullying stories I read and hear about, in the media and from people I know, and I would like to be able to state with confidence that more awareness exists now than did 10 or 20 years ago.  I'm not sure I can.  There is more publicity, which creates at least a superficial awareness, and this is an important step.  Even more important is to facilitate understanding and support; it seems that to too many of us, it's a problem that exists only for "other people," interestingly enough, much like suicide.  "My kid wouldn't get bullied."  "My child wouldn't bully another."  Well, guess what?  It happens, and every child on either side of it belongs to someone, and in a sense, to all of us.  And I hear and read about extreme examples where a bullied child or teen does commit suicide.   I wonder how many of the suicide victims I palpated for injuries through gloved hands had been tormented as young people?   I will never know, but I'm guessing the percentage is high. 

So, they all leave notes, right?  Of course not.  In fact, although our training taught the conservative estimate was that 60% or more do not, current statistical accounts suggest that fewer than 20% of suicide victims actually do leave a note.   Living in the times that we do now,  I wonder if social media has affected this.   It's something to research, perhaps, but again, I don't have the answers.  And in most of the suicides I investigated, notes were not found - at least not at the scene.

As an investigator, suicide investigations stayed with me.  At face value, they usually appeared to be so preventable, yet often the decedents had seemingly good support systems in their lives.  In communicating with the members of these support systems, I began to notice commonalities among the statements: 

"He seemed a lot happier lately; I can't believe he did this."  

"This is a shock - she was depressed for so long, but really got her act together during the past two weeks." 

Interesting that a chronically depressed person who may have even (repeatedly) expressed suicidal ideation might actually present as content, at peace, happy, and even giddy prior to the final act.  It makes sense to me; a decision has been made, the person feels a sense of relief, and there is a finite solution to a lifetime of struggles.  I am not advocating the decision in the least, but the logic exists.   And this does nothing to alleviate the guilt of anyone left behind. 

"I should have seen it." 

We aren't mind readers, even of those to whom we are closest.  We hide things from those we love, for our protection and for theirs, and they do likewise.  It is our nature.  By all means, those cries for help we are taught to recognize are of critical importance, but it is not realistic to expect to identify each and every one of them.  The guilt that exists is a fallacy.  We, as humans reacting to suicide, focus so much on the aftermath of an individual situation that we fail to see a collective.  And we have to do better, which means having real dialogue about suicide as a society.

Since leaving my forensics career, I've been able to step back and make some personal observations about suicide in American society. 

First of all, suicide is treated as a dirty secret.  I'm willing to bet almost everyone has contemplated suicide - perhaps (and hopefully) not considered it as a personal act, but contemplated all the same.   I don't think this is alarming or even negative introspection.  Most of us make a choice to live, even if that choice isn't conscious or deliberate, but if it is, then we know.  We understand, and we choose.  I don't know or understand what goes on inside the mind of someone who makes the opposite choice; it's not a choice I can imagine making.  Yet, for those who have considered suicide beyond contemplation, it is not something that is socially acceptable to admit.  It isn't even "okay" to say "I've thought about this before and decided not to do it."  Why is that the case?  I suspect it has much to do with how we view and treat mental illness in our society.  And, as usual, I have far more questions than answers, but I know in order to address the problem as a country or community or even smaller microcosm, this must change. To understand, help, and heal, candor is required.

I certainly empathize with the other side of this - the guilt, the anger, the resentment, the sadness, and the confusion.  Yet, as much as I don't want to know how it feels to be suicidal, I think those of us who aren't have a responsibility to better understand those who are suicidal.  I can only speak directly from a place of someone who had a loved one unsuccessfully attempt suicide.  The same feelings apply, only in that instance, thankfully, dialogue is possible.  I had the opportunity to try to understand, help, and forgive.   Even after almost two decades, I'm still working on all of this, but I'm not afraid to try, or to talk about the process from the loved one's side - or any other part of it.   If the attempt had been successful, I can only imagine how long it would have taken me to process the anger, sadness, guilt, and regret - probably a lifetime of my own.

Another observation, mentioned earlier, is that we have to keep doing better for our kids.  I am not a parent, but am pretty invested in the happiness and health of some children of family and friends.  I worry, and while I don't have answers to many of the problems out there, if something worries me, I will speak up.  It's essential, and not just because of teen suicide rates, but because we must create healthy, stable adults. 

And finally, a suicide trend I've become more recently aware of - and find appalling -  involves our veterans.  I don't know how many veteran suicides I investigated.  The reason I don't know this is sad in itself:  we saw a number of cases involving alcohol, prescription and/or illicit drug abuse leading directly to death through overdose, or indirectly through systems failures due to long term abuse.  Some of these folks were veterans with chronic physical pain.  The pain is initially treated with prescription drugs, and as chemical tolerance builds, the need to find other sources of relief grows.  This, in turn, often leads to alcohol and illicit drug use, and the use becomes chronic abuse.  The causes of these deaths are generally not challenging to find, however the manners were usually deemed "Undetermined."  It's tough to prove suicide in these instances, and our pathologist was not comfortable ruling the manner as "Natural" if an overdose was the primary cause (and I agree with his reasoning).

What we are facing now is this: combat veterans are returning to civilian life.  Some are physically injured, but I suspect even greater numbers are living in mental nightmares.  From what I've read and been told, civilian life can be challenging enough to re-adapt to, even for a non-combat veteran.  Add an injury and/or post-traumatic stress disorder (PTSD) to the mix, and then provide inadequate transitional services, and what do you have?  A population of veterans with a tremendous amount of stress - levels and types of stress that most of us cannot comprehend.  We absolutely must provide better assistance for these veterans, because some of them are certainly turning to substance abuse, while still others are opting for more drastic acts of self-violence.  I've observed the wake of one example of this, and it is heart-rending and far-reaching. 

Because this blog has been so difficult to write for so long, I've realized I have been caught up with format as well as content.   The format has been to share specific experiences and meaningful insights about my years in forensic investigation.  In this entry, I haven't done much of this, and while I know it isn't my best example of writing, I am satisfied with the results.   In keeping with the format and theme, however, I will share a case that left a strong and somber impression upon me.  It was not in any way a typical suicide; in fact, I'd seen nothing like it before, nor have I since:

The decedent was a woman in her very early 20s and a single mother of a small child.  The evening of her death, she left the child with her mother and went to a bar with friends.  Upon leaving the bar very late at night (early morning), she was arrested for drunk and disorderly conduct in the parking lot.  She was taken into custody, processed, and incarcerated.  She asked the police to allow her to call her mother to let her know where she was, and that she would not be home anytime soon to pick up her child.  She was denied this request.  She was then placed into a holding cell, which consisted of a room with a small barred window on the door and a closed circuit camera in one corner.  In other words, for all appearances, a pretty standard arrest and placement into a pretty standard jail cell. 

She started out fairly calm, if clearly still somewhat intoxicated.  She was certainly lucid enough to speak clearly and emphatically, as she continued to ask to be allowed to call her mother.  She talked of nothing but fear for her mother having to go to work in the morning and not knowing what to do with the child, or where her daughter was.  Her requests became pleas, and then screams, followed by soft crying and then more begging:  "Please, just let me tell my mom where I am.  She has my daughter.  I have to pick my daughter up in the morning!"  There was no response from the officers.

She then took off her sweater and sat in front of the door, still crying and pleading.  She wrapped the sweater around the doorknob and wrapped another part of it around her neck, then leaned forward.  She was still for what seemed to be an eternity, then kicked, then went limp.  Seconds became minutes before officers unlocked the door and found her unresponsive.  Her vitals were checked, and no resuscitation efforts were made.

How do I know the intricate details of her death?  As part of the investigation, I watched the video of her ending her life in the jail cell - the one the in-house officers either did not watch as it was happening or watched and acted upon far too late. 

Cause of death:  Hanging
Manner of death:  Suicide

We all have our nightmares.
And the insomnia continues.

While I find many sources of insight, encouragement, and stimulation in my life, specific credit and gratitude for this most recent writing inspiration go to Sheri M., Chris P., and Kelly W.C., for reasons they each know.

Dedicated with love to Paige and Miranda. 
And to my dear mother.

26 June, 2006

My Exorcism, Chapter Nine, Part II ~ "Propagate Safe History"

Politics have little place in forensic science, yet the human factor allows political agenda to creep into the least appropriate places. Our office was unfortunate enough to be a focus of local political and media attention for over a year and even the subject of national attention for a short time. This was not a pleasant time for any of us.

If you have read the previous entry with the article entitled "Dead Reckoning," then you have already learned about the case that started this all. In summary, five high school girls died in a single-vehicle crash one March afternoon while returning from prom dress shopping. Initially, it was unclear as to what caused the accident and only this was known: the vehicle was traveling at a high rate of speed, left no skid or yaw marks indicating attempts to brake, and it collided into a high embankment. Four of the five girls were killed on impact, and one was transported to Hospital at UPenn (HUP) by helicopter where she was pronounced dead in the ER.

The accident, along with a series of events that sparked afterwards, changed many lives.

Our office worked in conjunction with the Pennsylvania State Police to determine what caused the crash. One key piece of evidence obtained but not recognized immediately as important was the presence of several cans of Duster II, a compressed air keyboard cleaner, found in the back seat of the vehicle. When preliminary toxicology reports were obtained, propane was discovered in the driver's blood. As this is an odd finding, our chief forensic pathologist, Dimitri Contostavlos, became suspicious that inhalants may have been involved and began researching the practice of "huffing" propellant-based substances. What he found was that this was becoming an increasingly popular method of obtaining a high, particularly among teens.

Several problems exist with this practice. The chemicals in the propellants displace oxygen in the brain, which is dangerous in itself. Huffing can also cause sudden cardiac arrest, nerve damage, brain damage on several levels (especially with prolonged use), and damage to internal organs. Additionally, it causes temporary loss of consciousness or impairment. In the case of the girls' deaths, upon further toxicology tests it was found that not only did all four of the decedents who came into our office have the Duster II chemicals on board, but the driver had the highest levels.

From the parents' perspectives, this was already a nightmare. Add to the nightmare the discovery that their daughters had been engaging in a dangerous activity that directly lead to their deaths. That is a tough pill to swallow. Our pathologist spoke to the PSP about releasing the information, first to the parents, then to the media in order to properly educate the public about the huffing trend. Somewhere, it seems, communication deteriorated. The State Police did not notify the families of the release to the media. Dr. Contostavlos had spoken to the families but did not realize that they were unaware that the information was being released. Hence, although the families were aware of the circumstances, they were surprised to read about the findings in the county newspaper the day after they were informed.

This caused an uproar. I cannot imagine what the parents must have been going through. I do know that the media seemed all too pleased to talk to the parents and publish their outrage. At what? The fact that their daughters died because they were engaging in a dangerous practice that apparently puts many young people at risk? No. They were outraged at Dr. Contostavlos. In forensics, we are frequently the target of grief and rage, and to an extent, this is accepted by most who work in the field, however misdirected it might be. I personally have had people scream at me not to take their deceased loved one away from them. The Grim Reaper image is one that goes with the territory.

This, however, went beyond all reason. The parents went to the press and the county council demanding that Dr. Contostavlos be fired. Their argument was that there was no medical evidence to suggest that huffing caused the accident or that their daughters deliberately inhaled the contents of the cans. They were angered by the release of these findings to the media without first discussing it with them, and it seemed not to matter that the PSP had a role in not informing them of this.

I can say this: Dr. Contostavlos probably should have arranged a meeting with the families prior to the press release. Clearly, relying on the PSP to do this, whether or not they offered, was a mistake. He would be the first to admit that talking with families was his least honed skill, and that he lacked patience and sometimes tact, but in retrospect, this might have prevented some of the repercussions.


There is a good chance that nothing he could have done would have made any difference. He couldn't change the facts, nor could he summon the dead to rise again. Nothing less was acceptable.

During the year that followed this tragic accident, many things were uncovered. The parents all insisted that their children were completely drug and alcohol free and would not have dreamed of huffing from aerosol containers. But it was learned that the girls, hailed by the media as "the five angels," certainly had their share of problems in life. One had been in rehab for cocaine abuse. The fifth girl, who died at HUP and became a Philadelphia Medical Examiner's case, was found to have both the propellant chemicals and marijuana in her system. Does this make them bad people or troublesome teens? Of course not. It does indicate that at least two of them had prior experience with the use of a controlled substance. Angels? Perhaps by some definitions. Drug free? Not so.

This does not and should not take away from the grief felt by families, friends, and the community at this loss. It hit our office personally, as our secretary was very close with one girl's mother. As hype rose among the media and politicians and surrounding community, tension rose in our small office. There was as much of a riff in our office as among the county residents. Some were very sympathetic towards the parents; in particular, the family of a girl who had been killed a year before while driving drunk and high, and who also paralyzed her friend. The father of the injured girl spoke out in favor of Dr. Contostavlos and his efforts to not only defend his findings, but to educate the public about this apparent huffing problem. For months, the case was in the newspapers and on TV almost daily, and it seemed to be all anyone in the county spoke about. It was the subject of radio call-in programs.

County Council eventually succumbed to the pressure of the most vocal members of their constituency and announced that after 20 years, they would not be automatically renewing Dr. Contostavlos's contract as Medical Examiner. Rather, they would interview several candidates, and he was welcome to apply for the position as well. This political tactic came as no real surprise to anyone who had been involved with or followed the story.

That is when the nightmare really began for us.

Dr. Contostavlos is someone for whom I have and always had tremendous respect.  From the first day I walked into his morgue, he educated me unrelentingly about pathology, scene investigation, medicine, and many other aspects of forensics.  While he was not always good with people, he was by no means always bad with people. I have heard him speak comfortingly and empathetically to families who have lost someone, in person and on the phone.  I have also known him to be blunt with families when challenged, but not frequently.  I've seen him throw things and I've seen him hug people.  I saw and heard him lose his temper at staff members and police many, many times.  I've seen him pick his nose and flick his "findings" across the room. Cultured and alternately crass, kindly and beastly, logical and outrageous, the man is a true paradox.

When it was announced that the position of Chief Medical Examiner would be opening up, we were not shocked, yet we had no idea how this walking paradox of a man was going to react.

His initial response to the media attention was to launch a rather expansive educational campaign. He spoke to schools, parent groups, police, and hospitals basically anyone who expressed interest in an effort to broaden awareness about the practice and dangers of huffing. While he did a considerable amount of anticipated ranting in the office, it seemed he was channeling this fervor in a positive way, at least publicly.  Then Dr. Contostavlos was interviewed on 20/20 after the story began getting national attention.  Here is the interview summary:


A month after five high school senior girls died in a tragic car accident, the county medical examiner determined that four of the girls had been inhaling a potentially toxic cleanser, an inhalant commonly abused by teenagers. The report outraged the community; and a year later, the medical examiner’s contract was not renewed. Was it a case of killing the messenger?

“I think it’s a common thing to blame the messenger of bad news. I think that’s what it is,” says the former medical examiner, Dr. Dimitri Contostavlos, who was the county’s medical examiner for 20 years. And, according to the National Inhalant Prevention Coalition, inhalant use is a widespread problem in Delaware County, where the senior girls attended high school in suburban Philadelphia. “Seniors in Delaware County had two times the usage levels of inhalants as anybody else in the state or the country,” said Isabel Burk, who works for the Coalition.

The head of the local county government says the Delaware County Council had plenty of reasons to be unhappy with the doctor and insists its action was not in retaliation for the examiner’s report about the accident. Last week, the county council suspended Dr. Contostavlos immediately, claiming that he had created a hostile working environment in his office and had engaged in “many instances of bizarre, outrageous, and completely inappropriate behavior.”

Others disagree and say Dr. Contostavlos is paying the price for uncovering a community’s ugly secret. “I think in America we do kill the messenger. It’s very difficult to be a truth teller in America today. You usually end up sacrificing something and often, it’s your job and your livelihood,” Ms. Burk tells Mr. Cuomo.

Elizabeth Vargas is the host of the March 9 edition of “20/20 Downtown.” Victor Neufeld is the executive producer.

As time progressed, Dr. Contostavlos seemed to regress, until for all appearances, he had he lost perspective.  While the candidates were being selected to interview for the position, he joined online groups and forums (except that he asked his staff to post what he wrote because he didn't want to deal with technology).  He wrote scathing comments about other pathologists who were being interviewed, and continued to rant via email to listserve members about how he was being sabotaged by the county politicians.

It seemed that not a day went by without obsessive, paranoid ranting from the doctor.  The tension in the office grew as the doctor began placing blame for the situation on everyone except the investigators and the autopsy technician, which is not to say that he did not subject us to it.

To make matters worse, in the heat of all of this, our investigative supervisor (who had an almost exclusively administrative role in the office), was involved in a drunk driving accident in which he injured himself and a family of three.  He did not return to work due to injuries, and because of his DUI, he was ultimately asked to retire.  It was more publicity, and it was all negative.

Eventually, three candidates were interviewed in addition to Dr. Contostavlos. Eventually, one was selected and an offer was made. It was at that time Dr. Contostavlos was given notice that his contract would expire approximately three months from then. The assistant pathologist, who had been the target of much rage from Dr. C. decided to move back to Oregon so he and his wife could be closer to their families.  There was supposed to be a transitional period where the assistant pathologist and the new medical examiner would work together, then the assistant would leave.

This did not happen. Dr. Contostavlos seemed to further decompensate.  He grew more openly hostile and paranoid every day, and his bursts of rage and fits of temper finally frightened a visitor to the point of reporting him to County Council. The next day, just as I came on duty for my rotation, he was escorted off of the property by county police and told he was not to return, except once when the office was not occupied and he was supervised, to gather his belongings.

It was a sad way to see such a gifted pathologist and fascinating person end his tenure at the Delaware County Medical Examiner's Office.

In the days and weeks that followed, there was still much media attention, but it did begin to wane a bit. But it was far from over, because then the Delaware County Criminal Investigation Division (CID) showed up at our office.

They began by segregating the staff and interrogating us about Dr. Contostavlos autopsy practices. It seemed that they were under pressure from the council to find something - anything - that would help publicly justify their reasons for removing him.  I was honest and answered the detectives' questions. I don't know what was said in other interviews, but I do know that several people in the office loathed him. Others, like myself, seemed to accept him for who he was and just wanted the whole mess behind us.  But before we knew it, terms like "corpse abuse" were appearing in the paper, and the media hype resumed.

Eventually, our new pathologist arrived and the public focus shifted to that. During this entire ordeal, we were still attempting to perform well in our daily forensic functions, which were difficult enough by nature.  Was any lesson really learned?  Refer to this chapter title; propagating "safe history" is the only way to remain inscrutable in a public domain.  Publicizing controversial information, even with the best of intentions, and there is a good chance one will pay dearly for it.  That might be as tragic to me as the deaths of these girls, themselves - the tragedy of which, in sad irony, was somewhat lost in the hype.

After awhile, the local media found other stories to publish and left us alone.  But at the Delaware County Office of the Medical Examiner, six staff members were left stunned, traumatized, and overwhelmed in the wake of the past year's events.

14 May, 2006

My Exorcism, Chapter Nine, Part I ~ "Propagate Safe History"

For those of you following this series (which has been on a long hiatus), I will soon be posting the next chapter. The article included below provides some interesting background, not only about the scene that sparked a chain of events which changed our office forever, but about the personality of the pathologist I worked for during four of my five years as an investigator.

I did not read this article until recently. It was published during a time in which our office was the subject of much media attention, locally and even nationally. Those of us involved grew weary of seeing articles, interviews, and reports about our office on a daily basis and eventually began to avoid reading them.

This one I missed. Now, years later, I read it with not a little nostalgia and some degree of awe - and a bit of sadness as well.

What I appreciate most about this article is the way journalist Ivan Solotaroff captured the very essence of this intriguing man who I have always found so difficult to describe.

"Dead Reckoning"

By Ivan Solatoroff
From the July 1999 issue

Philadelphia Magazine

Dimitri Contostavlos, the medical examiner of Delaware County, rifles the top left drawer of his desk for the vertebra of a man he autopsied 30 years ago. It looks a bit like a fossil a small, flat circle of bone in a yellowed Ziploc though the pride and mystery on Dimitri's face as he hands it across the desk to me speak otherwise. "This is the body's uppermost vertebra," he says. "Called Atlas. He on whose shoulder the world rests."

Some leave their names on mathematical constants or hospital wings. The dark secret of this disk a murder is Dimitri's bid for immortality. Using the Phillips screwdriver of his Leatherman, a Swiss Army-type tool he bought recently and uses often, he points to a tiny fracture on one side: what has become known as the "Dimitri lesion." With great clarity and a vestigial South London accent, he explains how it helped him to declare that the bone's original owner died not from stroke, as had been assumed, but from a blow to the side of the neck. "Of the karate-chop variety," Dimitri concludes, flashing one of his agreeably didactic smiles as he returns the bone to his desk. "The neck is of huge importance to my work, you know. All mammals go for it when they want to kill. And that includes humans lacking a knife or a gun."

The neck is also the area that gave Dimitri his nickname: "Quinsy." That's not a typo of the TV M.E. played by Jack Klugman. "'Quinsy,'" Dimitri explains, "is an abscess of the neck, caused by staph or strep. It means I am, or can be seen as, an extreme pain in the neck. Particularly by those who do not want to hear what I have to say."

Some particularly unwanted words vaulted Dimitri into the national spotlight this past February: a report that five popular girls at Penncrest High School, all model students, were not the innocent victims of a freak highway crash on a stretch of U.S. 1 called Dead Man's Curve, as was originally and widely reported. They were, rather, the latest statistic in what the National Inhalant Prevention Coalition, a nonprofit organization, calls "a silent epidemic": huffing, the late-20th-century variant of glue-sniffing, currently America's fourth most common form of substance abuse. Dimitri's findings, published with a clear eye to alerting the county to the epidemic, led mostly to months of extreme bitterness. The parents of the girls refused to accept the findings. Dimitri, in turn, still refuses to accept their denial.

Dimitri's corner office, sandwiched between Delco's library headquarters and the county morgue, is in a peaceful complex set far behind the Fair Acres Hospital in Lima. The buildings are newly refurbished but so institutional and ugly that they look old, backed by a thick stand of hardwoods that would probably seem beautiful if they were anywhere else. As you drive up to the largely empty parking lot, there's simply no doubting you've come to the end of the line.

In a darkened office next to Dimitri's, his fellow examiner, Ed Wilson, is flipping through slides of a severely damaged brain. "An epileptic's," Dimitri advises me. "Went into seizure in hospital while awaiting treatment for an earlier seizure suffered at home. We're trying to determine which of the two led to the fatality, which may or may not lead to an investigation for negligence followed, doubtless, by a lawsuit. We're thought of as a branch of the police, but much of what we do here is civil, rather than criminal, investigation." Delco, population 550,000, looks into some 1,200 deaths a year. Only half make it to Dimitri's office, and of those, only half will undergo autopsy. "It averages at one a day," he says. "Today, none, so we can have a nice long lunch."

The morgue, at the end of which, is dominated by the autopsy room, which looks like an industrial kitchen. Colanders and sieves, used to filter earth and gravel from crime scenes, share the stainless steel shelves with ladles, saws, Adolph's Meat Tenderizer (whose purpose I don't ask after), a 10-inch chef's knife Dimitri found so good for cutting meat and vegetables at home he brought it to work. Over the autopsy table is a large greengrocer's scale. The refrigerators are in the next room: four individual shelves and a large walk-in, which is much harder to walk into than I had imagined. Currently inside are an unclaimed nonagenarian, a fetus that had been dropped into a tulip bush by the 15-year-old mother, and two others I'm happy to learn no more about: "Wisdom," wrote Horace, "sets bounds, even to knowledge."

Those bounds, one quickly learns, are the deep structure of this place and of the controversies that seem to constantly surround Dimitri Contostavlos. Death may well be our last taboo: that which cannot be looked at directly. Dimitri, who seems to revel in occasionally having the weight of the world or at least of Delco on his shoulders, has no compunction about making us look at death without flinching or altering the details with inexactness, secrecy, symbolism. Whether autopsying a mummified baby found wrapped in newspaper dated 1938 in the crawlspace of a Ridley Township home, or a retarded woman who died in her bathroom giving birth to a baby she hadn't known she was carrying, Dimitri has a gift for dispassion, plus a ready finger to point at anyone he feels has either bungled his job or is dangerous to the public weal. The list can range from policemen, social workers, politicians and members of his own eight-person staff to Jack Kevorkian, whom he calls an "exhibitionist and ego merchant," and chiropractors: "Dangerous people," he tells me, noting that I twist my neck often to relieve stress. "That cracking sound you make when you do that," he asks. "Do you imagine that it provides you with some sensation of relief?"

His pet peeve is coroners. Dimitri, by contrast, is a medical examiner, of whom there are fewer than 250 in America. "The very title of these colleagues," he pronounces, "speaks of their archaic, anachronistic institution. Coroner. From corona, or crown. A man who did his majesty's bidding, everything from estates to smuggling. Your average American coroner, an elected man, is a part-timer who averages $40,000 to $50,000 per year. His most common occupation? Doctor? Undertaker. His reason for being there? Politics. His talent, or lack thereof? Utterly random."

No one disputes Dimitri's talents certainly not his employers, who year to year have paid him the highest salary in the county but even his admirers admit he can be difficult. As his colleague Halbert E. Fillinger M.E. of Montgomery County and the state's only other forensic pathologist puts it, "He is a hair shirt."
Dimitri, who moved seamlessly from medical school in Dublin, Ireland, to forensics (which is, simply, the juncture at which law and medicine meet), knew from the first he had "zero patience for the so-called human side of medicine. The bedside manner. The patient in denial. Hysterical Mrs. Smith with her thrice-monthly appointments and nothing remotely the matter with her. This is 50 to 90 percent of a practitioner's work, you know. What I do, as your health enthusiasts like to say, is 100 percent organic. You're not a vegetarian, I trust?" he asks, scratching his head as we head for Bobby's in Newtown Square, his favorite seafood restaurant. "Utter rubbish."

One learns to take these pronouncements in stride with Dimitri, who becomes a kinder, gentler man with each step he takes from the morgue's front door. More precisely, he becomes a more interesting man with each sentence: a man of parts no morgue puns intended. The son of a prosperous ship's broker, Greek-born but raised a Londoner, he is what they used to call a cosmopolitan. After a truly English unhappy childhood spent in boarding schools and public schools in Sussex and the Lake District, he was privileged to see the blackouts of the Second World War from hotels in Maidenhead and a Welsh coastal town whose name he evokes with great elan: Devil's Bridge.

He failed to get into a good university in England, however, and wound up at Trinity College, Dublin. He enjoyed it immensely: "I'd never realized what a xenophobic, imperialistic race the English were until I went to Ireland," he says. "Once there, I became quite an Anglophobe and determined never to return." He credits a lecturer in forensics at Trinity, Jackie Wallace, with his straight line to the profession: The current M.E.s of Belfast and Dublin were also in the class. "With that decided," Dimitri says, "it was only a question of which English-speaking land I would emigrate to. I'd been lucky enough to marry an Irish girl" his wife, Ursula "and in those days, the U.S. quotas were lax on northern Europeans."

He wound up at the M.E.'s office in Camden, New Jersey ("the best-paying job available"), and spent 16 years working his way up between jobs in Chappaqua, New York; Baltimore; and Dade County, Florida (where he discovered the Dimitri lesion), then Philadelphia. He moved into his present job in 1979, when Delco, dissatisfied with the coroner system it had always used, created the position. He held it single-handedly until last year, when he told the county he wanted to take a pay cut and create a second M.E. slot, now filled by Ed Wilson. He admits to having no patience for the arts he watches few movies and finds interest in poetry and novels almost baffling but says he can't recall an hour that he's spent idle. He grew up skeet shooting and snipe-hunting, became fascinated with flying gliders, golfing and, currently, with fishing and gardening "roses, in particular." He has a passion for gadgets mostly manual stuff like his Leatherman tool or the huge light microscope that occupies half his desk, but he's slowly warming to technology: a cell phone he makes show of being unable to operate, until a D.A. from Cherokee County calls about a case that might involve the Dimitri lesion. He also has a Sharp hand-held computer he's forever leafing through storage areas like Cracked Lung Studies, Unremembered (names of friends and celebrities he always forgets), and Palindromes, for which he has a flair a recent composition spells out Dimitri's passion for the tales that dead men tell: Evil all its sin is still alive.

A brief autopsy of Dimitri's C.V. simply to help understand this complex man and his periodic skirmishes with the public: His disdain for the English notwithstanding, Dimitri is a model specimen of that most British of types, the perfectionist hobbyist. Endlessly curious and relentlessly pedagogical, he's a man who works hard to develop an opinion, which once held will be forever the truth. It extends to his work and the simple language of his reports. It's a rare doctor who doesn't hide behind jargon to create an expensive allure or simply to hide the brutality of what he has to say. Dimitri, if anything, hides in the brutality and in the nakedness of his verbiage. After 33 years, he must know how brutish it might seem to the parents of a teen who don't particularly want to compound their grief with hearing about suicide. Or as with his 1984 autopsy of a young Navy man who died in Australia and was brought back by suspicious parents that there was in fact no neglect or violence, simply a severe asthma attack.

Mention the controversies his bluntness sometimes evokes, however, and Dimitri seems baffled. He refers back to his distaste for the "human side" of medicine, or simply says it doesn't pay to obfuscate. "In the Philly office," he says, "if there was an issue of a suicide being denied burial in hallowed ground, we'd put on the death certificate, Killed himself while balance of mind disturbed. I just had one, and I don't remember if it was out of rote reflex or just to make them feel better, but I wrote that phrase again. Man, they were irate: 'How dare you! He had no history.'" He shrugs his shoulders helplessly.
Dimitri was on vacation in Greece the Saturday afternoon 17-year-old Loren Wells of Media, her friends Tracy Graham and Rachel M. Lehr, also 17, and Shaena E. Grigaitis and Rebecca J. Weirich, both 16, went shopping for prom dresses in Wells's red Chevy Corsica.

Shortly before 4:30, heading north on U.S. 1 at 65 to 75 m.p.h., blasting a Black Street and Mya cassette, Loren Wells lost control of the Corsica. Veering first into the right shoulder, she swerved across lanes into the berm dividing the four-lane road. She appeared to regain control but within seconds had swerved back again, this time into oncoming traffic. She hit a utility pole, cut back across her side of the road, and slammed head-on into a tree on the right shoulder at full speed. The impact sent the engine block through the front seat, killing her and three other girls instantly. The fifth, Tracy Graham, died at HUP several hours later.

The autopsies, conducted in Dimitri's absence by Ed Wilson, raised no red flags. Among the items in the Corsica, the mechanic handling the wreckage did find a can of Duster II a spray used to clean computer keyboards. He gave it to state police, who brought it to the M.E.'s office. Its significance went unrecognized, however, and it was returned to the mechanic.

Wells's blood work, sent to the state lab in Lyonville, showed no signs of alcohol abuse, which was no surprise. The girls were known as clean-living hardly the types to be drinking on a Saturday afternoon. The pathos was ratcheted up days later, when a video the girls had made a week before the accident warning of the evils of smoking and drinking and drug abuse on the road was shown on television.

Then Dimitri returned from Greece. Preliminary findings of a freak accident were ready to go out, but something about the report didn't smell right to him. A phone call to Corporal Fran Winkler, the Accident Reconstruction man from the Pennsylvania State Police, heightened his doubts. For one thing, he knew the stretch of U.S. 1. Halfway between Wawa Headquarters and the Franklin Mint, less than five miles from his office, it was called a "dead man's curve," an appellation repeated ad nauseam in the media for what was actually an easily driven uphill grade. As he learned from Corporal Winkler, the Corsica had been out of control for almost half a mile. "After 33 years of road deaths," he says, "you learn that bizarreness, barring extreme youth or agedness, means substance abuse."

When Wells's toxicology report came back from Drugscan, the Willow Grove lab he routinely uses, Dimitri reopened the case. One of the principal tools for analyzing blood is a gas chromotograph, a centrifuge-created graph of specific trace elements. Confirming the state's blood lab, Well's chromotograph showed no sign of ethyl alcohol, but it had a large, highly unusual spike for methyl alcohol. Mark Lichtenwalner, a toxicologist at Drugscan, was confounded by the result: "I think it's propane," he advised. Dimitri was piqued.

Two days later, Dimitri's investigative supervisor learned about the can of Duster II and had it brought back to the M.E.'s office. Dimitri read the contents, then got back on the phone with Lichtenwalner and asked if the spike could have been created by difluorethane a variant of freon. By the time the positive results came back, Dimitri, who had never heard of huffing, had learned all about the "silent epidemic."

"The chemicals for it," he says, "are in hundreds of everyday products. Paint thinners, cleaning fluids, marking pens, aerosol cans, bottles of Wite Out. Kids soak their sleeves in solvent and sit around sniffing it. Or with cans like Duster II, they invert it, then release the substance, which has become liquid. In cars, they lay it on dashboards then huff while they sit there or, worse yet, while they drive."

He'd also put together a chronology of the afternoon, tracked down the woman in the Springfield Mall who had sold Shanna Grigaitis the can of Duster II (Shanna had tried to buy three cans but only had enough money for one), then performed the acid test on himself. Opening a can of the cleaner in the back of his car with the windows closed, he breathed deeply for some five minutes, then emerged and had his blood tested. It confirmed that the girls could not have become exposed to second-hand fumes. No accident.

He called Corporal Winkler and asked if he agreed that the Duster II had been the "agent of destruction."

"One hundred percent," said Winkler, who added that the State Police, who were of course quite familiar with the "silent epidemic," also came to that conclusion.

"Should you release the information," he asked, "or should I?"

"Why don't you," said Winkler.

The parents of the five girls, accompanied by a state policeman, came to confront Dimitri the following evening. Dimitri will speak freely on almost any subject, but he declines to discuss the meeting, except to say it was "quite emotional at times." He does admit, however, to a prior run-in in an unrelated incident with one of the girl's parents. "It came after an autopsy report that I issued two years ago," he remembers as he takes his first bite of blackened salmon at a back booth in Bobby's. "Another death of a teen at the wheel, this time also involving the passenger's permanent brain damage. As I recall, it made news largely because the death occurred the same weekend as Princess Di. Good food, eh?" Dimitri draws his knife in a long motion across the plate, separating the salmon filet from the bone. "Princess Di," he says. "There's another open-and-shut case of driver impairment."

The parents of the Penncrest girls issued a written statement: "[I]t seems clear to us that there is inconclusive evidence that our children intentionally abused the cleaning agent involved." They added that the substance had been airborne, then declined further comment, asking that they be allowed to "resume the healing process."

Dimitri recalls that Channel 6, reporting on the challenge to his findings, ended with the words, "But the damage is already done." Nothing could have made Dimitri angrier. "The damage," he says, "was done when a Chevy Corsica hit a tree at a speed exceeding 65 mile per hour. Listen, I'm a physician, and I understood the importance of the healing process that the kids' parents raised. And though I understand that denial might be part of that healing process, at some point, it doesn't change the truth of my findings or represent them as the intrinsic danger."

And on he goes. I've spent five hours with Dimitri, riveted to almost every word. Suddenly, however, I find myself almost unable to listen to what he has to say. It's not that it seems repugnant, or wrong, or boring. My mind simply won't focus on his words. As he speaks, I recognize words, fragments even, but the general thrust is completely lost on me. "This is taboo," I tell myself, fascinated by the cognitive dissonance.

"But let's speak of something else, finally," he says. "You say your wife gardens. Have you bought her a Roto-Tiller?"

"No, we're going to rent one."

"Rent one!?" he bellows. It's the first sound of genuine anger I've heard, despite the long harangue. "Two hundred bucks!? For endless weeks of domestic peace? C'mon man," he says, getting that immensely agreeable and didactic smile on again. "Get your head on straight."

27 February, 2006

My Exorcism, Chapter 8 ~ "Dream the Asphalt Burial"

The first vehicular death I ever worked was like no other I’ve seen. I managed to go all summer and fall in training without being on duty for one traffic death other than a pedestrian struck by a car. Then one night in early December, while I was still in training, the skeleton crew (no pun intended, really!) operating the M.E.’s Office called me in to cover an overnight shift. One investigator had recently resigned, and the three who remained were weary from nonstop rotation. I was thrilled to have this responsibility, but the one rather common type of death with which I had no direct experience was vehicular deaths, so this was the one type of death I did not want to get a call to investigate.

So of course the only call I had all night was for just that – a vehicular accident. I don’t believe in fate at all, but it is interesting how my life has a habit of forcing me out of my comfort zones in rather extreme ways. While I don’t always relish this at the time, it does amount to some phenomenal learning experiences.

Also true to the weirdness that seems inevitable in this job (and often in my life), the first traffic fatality I investigated was not typical.

The death was reported to me by paramedics around 2 am. It was described as a single-vehicle accident, one fatality, and no other persons or vehicles thought to be involved. A young man driving a small truck had collided with a chain link fence and subsequently impacted with a tree.

We had two scene bags; I grabbed the one that was not used most recently thinking it would be well-stocked (my first mistake). Then I got horribly turned around trying to find the scene, which is now laughable to me as it was on a well-traveled, easy to find road. (Hey, it was dark and I was new to the area!) I finally arrived at the scene only to find that the Polaroid camera was out of film with no restock in the bag, and the 35mm slide camera was frozen (literally) with a dead battery. Fantastic. Pictures are vitally important in documenting scenes. Fortunately the local police took an abundance of pictures and processed a set for our office.

It was a frigid night – below 20 degrees is unusually cold for early December in southeastern PA. The police and I painstakingly took measurements of tire marks, drew sketches of the scene, and finally I examined the body.

While plain ethyl alcohol itself has very little odor, the commingling of blood and ethyl alcohol forms the toxic metabolite acetaldehyde, which produces a very distinct odor not easily forgotten - and very easily identified. I got to the point where I could often detect the presence of alcohol approaching any recently dead, exsanguinating decedent. If it hadn’t been clear from the circumstances of the accident that this driver was impaired, it was evident from the strong smell of his blood that alcohol was involved.

This brings us to what was not routine about this accident. The majority of single-vehicle fatalities involve impact injuries to the head and/or chest, whether it is from being ejected or from hitting the steering column and/or windshield.

This man was impaled.

His truck hit the chain link fence, kept going, and as it impacted with the tree, a metal post from the fence was pushed through the windshield, through his body, and into the seat. The police removed the post. I reached into his chest cavity and removed the metal clamp that once held the post to the links. Another one was found buried much deeper during his autopsy the next day.

Most of the vehicular accidents I investigated during my five years were alcohol related. In this case, the decedent’s BAC turned out to be well over .20. I did have some other vehicular scenes that were not alcohol related - five or six were with the elderly and/or infirm who died prior to the vehicle crashing. A few involved high speed carelessness with no chemical impairment. Then there were a few motorcycle fatalities (“donorcycles” as they are crudely referred to in the medical and forensic worlds). And still a few more were just strange, freak accidents.

These are so difficult for family and friends, often because they are preventable and sometimes because they are senseless. I lost a friend in middle school to an accident in which someone ran a stop sign and he was ejected. Another friend in high school died in a similar accident, only the driver of this one was the car he was riding in - he was also ejected.

I've heard police say on more than one occasion "I've never unbuckled a dead person."

I have. I'm still a pretty big proponent of seat belts. I also support wearing helmets on motorcycles, even though in every motorcycle fatality I investigated the decedent was wearing a helmet and still died of head injuries. Oftentimes, people are not as invincible as they'd like to think, and explaining this sad truth to people who are having a very tough time grasping that a loved one is dead is a delicate task. Asking a mother who speaks almost no English to identify her young daughter's bloody clothing because the body was too mangled from the accident to be viewable, then holding her upright as she screams and cries hysterically is not something I care to repeat.

The next chapter is about another vehicular accident; while it was not my scene, it rocked the very foundation of our office.

06 October, 2005

My Exorcism, Chapter Seven ~ "Contagious Waste Disposal Growing"

Media, Pennsylvania is the county seat for Delaware County. Visually charming, it houses a quaint, historic downtown that is typical in the east coast, a playhouse, and pleasant surrounding residential areas. The homicide rate is (or was at the time) very low in the Media area.

I had a handful of scenes in this town, and usually they were natural deaths. One scene I recall vividly was anything but natural; it involved the domestic shooting of 4 minors and a subsequent suicide. 

In March of 1999, I returned home from a conference in New Orleans and stopped by the office at the onset of evening shift change to talk to a couple of my coworkers.  Due to the nature of our crazy schedules, shift changes were about the only times anyone could find the investigators together unless we planned some off-duty activity well in advance. This particular evening, I  found my colleagues relaxed and cheerful after a relatively quiet week.

Minutes after I arrived, the phones began to ring, and the on-duty pager blared simultaneously.  County CID reported multiple homicides via gunshot in nearby Media. Our on-duty investigator was just leaving, and the investigator relieving him did not ask him to stay and help.  Feeling refreshed from a week off and recognizing that this was clearly not a one-person scene, I volunteered to go.

Immediately outside of the scene, the environment was chaotic.  I don't recall another scene with so many emergency personnel, police, and politicians  present as that night when they all hovered around the little house.  The chief of CID (who was mostly an administrator and rarely did scene work any longer) arrived. In my then three-year tenure at the office, I had not met him before that night. The press arrived before we did, thus contributing to the overall chaos.

Inside the house was not any better. The Media P.D. and CID had secured the scene very well, but there were still too many people, living and dead, and there was far too much blood. Furthermore, some of the blood was tracked throughout the house, as four of the five bodies remained, but one victim had been transported to the local trauma center. He was declared brain dead several days later, and I witnessed his official pronouncement of death before his organs were recovered for donation.

The circumstances of the incident were reported to us as follows: A woman and her two children were at home and two neighborhood teens were over visiting. The woman’s husband, from whom she had just obtained a Protection From Abuse order, forcibly entered the house, walking through the kitchen past his estranged wife and into the living room where the children were gathered. It seems that he first shot his mentally handicapped teenage son in the back, then each of the boys who were visiting, then his 7 year-old daughter. Then he shot himself.

Reconstructing the scene was not difficult from a technical standpoint, but it was very involved, and therefore long.  From start to finish the scene took about 6-7 hours to process. While we all certainly had longer scenes from time to time, that length was not typical.

I don’t remember how many bullets were in each decedent or where they entered and exited, but I do remember these details:  The teenage son of the perpetrator was shot in the back.  His daughter was shot twice in the anterior chest; one was from close range, and the other was a contact shot. What this  means is that the 7 year-old's father was facing her and standing no farther than arm’s length away when he fired one of the shots, and he was pressing the gun against her chest when he fired the other.

I cannot imagine the state of mind he must have been in.  I comprehend the mechanics of his actions, and intellectually can grasp that he was mentally ill.  I can even cogitate what he likely hoped to accomplish (punishing his wife), but I don’t truly understand.

After the detectives performed their duties, we processed our part of the scene.  We all did the best we could.  It was messy, crowded, and disturbing. When we got to the point of removing the bodies for transport, one by one, the officers and detectives exited the scene. After the two adolescents and one adult were moved to the van for transport to the morgue, we had no more stretchers available.  As I secured paper evidence bags over the little girl's hands and around her wrists and placed her in a too-large body bag, only my colleague remained in the house. After making sure that I was physically capable of carrying her alone, he, too, went outside.  While he always performed his job with the utmost consideration and professionalism, - even when difficult - he knew I understood that this was the toughest part for him, as he is a parent who has lost a child.

So I carried her out of the house in my arms and placed her in the van with the others. 

Several of the investigating officers and other personnel later told me that they couldn’t watch me carry her out, and said they wouldn't have been able to help even if I had asked.

I didn’t ask.

22 September, 2005

My Exorcism, Chapter 6 ~ "Not Until They Are Dead, Stop Breathing"

The dead, one gets used to seeing. Viewing a recently deceased person, touching a rapidly cooling body through gloved hands, even sometimes hearing the last inhaled air exit the body as I turned a decedent over to examine them took awhile longer to grow accustomed to. The recency of the departed life can often have a strong impact on even the strangers who are present.

Actually watching someone die is a different experience entirely. I never did acquire any level of comfort with this. I’ve lost a number of loved ones, but with none of them was I present for their actual death. I know plenty of people who have experienced this and found it somewhat peaceful - while still deeply sad - to be with a person drawing his or her last breath. Watching someone die violently is vastly different, of course. I have not witnessed a violent death in person – only on videotape. That is more than enough for me.

One videotape was from scene I personally worked. I was called out around 4:30 AM to a convenience store where the clerk had been found dead with no apparent injuries. The scene appeared non-violent and unremarkable with two exceptions: the emergency phone was off the hook, and a partially eaten English muffin breakfast sandwich was sitting next to the microwave behind the counter.
No signs of violence at the scene. No external injuries to the decedent. He was a moderately obese middle-aged man – potential candidate for natural disease such as myocardial infarction (heart attack), cerebral vascular accident (stroke), and the like. He was warm to touch, no rigor mortis, very early blanching livor mortis (blood settling to the dependent portions of the body). He had several missing teeth.

No resuscitation attempts as reported by medics. The consensus being tossed around by police was “heart attack.”

Not so fast, guys. He had been eating - a more important clue than one might think.  Eating, missing teeth, phone off the hook; I was concerned about this.

A store manager arrived and pulled the surveillance tape. The tape revealed that the man had indeed been alone, heated up his sandwich, took a bite or two, then appeared to be choking. After what seemed like an endless amount of time (probably to him as well), during which he picked up the emergency phone and attempted to force the food bolus from his trachea by slamming himself into the countertop, he collapsed. What a horrible way to die.

To further add to this tragedy, it was later discovered that his missing teeth were the result of a recent pistol-whipping that occurred while he was working at another convenience store. As a result, he was moved to different branch in a safer area.

Cause of death:
a) Asphyxiation b) Choking
Manner of death: Accident

The two people I watched die in person both died in a hospital, and both were transplant cases. I’m a huge believer in organ, bone, and tissue donation, and even worked as a tissue recovery specialist in Kansas City for awhile. It’s important to share this as my intention is not to scare anyone away from the idea of donation or the process itself. It can be fairly brutal to watch due to the time-sensitivity issue of certain living organs.

The first case of this nature I had was a college student who, at the persuasion of her boyfriend, tried heroin for the first time with him. The result was a coma from which she never awakened. After she was declared brain dead (over a period of days, possibly even weeks), the family signed the organ donation papers. In our office, it was standard practice that, if at all possible, an investigator be present during the organ recovery to document postmortem alterations to the body (like incisions, etc.). I had scrubbed in and assisted with a liver recovery once before, and this was a finely-tuned surgical procedure quite unlike autopsies. This organ recovery was nothing like either.

First of all, the transplant procurement specialists are required to leave the OR before the life support machines are turned off and remain outside the OR for a set period of time (I think it was 10 minutes) after the patient is pronounced dead. So the machines were shut off, one by one, while every action was documented. I stood behind her head, and I remember watching the monitors and thinking “Come on – breathe on your own” – as though I could help will her heart to keep up the life-sustaining rate. It did not, and after a few minutes, she was pronounced dead.

When the transplant team came in, it was clock-watching time. It seemed, from my point of view, that they ripped into her chest wall. I know that from a technical perspective, it was much more precise than this, but watching them wield scalpels faster than I ever knew was possible while packing ice into the chest cavity was unlike anything I had yet seen.

I take comfort, as I hope her family and friends did, knowing that her donation saved and/or improved the lives of others.

Cause of death: Complications of heroin overdose
Manner of death: Undetermined DA (drug abuse)

The second was very much like the first, and the circumstances were also heartbreaking. I will relay the story of a multiple shooting in another chapter. See the upcoming “contagious waste disposal” for full description.

21 September, 2005

My Exorcism, Chapter Five ~ "No Chance to Rectify"

During those late-night discussions we’ve all probably had, the question of the best and worst ways to die arise. Various methods of suffocation seem to be near the top of the "worst" list, according to many people I’ve spoken with about this. I’d have to agree; I know I feel at least a mild surge of panic if someone even playfully puts a pillow over my face. Being buried alive, and not just Poe-style, has to be a torturous affair as well.

I’ve seen some strange burial suffocation deaths, and I’ll relate two of them in reverse order of occurrence.

The second “burial” I investigated was the scene of a construction site. A building was being modified, and both indoor and outdoor construction had been ongoing for some months. Outside, trenches for pipes were being dug.

Trench Digging Rule 1: Always shore up the sides of your trench so they don’t collapse on you.
Trench Digging Rule 2: Probably one should not do this kind of work under the influence of a mind-altering substance.

I’m sure OSHA states it more eloquently, but you get the idea.
The trench walls caved in on him quickly. He was only buried up to his upper chest (I say “only”), but the pressure was enough to prevent him from expanding his diaphragm to get air. Co-workers were unable to dig him out quickly enough, as the walls kept falling.

Cause of death:

Manner of death: Accident (Industrial)

The other "burial" - and this one occurred first - was in one of the few rural areas of the county. I arrived at work and was greeted by Dr. Dimitri Contostavlos, our medical examiner, with (and, containing no prelude whatsoever, typical of his conversation style):
“Happy Birthday, young woman. They’re re-enacting the movie Witness in Birmingham Township. Go investigate.” 
(Translation for those who haven’t seen Witness, and don't mind spoilers, near the end of the movie, a villain is buried in a grain silo.)

That’s exactly what happened at this scene, minus the villain, but including the cameras. Two elderly farmers’ attempts to empty a silo filled with corn went horribly wrong (I won’t bother explaining the detailed mechanics of how it happened.) The grain was released very quickly onto of the farmers inside the silo. The other farmer (his brother), made every effort to pull him out, not knowing his foot was trapped in the auger. The decedent eventually suffocated. I will not soon forget the details of the corn kernel imprints covering his skin, his shoes. 

The scene itself was a near circus. I cannot even name all of the investigating agencies present all these years later. I do remember the immense respect I felt for the logistics agent coordinating it all, keeping everyone safe, etc. It was not a good place to be, for anyone; the heat, the poor air quality inside the silo making investigation difficult, the decedent’s brother’s state of mind, and all of our absolute feeling of inefficacy in alleviating his apparent grief and guilt. The press helicopters stirring up dust and tempers did nothing to help.

As you might imagine, neither of these men died quickly or painlessly. We had a saying in our office: “no one ever dies a painful death.” This was, of course, not a credo or a philosophy we implemented when having discussions with decedents’ loved ones; rather it was a way of us dealing with the fact that often people do suffer in the perimortem interval, and discussing that with family is a very touchy issue. An investigator must maintain high standards of honesty, objectivity, and tact, and oftentimes it is difficult to simultaneously adhere to all three standards. 

This puts the investigator in a precarious position should a family member ask “Did he suffer?” Responding with “Yes, he was slowly crushed to death or and was probably conscious for much of it” is not acceptable, obviously. Much of the time, the suffering is self-evident. If an investigator is wholly honest with anyone who asks, it should be stated that there are many unknown factors; investigators and medical examiners usually cannot tell if or for how long someone is conscious or acutely aware of pain during the dying process. I could speculate, just like the loved ones inevitably do, but I didn’t voice these speculations.

But those speculations and re-creations were turned inward – and the primary difference, other than me possessing objectivity because the decedents were not people I knew - was made up for in empathy and knowledge. I know the anatomical mechanics and the physiological processes that occur during suffocation – or most deaths. I know what systems are breaking down and how those manifest. Having seen and analyzed the results, I can realistically imagine the suffering. And after my eyes shut, I often do.

This is, in part, why sleep eludes me.

16 September, 2005

My Exorcism, Chapter Four ~ "Death Grabs at Stillborn Child"

The death of an infant or child is never easy for anyone involved. Even with the death of a terminally ill child, there is rarely any comfort, sense of timeliness or justice – rather there exists only pain, despair, and guilt.

I came to understand that for a parent, in the death of a child, age is incidental; most parents simply do not expect to outlive their children. This chapter, however, is about my experiences with the deaths of infants and very young children.

From a knowledge standpoint, I was fortunate to gain the experiences I had. I had the distinction of being the infant and child death specialist in our office. I served on the Child Death Review Team for the county, which provided one of the few proactive outlets I had as an investigator; this was good.

From a mental health perspective, however, fortunate is not the most accurate descriptor. I would not erase or alter these trying experiences. The long-term effects for me, the consummate introvert, arrive belatedly, though, so truly “dealing” with tragedy – be it peripheral or first-hand – is a prolonged and complicated process. In other words, I left my position in forensics  in 2001, and only after several years did the proverbial ghosts begin to manifest. I do not think I am balancing on the cusp of lunacy (or if I am, it is not because of working with the dead), but I am self aware enough to know when an exorcism is in order.

For death investigators, there are always cases that test our limits and push relentlessly into the wounds of our weaknesses.

During my first month at the office, a colleague and I were called to a scene where a deceased newborn was found wrapped in plastic and stowed in a cooler in the attic of a family home. The child was well preserved but had obviously been in this place for years. It was never determined whose child this was or what the circumstances of the child’s birth were, but it was determined that the fetus was in all likelihood viable, that is, not stillborn.

Several years later, the same colleague responded to the scene of a young boy (around 18 months) who died suddenly. From what I recall, the only external sign of trauma visible was a very deep incised wound on one of his fingers. The autopsy revealed that he died of asphyxiation caused by a blood-soaked paper towel forcibly inserted into his throat and sinus cavities. Further investigation revealed that the child had injured his finger (how is unknown to me), his mother wrapped the finger in a paper towel, and in an effort to quiet him, forced the paper towel into his mouth and he aspirated it. His mother had several older children and was pregnant at the time.

I’m not sure I can adequately express my reaction to this situation or to the fact that circumstances such as these are all too common. Anger doesn’t begin to describe the wave that hit when this child’s autopsy findings were revealed. My colleague was near emotional paralysis for a short time; I will delve into the debriefing we investigators practiced in other chapters, but for now, suffice it to say we were all affected. A different breed of people may not have channeled it as productively, fairly, and efficiently as the people I worked alongside. For their enduring strength and reason, I will always be grateful, as should the residents of Delaware County.

I have heard a great deal of discussion about parental rights and the ensuing counter arguments for child advocacy. I don’t know what is morally correct, to be honest, but I know which side I favor.

How are these two cases related? They aren't, except in that they happen to be two of many involving a concept I refer to as "disposable children." 
Is there not enough waste and suffering in the world?