First Days
I hadn’t really wanted to be the coroner. I was appointed to my first service when the elected coroner left town. Then, maybe there was some intent behind this circumstance, since I have found that life can be like that; where we end up can be where we were meant to be.
When I was a junior in high school I was nominated and went to the Boys State Convention in our state’s sweltering capital city for a week in the summer. I was told it was an honor and I should go, since it would look good on my college application. I was told it was run by the American Legion and I would learn about government. So, I agreed to spend a hot week in June in Sacramento. This was in the late 1960s. All I knew about the American Legion at that time was that they sponsored the Fourth of July fireworks. Boys State was an eye-opener. I was assigned to one of the two parties (Whigs and Tories) and to one of the 48 counties (Harney, not my home county) in our state. We were supposed to run for offices, campaign, make deals, get elected to the highest office we could strive for. It seemed everybody wanted to be governor. I thought it seemed so silly, so arbitrary, and so chauvinistic, given the turmoil of our time. I opted out. I saw the position of Boys State governor as a mockery, so I ran for County coroner. I ran unopposed and won. Nobody seemed to get the joke. But I have learned that my sense of satire may be more about me than about the world around me. And I learned that playing at government may seem silly. In the actual capacity of an elected official, I have to keep reminding myself that this is serious.
When I came to this town I call home, just out of residency I had a patient die unexpectedly just a month after meeting her. Before her death, the family had brought this nice 80-year-old woman in to see me so she could get admitted to the nursing home. I assume I had an opening in my schedule, since I did not know the family or the patient; such is the lot of the new guy. She was getting forgetful and more frail it seemed, and she and her family agreed she could be best cared for “in a home”. She had been living by herself in the rural county and the burden, the risks had become more than all could bear. I sensed a dignity in this old woman’s agreement to her family’s wishes. The nursing home required that all residents have an attending physician. And this woman did not have an established doctor, so I was it. She took no medicines and had been in very good health for many years, so no need for the continuity of a doctor’s care, until now. I did my physical exam, interviewed her, and declared her fit to be in the nursing home. I signed the forms. It seemed like I was fulfilling a bureaucratic requirement rather than true health needs and such a function offended me a little. I imagine it probably offended her too, but we both held to our parts in this dance. Still, I was glad to meet this independent and noble, but frail and now failing woman. I did not know what help I could be to her.
A month later I visited her in the home. She was well; she remembered me and seemed fit but a bit more vacant than in our office encounter. Then a week later the nurses from the home called me at 8:30 in the morning to tell me she had quietly died at the breakfast table. I had no idea why. Neither did they. She was in her 80’s. She had no history of heart problems, no surgeries, no premonitory symptoms the nurses could tell me about. It seemed a pretty peaceful event, one I could wish for in my passing.
A few days later a form appears on my desk I had never seen before: a death certificate. Lots of boxes and most had already been filled out. But there was a little red ink dot by “cause of death” and another where I should sign as the attending and certifying physician. I asked my nurse what this was all about. She had no idea. Where had this come from? She said a receptionist had brought it back and left it there for me. I found the receptionist. She pointed to a sober appearing gentleman sitting in the lobby. He wore a jacket and tie. I went out to him and introduced myself. He was from the funeral home.
“I’m sorry, but I don’t really know why she died.”
“So, you can’t certify her death?”
“I’m not sure what that means.”
“Well, usually the attending physician fills these out when it’s a natural death and attended.”
“What’s that mean, “attended”?”
“Well, it means you had been seeing her in her recent illness.”
“Yes, I saw her last week, but I didn’t think she was ill. She was old.”
“Oh.”
“Could we do an autopsy?”
He winced. “Would you like me to refer this to the coroner? Or maybe you could just call Dr. Sweetbine.”
“Why don’t I do that.”
Andrew Sweetbine was a young surgeon, new to town like me. He had been elected to the office right after I came to town, replacing the senior surgeon whom he had joined in practice. I liked him and was comfortable talking with him. I called and explained my dilemma.
“Sid”, he offered, “usually the attending fills these out. It’s not really a coroner’s case. And I can’t see spending a thousand dollars of the taxpayer’s money on this one. That’s what an autopsy runs these days.”
“Well, could I order an autopsy?”
“Yes, you could, but Medicare won’t pay for it, and the family doesn’t usually like to pay that bill either so usually that isn’t done.”
“So, you’re saying I should just make a good guess.”
In my mind I am running through all the causes of sudden death I had learned in medical school and how many may have no clear findings on autopsy such as cardiac arrhythmias, or hyper-acute myocardial infarctions.
“That would be just fine.” Dr. Sweetbine was easing me into the arbitrary job of officiating as a practicing physician.
“Can I say, ‘age related causes’?”
“You could but I think the state will send it back to you. They have to have a code for the cause of death and that doesn’t fit their codes.”
“So, I should say heart attack or myocardial infarction.”
“Or you could do fatal arrhythmia or stroke.”
“I don’t think she had a stroke.”
“Well, I’ll leave it up to you.”
Cause of Death: Myocardial Infarction
Manner of Death: Natural
Later in the halls of the hospital I asked Andy about his role as coroner. He explained that all the doctors in town had taken turns in the role. Three of my partners had been through it. Andy had taken the job after his elder surgeon partner had done his turn. True, he had to stand for election, but he noted, if you ran as an independent the parties left you alone. And if you put “MD” behind your name on the ballot you always won. “People think you need to be a doctor to be the coroner,” he added.
“You don’t?”
“No, most of the coroners in this state are funeral home directors. This county is the only one with a doctor as coroner. But it does give me the power to arrest the sheriff if the need arises.” He grinned. “If that happens, then I become the sheriff; chain of command thing.”
“Geez Andy,” I shook my head. “Hey, I’ve got this book you might find interesting, I found it at a used medical book sale: Death Investigation. It’s real short, kind of a handbook.”
“Sure, let me look at it.”
So, a year later, when Andy’s marriage broke up and he decided to move back to Colorado he calls me and asks if I’ll take over as coroner. “You are the new guy in town and honestly Sid; you are the only one who has ever shown any interest in the job. Besides, you have that handbook. You’re all set.”
After he explained the job some more, I reluctantly agreed to take the position. I was appointed in a brief ceremony by the county commissioners. Then, I started learning my new job quickly.
In my first years in this town, I maintained a few habits I had started in residency. I rode my bike to work unless there was snow or I knew I had to go out of town, and I wore Hawaiian shirts on Fridays. This fall morning was brisk and a bit frosty and sure enough, a storm blew in from the northwest so that by mid-morning we had a chill driving rain. About 11AM my nurse knocks on the exam room door and interrupts me with a patient. Her face was sober. “City police on line three, they want to talk to you.”
The city police dispatcher tells me I am needed at a death scene as the coroner. She has to repeat the directions three times because I’m reeling. It’s happening, a coroner call: a dead man in a trailer. I figure out it’s only a few blocks from the office. I say I’ll go right away. I finish with the patient and go to the old Schwinn one-speed.
I pedal the three blocks into the wind and rain in my flapping floral shirt. The yellow crime scene tape and patrol cars are before the little rusty trailer up on blocks in the side yard of a cement plant. As I pedal up, missing the puddles, two uniforms come out of the shelter of the office and look puzzled.
“Hello, I’m Dr. Hawthorne, the coroner.” They are relieved. But I still am not sure what I’m supposed to do in this role. I wait. We go back under shelter, and they start telling me the story.
Man is found face down in his trailer this morning by his brother. He was supposed to be at work but didn’t show, so brother came looking. There’s blood on the carpet, looks like coming from his head. Brother has told of an argument last night at a bar between the deceased and an ex-boyfriend of a woman. It seems they got in a fight, but the deceased thought he’d won, the brother told. Now he’s dead this morning. They explain they have not moved the body or ID’d it, waiting for me, the coroner. I appreciated in this telling that they thought I had a role, though what it was would be news to me. I also appreciated that they might not know how little I knew about my role. But it sounded like they had completed their job and were waiting for me. So, I said, “Let’s go in.”
We cross the stormy puddled drive to the decrepit 16-foot travel trailer. A sideways cinder block was the step. They got out their flashlights and opened the door, no power in the former recreational vehicle. With the door open, the gray light came in from a small window on the far side, but I could see no immediate horrors. The senior uniform (detective?) leaned in to me in the wind and sprinkles. “It’s tight in there doc, why don’t you go in first. You’ll see him in the narrow hallway head down toward you. Be careful about the blood on your shoes. Here, take my light.” He hands me the heavy black cylinder. It felt like a weapon.
I step up on the block and up into the trailer. I could feel it shift a bit with my weight. There he was; a window at the very back of the trailer cast its gray glare into the darkness across the naked back of the man, his rumpled dirty levis covered twisted legs farther back, he is barefoot. The sleeping area is in the back, under the window, a crumpled sleeping bag lit by the gray glare. My eyes took a while to adjust; the flashlight seemed to offer no help, its beam a dull yellow, the window so bright in the gloom. There were full ashtrays on the counter and little table, a few empty beer bottles and muddy work boots by the door here. I looked down to check my shoes and could see my toe had touched the pool of dark brown goo that his head was face down in. The small space is stifling in the thickness of odors, but not hot, more like a moldy basement full of boxes of old books you should have thrown out. I was not then familiar with the smell of the recently dead.
The detective followed me in, and the trailer shifted again. The other officer stayed out in the storm. He had a zipped-up jacket. “So, we think he was sleeping and got roused. He put his pants on but no shirt and came toward the door.” He’s telling me things while I am still looking over the scene. “Here in this little aisle he met his assailant, either after opening the door or the assailant forced it. It’s a pretty weak door, but he did have this bolt.” He shows the little cylinder bolt, intact.
We are standing very close, and I am getting a sense of how the body lies. He’s face down, his body turned to the right a bit against the little settee. The detective continued. “We think he confronted his assailant here and was struck, stabbed or shot, a mortal wound dropped him quickly to fall like that. I don’t think he moved after he fell. No exit wound.”
I offer my expertise. “Yeah, that’s a problem.; maybe a blunt blow. Can we turn him over?”
“We’ve got all our pictures.”
The detective steps over the body into the narrow aisle. First, he pulls the wallet, thick lump in the right back pocket and checks the ID. “Yup, that’s him.” He sets it aside then grasps the belt at the back of the pants to roll him. But the belt is not clasped and starts to pull up. And the rigor that has set in makes him stiff, not like the flopping bodies you see on TV. It’s like trying to roll a snag on top in a brush pile. But his face comes up off the floor as the detective holds him there and I squat down. The congealed blood covers the face, but I can see the left eye is bulging large and there is a long straight cut below the eye on the left cheek.
“Could have been hit, I guess.” I’m relying on my ER experiences with wounds that need cleaning and stitching, but I’ve never been here before. I start casting wide. “Could have been a stroke or aneurysm,” I offer. I don’t want this to be a homicide, a rare occurrence in our small town. I immediately sense the silliness of the suggestion, but the detective is patient. He does not scoff, though he should have. He gets him rolled up and stable then I step out, still feeling silly while they take more pictures.
“So, what do I do now?” No sense bluffing.
“Well, we need to know exactly how and when he died, so Doc, you gotta arrange an autopsy.”
“How do I do that?”
He smiles. “Usually, the other coroners made phone calls and just got it done.”
“OK, I’ll get on the phone.”
“Great, we’ll call the funeral home, and they’ll move the body.”
I pedaled back to the Friday afternoon clinic, missed lunch, made some phone calls and saw my scheduled afternoon patients. There is no Yellow Pages listing for “Autopsy Services”. And this was pre internet/ YouTube. I called the local pathologist, but he was already gone for the weekend, and I remembered Andy had told me he didn’t like doing any cases that might require courtroom testimony. I need a forensic pathologist. I call the nearest town with a pathology group, three guys I’ve never met and get the guy on call on the phone. I introduce myself as the coroner and explain what I need. He cuts me off. “You are a doctor from Moscow?”
“Yes, but I am calling you as the coroner.”
“I don’t talk to doctors from Moscow.” He slams down the receiver. Years or months later I learned what slight he had suffered, but at the time I felt like a junior high kid in the lunchroom denied a seat at the table of jocks and cheerleaders.
The pathologist 90 miles north is also gone for the weekend, so nothing could be done before Monday. And probably not even until Tuesday. This is Labor Day weekend. The detective said they wanted this done right away to charge the suspect, today preferred, maybe tomorrow, so I got back on the phone.
I think west for the bigger cities and a pathologist there agrees to do it, but it means getting the body 350 miles and back. Then I think of the state east, just 150 miles away. By now it’s 5:30PM and their time zone will put it an hour later. I call the ER of a big hospital and explain what I need to the charge nurse. I had learned in residency that charge nurses know everything. She gives me a number and I get a guy on the phone. I tell him the story. He listened attentively and even offered, “Sounds like a small caliber to the face.”
“Can you do this for me tomorrow morning?”
“Well, sure, if it’s OK with my boss. I work for our State Attorney General. Have your prosecutor call your State AG and have him call my AG and we’ll get him done. Can you get him here by morning? It might be snowing on the pass.”
I make the calls; the prosecutor, the city police, the funeral home and we get it lined up to drive the body over the pass in the morning. The detective goes too. The friendly pathologist calls me Saturday afternoon to tell me it was a .22 caliber in the base of the skull, entry through the left eye socket, the cut below the eye another grazing bullet wound. “It would have dropped him fast, like you suggested.”
By Sunday the assailant had confessed. And I was starting to learn this job.
Cause of Death: gunshot wound to the head
Manner of Death: homicide