West of the Rotunda

This is one that I’m sure would’ve had a different ending if it was on a TV show.  Not enough drama in the truth.  They gotta give you a wrapped up bad guy, led away with someone, some detective giving them the Miranda litany.  I’ll bet third graders in this country know, “you have the right to remain silent.  You have the right to an attorney…”  Probably up there with, “I pledge allegiance to the flag…”  And just like the pledge means our day of merciless boredom is about to begin, Miranda means another bad guy is being hauled off and a commercial is coming.  But the beauty of any story is that there can be more than one truth.  But stories like that make it hard to cut to commercial. In other words, this shit doesn’t sell.

So, without commercial breaks…

 I got this call early one weekday morning as I was doing hospital rounds.  It wasn’t even nine o’clock in the morning and my pager gave me the number for Paradise Police Department.  I called and they said I was needed for a death at Garfield and Kenwood.  Fifteen years in this little town and I still don’t know all the streets.  “Where is that?  Is that over by the Junior High or by Safeway?”

The dispatch lady answers a couple radio messages in her code “10 99…  10 36” then replies, “it’s by the fairgrounds.  You can’t miss it with all the fire trucks.”

“There was a fire?”  I remembered all the sirens just a half-hour ago as I walked into the hospital.

“Small one.”  She doesn’t want to tell me too much.  She’s busy.  “It’s out now and one deceased.”

“Do you have a name?”  She gives me a name I don’t recognize, but she’s in our two-year-old computer database. But no office visits, no medication refills so I don’t know anything other than a 74-year-old lady.

Sure enough, I didn’t miss it.  The streets around the fairgrounds were blocked with the massive red pumper trucks.  Our all-volunteer fire department is quite handy and enthusiastic.  They were out in force on this cool spring morning.  It had rained and the streets were wet, no ice, no snow.

I had to park a couple blocks away since everyone parked their second or third cars on the street in this residential neighborhood, and between every second car was a driveway cut.  I walked up in my jacket.

The officer keeping the street blocked recognized me and waved me through.  I rounded the corner and came to the nexus of official vehicles.  The firemen were pulling hose and shouting and bustling.  There were two or three detectives there. Almost like the scenes you see on TV.  Except this was a 1960s ranch home with an unkempt yard, no high-rise or brownstone.  But the resemblance to the drama of TV shows might have explained the pulsing testosterone I could sense from the firefighters.  One recognized me and brought me over to a part of the back lawn where cops were standing. 

A blue tarp had been strung across a line between the garage and a pumper truck.  This was an attempt at privacy for the body I was to view.  Heck even the Chief of Police was there, but he just nodded hello in a professional and sober manner.  He was letting his guys do their job, not needing to steal the show.  I recognized the captain of the city police detectives, and he filled me in as we walked around the hanging blue tarp.

Neighbors had called in the fire about 8 a.m.  The trucks had rolled up to see smoke rolling out of the eaves and the front picture window obscured and black.  They’d gone in through the front door to a living room dense with smoke and junk. 

At this point one of the firemen who had joined us behind the blue tarp started describing the masses of piled up junk. They became an obstacle course in the dense smoke and now shallow flame and heat.  They had knocked down some flame and the picture window had shattered.  He described how he beat down the flareup when the oxygen rushed in.

They felt their way around to find the couch, mostly burned and our body, barely recognizable as such in the smoke.  But once that was confirmed they did their best and brought her out, but she was partially cooked into the position I now was looking at behind the blue tarp.

I imagine she was a difficult carry, since, as she laid on her back on the damp lawn her position was still as if seated.  Her legs bent at the waist and her knees at 90°, cooked into a seated position.  Her clothes, if she’d had any, were now incinerated and her skin was quite a bit also.  There were dark black patches, red raw patches, hair gone, but some areas still fairly normal looking.  Maybe she was slow cooked.  Smoked, or baked, not done yet so the joints were still stiff.

The husband had come back while the crew was here. He was down at the station giving his statement.  But the gist was that he had gone out for his usual 7 a.m. breakfast when McDonald’s opened and had said goodbye to her as she sat on the couch for the first or second of her morning cigarettes.  Nothing unusual reported.  The cops weren’t suspicious.  But it seemed a bit funny, a lady sitting on the couch that caught fire and not getting up, so I agreed that an autopsy might be helpful.  There was no obvious injury on her skull, like he might have cracked her one and then set the fire before heading to McDonald’s for his alibi. But there were enough for questions about the scene that more information from an autopsy would seem prudent. I had become more prudent in these years of doing this. I hadn’t always been so.

So, we might want to break for commercial here for dramatic effect: no definite crime, no real question of right and wrong, everybody kind of just shrugging.  Like I said, I don’t think this would make good TV.

I called the lady’s doctor.  I wanted to see if she had any natural history of diseases that would explain why she’d let herself get burned up:  overdose, suicide, maybe a heart attack or stroke on her third cigarette.  I explained the scene to him over the phone and his first reaction was “Oh!”  like now he understood.

“So, Doc, you think of any reason why she’d die suddenly?”

“No. Not really.  I saw her just a week or two ago.  She had high blood pressure, but I can’t imagine she had a stroke or anything.  But she did drink.  And she took a lot of drugs.”

“Really, what kind?”

“Prescription drugs.  She was always calling for refills.  Let’s see.  She was on Xanax and hydrocodone.  From me at least.  She could’ve been getting more from someone else.”

“She’s not getting any from our office.”

“Well, that’s good. She was beginning to show signs of dementia.  I suspected this from the years of alcohol.  But her husband had commented on how forgetful she seemed. And I suspected that she might be forgetting and taking her medications inappropriately.  And she had started coming into the office in her housecoat, looking pretty ragged.  I just thought she might be drinking more.”

“Did the husband seem odd to you?”

“No, why?”

“Oh, just asking.”

So, I relayed this medical history to the pathologist.  Of course, the toxicology levels took weeks to come back but they were inconclusive.  None were in the toxic or lethal range like she’d overdosed, and her alcohol level was not zero but near that.  Her cause of death that he came up with, since this guy never wanted to be too committal, was “conflagration.”

Maybe he was an English Major.

The way he explained that to me was that there was evidence for smoke inhalation, but also severe burns.  And if you give the smoke inhalation as the cause, then the burns were postmortem, but some microscopic evidence suggested some of the burned injury was premortem or near, so you don’t want to commit to smoke inhalation as the cause…  So much hand waving really just meant he didn’t want to get off the fence and call it one way or the other. Here I had an unhelpful pathologist acting like a radiologist. That’s an inside medical joke that would not bring any TV laughs. And why would a dead body be a reasonable joke?

So, I was left imagining it.  Again, this imagining thing doesn’t do too good for TV.  Fade into fuzzy pictures, maybe black-and-white…  You know.  Anyway, the lady has her third cigarette, forgetful, maybe went back and took another Xanax, forgetting she’d taken the first after she’d peed.  Then she returns to the couch for her fourth or fifth cigarette.  It drops onto the carpet; she falls asleep sitting up.  The smoldering carpet fumes giving off carbon monoxide to further sedate her. They all slowly accumulate, drugs, smoke, CO, and she’s so far gone when the heat finally arrives to her legs, ankles, arms and as her nylon housecoat explodes, she doesn’t move. Maybe this is a merciful ending.

Wah-lah. Is this the answer?

So, I called it an accident. That’s my job, I gotta call it.

I did check with the police, and they were comfortable with that.  I had called the husband on the phone the day after the fire to tell him we were doing an autopsy and he could claim the body at the funeral home the next day.  I had asked him if he’d noticed anything unusual.  When he spoke, I recognized his voice.  I had heard him in the halls of our office when he had come to visit one of my partners.  He had a loud, abrasive voice like you imagine a man telling you to get off his lawn as you are chasing your Frisbee.  “Naw, Doc.  She was her usual self that morning.  I said goodbye like always.  She was there on the couch.”

“So, she wasn’t slurring her words, or she didn’t walk differently like she’d had a stroke or something?  She didn’t complain of a headache?”

“Naw, nothing like that.”

“She hadn’t seemed sick or anything?”

“Naw.”

“OK.  Well, I’ll let you know when we get the results of the autopsy.  It usually takes a good three weeks.  If you haven’t heard from me in a month, give me a call.”

“Sure thing.” His rough voice made me think of a chain saw. Not the big ones loggers use, but one of those small ones your neighbor uses to cut up limbs.

He didn’t seem too distraught, real matter of fact.  So, when I heard his voice in the hall about three weeks later my mind was brought back to this man and his burned-up wife.  I thought of his loss, his wife of 50 years, the drinker, smoking away her hours amid a cluttered living room and he off to get his breakfast with his buddies at McDonald’s.  I wondered about how he felt, his awareness of her growing infirmity, losing her mind, her function.  The coming conflicts of care, home, nursing home, feeding, dressing. Had there been arguments?  Was there conflict?  The receptionist said he was asking for me. 

I came around to greet him and invite him into a room for a private talk.  “Ah naw, Doc.  Don’t want to take up your time.  Sorry to bother you.  I just wondered what you found out and all.”

He wore blue jeans with red suspenders straddling the sides of a big beer belly over a cotton plaid shirt.  His baseball cap had the phrase, “You Want Trouble?”  on the crown.  His face was creased, and he walked with the arthritic roll of an old logger, now relegated to Social Security and tales of the woods, where men were men and the government wasn’t keeping anybody from their work of cutting down trees, building roads.  His eyes were hard and dull, like he wouldn’t mind knocking in the skull of a hippie or an Injun if they came into his bar on a Friday night.

“Did you want to step back here?”  I wanted to talk some more with him, see if there might be more. 

Here the TV show would’ve had the bereaved redneck husband come into an exam room and after a few heartfelt, kind questions from the sympathetic coroner he’d have opened up to how hard it was getting for him taking care of the old lady.  How she just sat and smoked all day and never picked nothing up.  How she wouldn’t even have sex no more Doc.  Hell, he’d look into my eyes, anger, and tears, and he’d demur, it wouldn’t be long before she’d be pissing herself. The conflict of true emotion and an unavoidable honesty resolved with my skillful open-hearted questions. And I’d have the forensic evidence from a state-of-the-art lab that showed he’d slipped her two or three extra Xanax’s, then held the pillow over her face, sat her on the couch and left the fire smoldering as he went out to the morning McDonald’s as his alibi.  But this isn’t TV.  This is life; uncertain, confusing, boring life.

“Naw Doc.  You’re busy.  I guess you didn’t find nothing.”  He turned and walked out.  It could’ve been the only way he could show his grief.  It could’ve been a wily cover. And I was just a county coroner.

            Cause of Death: injuries from a fire

            Manner of Death: accident

I often seek solitude, but it’s always temporary. I lived very isolated for a couple years and I got a clear sense what it was doing to my psyche. So, I jumped back into the world. But I still tend to isolate.

This lady was not like me. Or maybe she was in her way. But I appreciated her fortitude. Some call that stubbornness.

I got the call on a cool fall weekend when I thought I could get something done. Maybe I was painting or finishing sheet rock or tearing out walls. I don’t really remember those details. But it was a sheriff’s dispatch call into the county so I paid as good attention as I could to the directions. I made notes. They were long.

I told Martha I was heading out and went to the old Hilux. The differential had been howling recently, but it would make the twenty miles, I hoped. I got gas as I headed out of town.

It seemed more quiet than usual. Maybe there hadn’t been a football game here this weekend, I didn’t know. The sun was heading southwest, and the golden harvested fields glowed. We’d had frost this morning. Might get cold again tonight.

I hadn’t been out these roads. I knew the main roads, but there’s little sense going out all these little back roads unless you live here, or you get a call.

After the second turn I started to worry I was on the wrong road, but the third turn came as the nice dispatch lady had described and now it was gravel. So, I kept going.

That is my nature, to keep going. That is why, when I felt that danger of solitude and I dove off back into people, it was a significant move. I can keep going, even when I think it’s wrong. Unless, for some reason, I don’t. Driving unknown roads makes we wonder these things.

The road narrowed and climbed. There were occasional driveways off into the trees, but mainly just gravel and cutbanks. I knew this direction was toward the mountain that dominated our prairie.

On the turns one rear tire would slip and spit gravel. Everybody else has four-wheel drive. I just wished Toyota gave me a limited slip differential. I downshifted and kept on, now very unsure. I was entering a bit of a canyon. Not like the red rock of the southwest, but what we have out here on the edges of the Palouse. Steep hillside with timber, absent from the windblown rolling hills. These canyons usually have a stream, while the undulating prairie just has mud.

I pledged to do another two or three twists before I headed back.

But there he was, Detective Earl, my hero. I felt relief to see him here. I don’t always get along with all the sheriff’s staff.

I parked behind his rig as far off the road as I dared, given the drop off.

“So, Earl, what have we got?” I walked up toward his Ford Explorer. The rear hatch was up, and he had his camera gear all exposed.

“I’m not sure Doc. That’s why I wanted you to come all the way out here.”

We stood shoulder to shoulder with our backs to the Explorer, facing the uphill cutbank.

“Do you have a name?”

He exhaled and shook his head. “Yeah, but I’m not sure that’s going to help you much.”

He told me what he knew. She was a 63-year-old lady who seemed to live out here on her own. The neighbor would see her walking into town once a week, then walking back. She seemed to always do this on Wednesday. She’d come back with bags in her hands. They didn’t seem to know where she lived, just that she walked up and down this road on a weekly basis. They didn’t know her name, nothing about her.

But a guy had gone down to the creek down below in the draw this week looking for his dog and come upon her. She’s dead. So, we called you.

And that is the definition of the coroner job. Dead, call the coroner.

“So, Earl, how do you know she’s 63? You got ID?”

“Yes, we looked through her stuff and found her ID.”

“Foul play?”

“I don’t think so.”

“Let’s go look.”

He turned and I followed. He hit a trail off the downhill slope that should have been obvious to anyone walking, looking. But left-hand drive vehicles kept the driver away from this perspective going up, and most folks going up this road would be alone in their rigs, no passenger. Going down, you wouldn’t catch it, watching the curves and road. Within twenty yards of where we dropped off, we were near the creek and coming to an overhang.

She had a decent spot. There was the creek down below, running even now in late fall. And the outcrop of granite sheltered her home. I could see her back there in hollow, curled up under a couple blankets. The charcoal fire pit before her was modest. She kept a neat camp.

“We haven’t moved her. I got all the pictures I need.”

I stood on the rocks and looked at the creek, the slope opposite. There was no elk stag looking back, no cougar poised, no drama. Just the dark hillside under trees.  I panned down and up, taking in her panorama. It was quite beautiful if you are OK with closed in places. I prefer a view of the distance. I walked around some before going to her. I found her latrine, quite neat. She had buried her cans and garbage in a couple spots downstream.

I walked back toward Earl. “So, why’d she die?” I ask the detective. 

He smiles his soft smile. “That’s why I called for you, Doc.”

I hesitated to look at her. I kind of knew what I would find. And just how little that would tell me. I stood by Earl and scanned her abode. Small axe and saw, a shovel leaned against the rock wall. There were a couple long gnarled sticks leaned up there too. Walking sticks, maybe, but too short for that. And I saw a pile of rocks build up to cover over stuff on the upstream side. She was keeping varmints out of her vittles.

“She’s got the tools she needs.” I nod toward the implements. “Those are too short for walking sticks.”

Earl smiled. “My wife uses those to dig camas.”

I nod.

I finally go up to her bedroom, under the overhang. As I do I feel the chill of the downslope breeze curling down mountain. It is still light above, but soon will be dark. How many of these sun downs has she seen?

She is close to desiccating. Her eyes have melted, and flies have laid eggs. But they are all gone now. I pull back the dirty blankets. She lies on her side with hands tucked under her cheek. Her knees are flexed, like the Buddha’s in his death pose. Or like you might for comfort as the cold comes toward you. No signs of struggle, no trauma. Earl takes pictures.

“She just died.” I say.

“Hypothermia, you think?” Earl asks as he snaps shots.

“Can’t call it that. The state codes hypothermia as an accident. I think her death was pretty natural.”

“Can’t get much more natural than this.”

“I’ll ask around. Maybe somebody knows her in the medical community.”

“Autopsy?” They always want an autopsy.

“No. I can call it.”

I found her in the hospital records. She wasn’t in our clinic files. She’d been admitted about a year ago, maybe earlier. The hospital records were very uninformative. Suspicion of pneumonia. She’d collapsed in the rural town and been brought in by ambulance. Recovered in a day. The attending physician had ordered a bath. She had left the next day before he could see her. I gave him a call.

“Oh yes, she was very interesting.” This doc was very thoughtful. I liked the way he would consider things.

“Can you tell me anything about her?”

“Well, she told me she had worked as a technician at the vet school over in Pullman for a while. But she had quit that.”

“Did she tell you where she was living?”

He paused. “You know, she was actually pretty evasive about that. She said she lived by herself out near Troy.”

“Did she mention family?”

“Yeah, she did when I asked.” He kind of chuckled. “She said her family didn’t approve of her. She didn’t talk with them anymore.”

I wished I had gotten to talk with her.

“Did she seem paranoid? Delusional?”

He hesitated. “Not really. I just got the sense she liked to be alone.”

I paused, “Thanks.”

At this point, after all these years calling deaths that I knew would not fit the boxes of the Department of Vital Statistics, I knew I needed to make something up. I wanted to submit the cause of her death as solitude, but I knew that wouldn’t fly. And solitude can restore. But most of us take it in shallow draughts, not swim in it.

I’m getting too metaphysical here, I know. Just do your job. Check the boxes, fill out the forms.

No expensive autopsy would add any insight. Nor any dignity to her life or death. So, I faked it. All alone, all by myself.

Cause of Death: Pneumonia

Manner of Death: Natural

The Never-ending Story

See if you can tell where this begins.  Or if it ends.  I’m finally telling it because a young man asked me for a good story at the dinner table the other night.  To end a wonderful meal, he wanted a good story.  I got him to define “good story”.  He said, “You know, one that has an ending.  It doesn’t trail off into nothing…”

“OK,” I said.  “I’ll start this one.  You tell me if it’s a good story.  Stop me if it’s bad.  And we’ll all listen for an ending. Maybe it won’t trail off.”

So, it starts, I think, just a week ago.  There’s a one car rollover in the Eastern County early in the AM.  Single occupant driver, dead at the scene.  25-year-old male.  Jeff Thompson. I get the call at the start of my day in the office, so I talk to the officers on the scene, get some information and instead of going to the scene of the accident I say I’ll look at the body in the funeral home once it’s brought in to determine the injuries that caused death. It would take an hour and a half to get out there and they take pictures and document everything anyway. They were agreeable. And probably glad they wouldn’t have to hold everything up for the coroner to get there. 

Usually, you can find a broken neck, caved-in skull or chest injuries that will help you fill out the death certificate.  I go about my morning with patients.  Maybe my loyalty to the schedule influenced my decision not to go to the scene. But I wear both hats, don’t I?

I get a call at noon from the funeral home.  When am I going to come look at the body?  I’m not sure.  Maybe this evening after office hours.  Can they see any obvious cause?  Not really, they say.  Did you get blood?  Yes, they sent blood off with the investigating State patrol officer.  He’ll send it to the state lab to check for drugs and alcohol.  Since they are calling and can’t see something obvious, I figure I better go out there on my noon hour and take a quick look.  Before I go, I look through his medical record.  It turns out this kid had a long history.  Just four years ago he was in the hospital for a month after accidentally shooting himself in the neck with a handgun.  He had been high on methamphetamine and drunk at the time.  He had a revolver in his belt when he got out of a car. The gun had fallen out onto the ground. It discharged, shooting him in the neck.  The bullet had entered in his lower neck right above the sternum, traveling up to the right exiting below the right ear.  He required lots of surgeries, transfusions, and he couldn’t swallow for months.  He was on tube feeding for a while.  Then he’d been depressed and on pain meds and antidepressants. Oh yeah, drugs in his system when first admitted.

Quick run to the funeral home to look at Mr. Thompson.  None of the staff were there.  They had a funeral to run out in Palouse that afternoon, so I came in the always unlocked back door.  The kid was laid out under a plastic sheet.  The scars from his gunshot wound and surgeries were there.  Small puncture wound over the heart where they had drawn blood.  Faint abrasion over the right forehead and temple and some minor abrasions on the left elbow.  No skull fractures.  No broken neck.  You check for that by twisting the head and listening for or just feeling for crunching.  No rib or sternal fractures with the same crunching test. No long bone fractures.  I thought that maybe his right collarbone was broken, it crunched a bit when I pushed on it, but that never killed anybody.  The pelvis didn’t crunch. 

But there was a significant finding.  The whole head, face neck and upper chest in a shawl distribution had petechiae.  These are the pinpoint purple marks on the skin when small blood vessels break.  They’re usually the sign of obstruction to venous return or a significant abnormality to blood flow.  That is, the heart is pumping but blood can’t get out of the area being perfused. They signify a blood pumping obstruction.

If you swing your arm in a circle real fast for a minute or two, you’ll get petechiae in your hand and forearm. The centrifugal force of your arm going around pushes the blood out the tiny delicate blood vessels from where it has been pooled in the veins. If you puke enough, your face will get petechia. Ladies get it across   their face after pushing babies out. It’s a common occurrence in my field.

You will also see this in people who have something obstructing veins. A lady came into our Saturday clinic for “a rash”. The nurse practitioner called me out of a room to look at it. She described a pink, punctate rash, in a shawl distribution, from her face down across her shoulders.

From her description, I didn’t need to see the patient, but I did. Then I told the nurse practitioner to order a chest x-ray. Because this patient had something obstructing her blood flow back to her heart. Indeed, she had a mass in her chest, a lymphoma.

 So, this was a sign for positional asphyxia or a crush to the neck or chest. I has seen this  before in a man who was working underneath a car. It dropped off the jacks and came down on him.  The weight of the car crushed him, but his heart kept pumping, building up the pressure on the small blood vessels.  The pressure on his chest kept the blood from returning to the heart.  That dead man had petechia from his nipples to the top of his head. The weight of the car restricted the flow of blood, though his heart was doing its best to push the life blood out there. The weight of the car was keeping it from coming back. Capillary don’t stand up to back pressure. They pop and you get petechia.

So, I was guessing this kid had gotten crushed somehow in the car wreck.  But I hadn’t gone to the scene, so I didn’t know for sure how he’d been found.  I will have to call the State patrol officer.

I thought maybe we ought to get an autopsy to make sure.  I left a note for the funeral home that I was going to try to arrange for an autopsy that evening or afternoon.  I asked them to try to get urine and a blood specimen for me since I never get a result from the state lab and I’d like to know in less than six months, which is what it usually takes for the state lab to run the tests.

Are you bored yet?  Stop me if you want me to quit…

OK.  The local pathologist guy who only charges about $900 for an autopsy wouldn’t do it.  He was worried about it going to court.  I call the forensic pathologist in Lewiston, and he said he’d do it tomorrow.  But I start thinking.  His starting fee is around $1500.  Once you add in all the x-rays, toxicology etc. this is going to cost the county about $3000 and that’s just what this guy cost us after he died.  Can’t imagine what his hospital bill from his gunshot wound cost.  I’m sure the county paid for that since he was an unemployed drug addict.  But I’ve got a job to do here, investigate deaths.  Oh hell; I try to call the State patrol officer but he’s not in and doesn’t return my page.  So, it’s kinda arranged that we’ll get an autopsy the next day.  The funeral home agrees to take him down to Lewiston the next morning. This took up my lunch hour.

So, I could trail off here on the story, with how I’m agonizing over spending another dime on this kid who probably never paid a dollar in taxes and how I’ve got to do my duty. Kind of sum it up with a sense of doing the right thing in the face of all the screw ups in the world.

Is that a good ending?  Are you bored yet?  No?  Good, because the story doesn’t really end here.

About three or four o’clock I get two rapid overhead pages in the clinic, ” Dr. Hawthorne, line 2″, then “Dr. Hawthorne, Line 5”.  First is from the sheriff’s office.  They want me to know they got a call from a Mr. Roberts, claims to be the father of the deceased and he’s mad as hell, doesn’t want anybody doing no autopsy on “his boy”. They were just giving me a heads up.  I say thank you.

The next call is from the funeral home saying the same thing, that this guy, a “Mr. Roberts” is really mad.  Would you please talk to him?  They ask me.  They want me to deal with this.  I think in their line of work they are always trying to make people feel OK about things, death and all.  They don’t really want to give them bad news if they can help it.  So, I say I’ll call this guy.  In between the last two patients I do a little research and look up the name.  It seems a little odd, the dad having a different last name.  Plus, the last name is a little familiar.

So which part do you want to hear first, the phone conversation or the history thing?  Or I can stop right here.  The phone conversation’s pretty short.  We’ll do that, then you can go to the bathroom and let me know about going on.

So, I call the guy and he’s pretty drunk by four in the afternoon.  He’s telling me he knows his boy was out partying last night, probably got high on meth and drunk and fell asleep on the road coming home. “Now what good is cutting him up going to do?”, he slurs to me over the wires.  “I ain’t going to let no one cut my boy.  He’s suffered enough in his life.  Hell, he shot hisself once.  And he’s been on drugs for years now.  Let us all have some peace.”

“Mr. Roberts, when did you last see Larry?”, I try the just doing business approach.

“Just last night.”

“What time?”

“About nine.  He said he was going out with some friends.”

“Had he been depressed?”

“Not recently. He used to be. He’d go up and down you know.”

“Listen Mr. Roberts.  I appreciate how you feel here but you need to understand it’s my job to investigate deaths and I’m not sure how your son died.  It is my decision if an autopsy will need to be done or not and I’ll make that decision based on my investigation.”

“Well just what good will an autopsy do?  He rolled his car over an he’s dead.  What more do you need to know?”

“You said he was using drugs.  Maybe he took an overdose and rolled the car.”

“What?  So, he was driving a car while he was overdosed? And just happened to roll it over?  He couldn’t have done that.  He warn’t that smart.”

“Well, look Mr. Roberts, I’m still investigating this, and I’ll be making a decision by tomorrow morning about the autopsy.  I’ll let you know.”

You go ahead and go to the bathroom now.  Then you can decide about the rest of the story.  Should we have some coffee now?

Still interested? I’m warning you; it could trail off here pretty soon.

So, by the next morning I got ahold of the investigating State patrol officer.  He described it as a fairly slow speed accident.  Straight stretch of road and didn’t look like he’d swerved to try to correct or anything.  So, it seemed like he could have just fallen asleep at the wheel like his “dad” had suggested.  It was a small car with a sunroof.  He got ejected and the car was actually lying on top of him when he was found so the positional compression asphyxia was a very reasonable cause of death.

I wondered whether he was awake as he was being crushed.  These sorts of morbid thoughts are common for me.  However, you never really know these things.  So, I called the funeral home and pathologist and cancelled the autopsy.  Save the county 3000 bucks.  I also called and left a message with the family at 9AM that we weren’t going to do an autopsy.  I’d make the old man’s day. I was relieved that a younger kid took the message.

So, is this the end? 

Cause of death, crush, positional asphyxia. 

Manner of death: accident. 

Oh yes, his drug screen was positive for methamphetamine and marijuana.  I guess we could end here.  Good story?  Endings are nice. 

Oh yes, the history part.  Well, I guess it was the name Roberts that triggered it.  I got his mom’s name, and it reminded me of another death.  A 10-year-old boy, eight years ago.  Would’ve been a little half-brother to this Jeff Thompson. 

David Thompson.  I guess this is the start of another story.  It might be related, you let me know.  Or we could stop here. God, I wish it would stop somewhere. It seems like it just keeps going on.

So, this was eight years ago in the fall.  I’m seeing patients in the office toward the end of my morning, and I get a knock on the door that the sheriff’s dispatch is on line three.  I pick up and the dispatch lady is hysterical.  “Oh Doctor, there’s been a horrible accident.  It’s an emergency.  They need you to go to Deary right away.  Oh, it’s just a horrible thing.  They need you their right away.  It’s an emergency.”

I’m waiting for her to calm down.  Finally, I interrupt her.  “Ma’am.  You are calling me as the coroner, right?  OK, well then ma’am, is this person dead?  OK, ma’am.  If they are dead, it’s not an emergency.  It’s a tragedy, but not an emergency.  I will finish up with my last patient before noon then I’ll go out there.”

“They need you right away doctor.  It truly is an emergency.  A young boy has been shot.  Can I tell them you’re on your way?”

“No, I’ll be leaving at noon.  It’ll take me half an hour to get there.  I’ll probably be there by 12:30. Goodbye.”

Five minutes later I get a call from the sheriff.  “So, Doc,” he asks, “are you going to this scene or not?”

“I’ll be going at noon.  I’ll be there around 12:30.”

“So, you are going?”

“Yes, I am going.”  I imagined that the dispatch lady shared her disappointment with the sheriff.

“OK.  See you there.”  The sheriff was a pretty reasonable guy.

It was a beautiful fall day.  I had to ask directions at the little store in town.  The shopkeeper seemed to know where I needed to be.  There were three sheriff’s department cars parked around the single-wide trailer up the hill.  It was a couple maybe three streets off the highway next to a bunch of other trailers.

I spoke with the sheriff and the investigating detective who were waiting for me outside the singlewide.  They outlined the scene for me. 

It had been a teacher training day for the school district, so the kids weren’t in school.  There were three boys playing in the trailer.  No parents were home.

The detective prepares me.  “When you go in, you’ll see evidence of them horsing around.  They must have gotten into their fathers hunting stuff because there are arrows stuck in the wall and the ceiling.” 

He outlined the events to me from interviewing the two surviving boys.  The deceased was a fifth-grader, David Roberts.  The other two boys, Jared Thomas and Billy Curtis were fourth graders, but were playing with him because they were buddies.  At one point David took the other kids into the parent’s bedroom to show them his dads hunting rifle.  Then he went into the bathroom and was sitting on the toilet.  The Curtis kid went back into the bedroom and got the deer rifle and took it into the bathroom to tease the Roberts boy.  The Thomas kid was trying to get them to stop he said. 

I can just imagine the Roberts kid on the toilet taunts. “You don’t even know how to shoot that!”

“I do too, see!”   The Curtis kid said he remembered racking the bolt once and chambering a round.

He held the gun up and pointed it at the kid on the toilet, the Roberts boy, and shot him.

I looked at the sheriff and at the detective.  “You guys are calling this an accident?”  Both looked at me and nodded. 

“You talked to the prosecutor about this?”  The sheriff nodded to me.  I’m aware that there is an election in three weeks and the prosecutor doesn’t want to look like he’s hard on 10-year-olds.

I shake my head and go in.  He got shot right between the eyes at close range.  He had had his pants down and was sitting on the toilet.  But the force of the shot had thrown his body over into the corner of the small bathroom, head down in the tub next to the toilet. His bare butt up was in the air with the pants down around his ankles.  Like the kids might have been playing at sodomy if there hadn’t been a fine spray of blood and brain parts all over the walls, ceiling, window, sink, and bathtub.  The floor was littered with small parts of skull.  When I first stepped into the bathroom, I thought I was stepping on spilled Cat Chow.  But no, the skull can be shattered into nice small little pieces.  The boy had left a long, large, slightly curled turd in the toilet.

Cause of Death: gunshot

Manner of death: accident

So, is the story over now?  That’s a pretty dramatic ending. Or should I tell you about the older brother of the Thomas boy?  He got shot at a drug party in the southern part of the county.  But he didn’t die.  He lived despite a short-range handgun shot to his right chest.  He never would tell the cops who pulled the trigger. 

That’s not really the part of how the story goes on, but it’s somehow related, I think. 

It really goes back a year or so before that poor kid got shot in the trailer. 

I met the Thomas boy’s mom in the clinic.  He was the one trying to talk down the other kid with the rifle. At least that’s the best I can do to sort all this out.

She came to see me because she was finally trying to deal with getting off booze and drugs.  She was also pretty depressed and finally, actually talking about and angry about the years of sexual abuse she had while growing up.  Her husband was supporting her efforts.

Apparently, she’d had to deal with a couple of uncles having sex with her from the age of 12 on.  She got married at 16 just to get out of the mess. 

Maybe you can tell here now that I’m starting to trail off…  Maybe this really isn’t a very good story.  I’m not sure how it’s going to end. I’m not sure I can stick an ending on it for you. Maybe we should end it here.

She was found by the road. And so, I was called.

It can be foggy after a rain in the spring. The wheat loves the rain that rolls in from the ocean two hundred miles west. We get good rain here in June. Dry land wheat flourishes.

I got the call before lunch on a Saturday. I wasn’t covering the ER or working in our Saturday clinic. I thought I had it to myself. But I am the county coroner.

“Dr. Hawthorne, Idaho State Police request that you come to a scene.” The polite professional dispatch lady gave me directions. She was not a patient, though some of them were. It can make the professionalism a bit hard.

It was south of town, off the main highway.

I’d been to plenty of death scenes on that highway. Three people killed when a semi had braked on the downhill and its’ unloaded trailer had swung into the oncoming lane. Two young women dead, and one child in the back seat as the big semi-trailer wheel had rolled over their compact. An infant had survived.

I had known both the young moms from their ER visits. Sometimes crazed by drugs, other times desperate from emotions. Those can look the same. But they are dead now, a different, other time coroner call. It seems this county, my home is peopled with these memories, these events. My limited contact of an ER visit, an office visit, or a death scene investigation doesn’t really bring out the best. These interactions don’t all run together, except when they do.

As I see up ahead the grade where the two moms were killed, I remember another, further along, past the crest of this hill.

A head on, both drivers dead, one trying to pass. Both cars were in their lanes, but the southbound car was now facing north, and the northbound car now facing opposite, their mangled front bumpers about ten feet apart. When such energy is applied squarely, inversion can happen. Like making a ball stop on the pool table, the impact has to be square. Both died almost instantly.

Back a half mile, had been another scene. A mother who had gone off one of these dangerous curves in her minivan. All the kids survived.  She had not. This stretch of road has killed a lot of folks. And our state has still not fixed it.

But this call was off a slow side road.

The morning fog had burned off and it was a bright, early summer day. The fields were deep green with two-foot-tall winter wheat. They plant it in the fall, and it slowly grows, then erupts in the spring rains and warmth.

I rounded the treacherous curves and climbed the hill where the semi-trailer had taken out the young moms and one of their babes. On the other side I got down to the country road that headed due west, off the main two-lane fatal highway.

After a half mile, the ISP rigs were there. And I saw a tan blanket over something on the left, south shoulder.  I pulled over to the right in my little rusty Hilux..

As I got out, I just looked around. There was a tall field of winter wheat to the south. The ISP rigs bracketed the blanket covered victim. And the two ISP officers were striding down from the hill north of the quiet road.

I waited.

Introductions. I didn’t know them, and they didn’t know me. Now we did.

They told me the story as they had sorted it out, but suggested I come up the hill to see what they had seen. I appreciated they were open to my observations.

A local had been going to town early this morning. It was quite foggy, but he had seen the deceased right there by the side of the road and had called it in. The sheriff’s office had assumed from the description it was a highway fatality and had called the State Patrol, so that’s why they were here. Jurisdiction wasn’t something I studied. But I learned it mattered to many I dealt with.

They had investigated. The deceased was identified. The scene was confusing.

By now we have crested the little northern hill. I turn and look south as they are laying out their understanding.

Green fields tell the tale of recent intrusion. The signs are clear from here. There is a mashed up stand close to the road, then a two track through the field in a long loop ending at an older sedan stuck out in the soft, moist soil. The field where the car is stuck is below the road. It is softer, more fertile soil.

“So, it looks to me like she went off the road and landed in the field.” The ISP officer is painting the picture. “Then she tried to keep driving but got stuck.”

I can see what he’s saying.

“Have you looked at the vehicle?”

He laughs. “Yeah, it’s all beat to shit.”

I look for a while.

“Let me look at her.” We go back down the hill to the tan blanket.

She’s a young, vital woman. But dead. She lies face up, her head to the east. It’s as if is she is at peace next to the road. It’s like she just couldn’t keep going.

Her blouse is torn and there are linear bloody scratches on her upper chest.

I notice an asymmetry. Her left chest is much prouder than her right. I notice her trachea, her windpipe, is deviated to the right. These are signs we were taught to look for in accident victims when they came into the emergency room.

I press on her sternum. I feel a grating.

I place my hand on her curly brown hair and twist her head. There is no crepitus.

I have decided from this brief examination she had a significant chest trauma that probably gave her a tension pneumothorax. This is a serious condition that pushes air into one side of the chest and deflates the other side. There is a simple treatment. But untreated, the tension slows the blood flow through the heart, suspended there in our chest. And we die of acute heart failure. The air pressure blocks the blood flow to the heart, and we can’t get enough blood to pump to us. I had been schooled in how to treat this when such patients come into the ER. But she never made it that far.

“Let’s look at the car.”

We head out into the soggy wheat field. Winter wheat can be tall in these bottoms. It’s above waist height.

The old sedan had lost its windshield. The roof isn’t caved in, but the side windows are blown. I can’t get the driver side door to open.

“This car landed on its roof and rolled back onto its wheels.” I’m telling the ISP guys my impression. “She thought she was OK, so she kept driving. Then she got stuck in this wet ground.”

They are looking at the rear wheels sunken in the soft soil.

“She couldn’t open the door, it’s jammed.” I jerked on the handle. “So, she climbed out. See the blood on these shards?” I pointed to the jagged glass on the driver’s door window. “She must have been high as hell.”

“So, what killed her?”

“From my examination, she had a tension pneumothorax. One side of her chest got deflated and the other got too full. She must have pounded her chest against that steering wheel when her car flipped. It’s even possible she was partially ejected. When a car spins the force is powerful, and I doubt she was belted. She could had been half out the window as the car rolled on top of her. I’ve seen that before. It had to hurt like hell, but she was probably high and didn’t feel it. After a while, when she was walking along the road, she couldn’t breathe. Each breath fills one lung, and it pushes into the other collapsing one. It messes up the blood flow. She must have headed off walking back to the highway and just laid down and died when her oxygen ran short. Meth is powerful.”

Her tox screen came back with morphine and methamphetamine.

Cause of Death: Chest Trauma from Motor Vehicle Accident

Manner Of Death: Accidental

I didn’t usually take these calls as coroner. I was always afraid it was some voyeur, too interested in something that was none of their business. But coroner reports are public record, even if it’s none of their business. That was why I rarely completed a coroner’s report, just filled out the death certificate.

I try to make it about the paperwork, the investigation, keep things official. There’s always more to the story.

But I got told this woman wanted to talk to me about this roadside death. It was weeks after I had filed the death certificate.

I’m not sure why, but I called her back.

We swapped identities. She stated she was the sister of the deceased. I believed her.

“Sandra always struggled.” She offered. The toxicology findings are not on the death certificate.

“I’m sorry for your loss.” I paused.

I could hear her sorrow, her struggle for peace on the distant phone.

She asked: “Was there any other evidence about her death?”

I paused again, not knowing if such information would bring peace, or more misery. But through the long wires and distance I thought it might help her some to share.

So, I did. Kind of against my professional nature, but really, even the dead, and the survivors, need care. That’s what we should do. Care for each other. And telling a story can be caring.