IJHC (The International Journal of Healing and Caring) - What Really Happened? A Forensice Pathologist's Perspective on Immortality and Living

The subject of Healing is not a common one for a forensic pathologist, who usually speaks for the dead. Truth and nothing but the truth is the common thread. In my practice as a County Coroner, my job is to explain “What Happened” to family members, police and the courts if necessary. The question is answered by examining the death scene, the circumstances surrounding the death, the medical and social history, and finally by performing an autopsy when indicated.

To arrive at the truth about what really happened, I teach my death investigators the distinction between making observations as opposed to rushing to judgment. “Things are not always as they seem,” I say. A death from carbon monoxide poisoning in a passenger vehicle may be accidental due to a leaky exhaust or may be intentional by alteration of the muffler and exhaust system to cause asphyxia. “Gather information, document the scene, follow the guidelines and trust that you will arrive at the truth.”

Occasionally something unexpected happens during such an investigation, something for which I was not professionally prepared. But nonetheless, there it was.

In the winter of 1994, police officers in my jurisdiction discovered the tracks of a car leading off the roadway; the vehicle overturned into a frozen creek bed. It was 4:45 AM: the vehicle engine was running, and the driver was slumped over the wheel with obvious head injuries. Paramedics rushed to the scene and transported the victim, later identified as a 26-year-old, recently married man, to the ER.

Extensive head injuries were documented, diagnosed and treated but despite all resuscitative efforts, the young man was declared brain dead several hours later. After confirming positive identification with his Minnesota driver’s license photo, his wife (the legal next-of-kin) was notified. She rushed to the emergency department.

In those times, the medical and hospital staffs were becoming aware of the importance of tissue and organ donation. As Coroner, I was also acutely aware of my role in approving the donation of organs without compromising the death investigation process. The emergency room head nurse notified me and filled in the details. The patient met the criteria for brain death, but since the death was due to trauma, a coroner’s investigation was indicated.

“Would you allow the donation of organs, a beating heart, lungs, kidneys, and pancreas before the autopsy,” she asked?

“Do there appear to be any injuries to the trunk, chest or abdomen?” I asked.

“No,” she answered, “only to the head; but I’ll hand the phone over to the surgeon in charge.”

A deep but familiar voice came over the line, “How are you, Dr. A?” he said. “This is Dr. Tom Cook, the ER attending surgeon.”

“Hi, Tom, I have to investigate this death, and the family would like to donate his organs. I’d like to comply, but an autopsy must be performed. I’ll allow donation as long as it doesn’t impede my documentation of injuries and determining the cause and manner of death. Do you see any evidence of injury to the chest or abdomen?”

“It appears to be all head injury. The CT scan showed numerous cranial fractures and extensive intracerebral bleeding. The chest and abdominal scans were reviewed by the radiologist and were read as clear with no evidence for internal injury.”

“OK, thanks. I’ll let the team harvest the chest and abdominal organs. I will perform the autopsy tomorrow to document the head injuries when they are finished.” Hanging up the phone I felt satisfied that all of us had done the best job possible under such tragic circumstances. I notified my investigator of the death so that he could begin gathering the documents and investigating the death scene (the vehicle crash site) as well.

I finished my hospital duties that day and as the afternoon slipped into evening I hurried across the street to my desk in the Coroner’s Office. As I started through the tunnel connecting the hospital and professional building, I saw the hospital chaplain. Even from a distance he looked concerned. As his eyes met mine, he raised his hand stating, “I have to talk with you about the fatality in the emergency room.” I stepped up my pace to meet him in the empty tunnel.

“Everything went well. I spoke with the attending physician and Okayed the tissue and organ donation prior to the autopsy,” I said, holding out both my hands.

“I am pleased,” he replied, “but that’s not what I wanted to tell you.”

“Well, what is it then?” I asked expectantly.

“I think we had better go back to your office,” he said. “You’re not going to believe this.” The hospital chaplain was a tall, wonderfully pleasant man with a big heart and kind eyes. He always chose his words carefully and was best known for his kindness and compassion. As I unlocked my office door, he asked, “Do you know how the body of this young man was found?”

“Yes,” I said, “by the Coon Rapids Police Department in a frozen creek bed at about 4:45 AM.”

“No,” he said. “Do you know how they really found him?”

“Tell me,” I said. “I spoke with his young wife in the ER with her mother. She and the decedent had just been married. He was working an overtime shift to make extra money as a down payment for their house.

“When I talked with her she said something that really stopped me.”

“What was it?” I asked, as he paused.

“She told me that at about 4:20 AM she had a dream, a profound dream, in which her husband was standing by her bedside apologizing, telling her that he loved her, and that he had been in an accident.

His vehicle was in a ditch where it couldn’t be seen from the road. She abruptly awoke, called the Coon Rapids Police Department and with absolute certainty told them her husband was in an accident not far from their home and that his car was in a ravine where he could not be seen from the road. His body was discovered by officers less than 20 minutes later.”

I felt a chill go down my back. “Let me call the PD,” I said as I reached for the phone. The desk sergeant on duty confirmed with his dispatch the time of her call and content. “That is amazing!” I said to the chaplain. “Did she say anything else?”

“No,” he replied thoughtfully, looking down, “except one thing. She told me that it didn’t really seem to be a dream. She said he was really standing there, next to her bed.”

I completed the postmortem examination the following day, after the family generously donated his beating heart, lungs, kidneys, pancreas and eyes. The death was classified as an accident and attributed to blunt force head injuries. I was never able to personally speak with the young man’s wife since she was too overcome by her grief and her family had circled protectively around her. As I pondered my conversation with the chaplain, I reflected on my caveats to death investigators: gather information, document the scene, follow the guidelines, and trust that you will arrive at the truth. Observe, but don’t rush to judgment. Standing between life and death, I had been allowed to observe something of the mysterious.

Truth seems to come from a knowing – a knowing that lies deep within. It seems indisputable. It rings with clarity. There was no doubt in my heart that our conversation shared that late afternoon in my office felt like the truth. There was no way to prove it to a reasonable degree of medical certainty. It was simply there and its presence seemed more a reminder than a challenge. It lifted my heart, put a smile on my face and healed my doubts. Truth, a deep knowing, a glimpse through the mysterious veil separating the living and the dead, seems to heal and give hope. On that day, I began to understand the truth about what really happens.

Janis C. Amatuzio, M.D. is a forensic pathologist and coroner for several Minnesota counties. She is the author of Forever Ours and frequently requested to speak on “Lessons in Living from Your County Coroner.”

What Really Happened? A Forensice Pathologist's Perspective on Immortality and Living

by Janis Amatuzio, MD