Authors: David Simon
At the beginning of the external examination, each body is removed from the walk-in freezer and weighed, then rolled on a metal gurney to the overhead camera that provides the photographs of record before the autopsy. Next, the body is rolled into the autopsy area, a long expanse of ceramic tile and metal that can accommodate as many as six examinations simultaneously. The Baltimore facility does not have, like many autopsy rooms, overhead microphones that allow the pathologists to record findings for later transcription. Instead, the doctors take notes periodically using clipboards and ball-points left on a nearby shelf.
If the victim was clothed, the pathologist will try to match the holes and tears in each item of clothing to the corresponding wounds: Not only does this help confirm that the victim was killed in the presumed manner—a good pathologist can spot a body that has been dressed after being shot or stabbed—but in the case of gunshot wounds, the clothes can then be checked visually or chemically tested for ballistic residue.
Once the victim’s clothes have received a preliminary examination, each article is then removed carefully to preserve any trace evidence. As with a crime scene, precision is preferable to speed. Bullets and bullet fragments, for example, often manage to leave the body only to lodge in the victim’s clothing, and often that evidence will be recovered as the body is slowly undressed.
In cases where sexual assault is suspected, the external examination includes a careful search for any internal trauma, as well as vaginal, oral or anal swabs for ejaculate, because semen recovered at the point of autopsy may be used later for comparison to link a suspect to the crime.
Other trace evidence can be extracted from the victim’s hands. In a murder that follows a struggle or sexual assault, fingernail clippings may produce fragments of skin, hair or even the blood of the assailant. If the struggle involved a knife, defense wounds—a pattern of straight incisions, often relatively small—may be visible on the victim’s hands. Likewise, if at any point the victim fired a weapon, particularly a large-caliber handgun, chemical tests for barium, antimony and lead deposits on the back of each hand might yield proof of that fact. The examination of a victim’s hands may also mean the difference between a ruling of homicide or suicide; in about 10 percent of all self-inflicted gunshot wounds,
the shooting hand will be speckled by blood and tissue particles—“blowback” from the wound track.
Just as a detective stares at a crime scene and tries to see those things that are out of place or missing entirely, a pathologist conducts an autopsy with a similar eye. Any mark, any lesion, any unexplained trauma to the body is carefully noted and examined. For that reason, hospital trauma teams are told to leave catheters, shunts and other tools of medical intervention intact so that the pathologist can differentiate between physical alterations that occurred in the effort to save the victim and those that occurred prior to the emergency room.
Once the external examination is complete, the actual autopsy begins: the pathologist makes a Y-shaped incision across the chest with a scalpel, then uses an electric saw to cut through the ribs and remove the breastplate. In the case of penetrating wounds, the doctor will follow the wound track at each level of the body’s infrastructure, noting the trajectory of the bullet or the direction of the blade wound. The process continues until the full extent of the wound is known and, in the case of gunshot wounds, until either the entrance wounds are matched with exits or the spent projectile is recovered from the body.
The wounds are further evaluated in terms of their likely effect on the victim. A through-and-through wound to the head no doubt caused immediate collapse, but another wound, a chest shot that pierced a lung and the vena cava, might not have resulted in death for perhaps five to ten minutes, though it would have ultimately proven just as lethal. By this process, a pathologist can speculate about what actions may have been physiologically possible after a wound was inflicted. This is always a difficult guessing game, however, because shooting victims do not demonstrate the same reliable and consistent behavior depicted in television and film. Unfortunately for homicide detectives, a badly wounded person often refuses to limit the crime scene by simply falling down at the first wound and then waiting for the ambulance or morgue wagon.
The distortion of television and popular culture is nowhere more apparent than in the intimate relationship of bullets and bodies. Hollywood tells us that a Saturday Night Special can put a man on the pavement, yet ballistic experts know that no bullet short of an artillery shell is capable of knocking a human being off his feet. Regardless of a bullet’s weight, shape and velocity and regardless of the size of the handgun from which it was fired, it is too small a projectile to topple a person by the impact of
its own mass. If bullets truly had such power, the laws of physics would require that the shooter would also be knocked off his feet in similar fashion when he discharged the weapon. Even with the largest firearms, this doesn’t occur.
In fact, a bullet stops a human being by doing one of two things: striking the brain, brain stem or spinal cord, causing immediate damage to the central nervous system; or damaging enough of the cardiovascular system to cause massive blood loss to the brain and eventual collapse. The first scenario has an immediate result, though the average shooter’s ability to intentionally strike the brain or spinal cord of a target is largely limited to luck. The second scenario takes longer to play out because there is an awful lot of blood for a human body to lose. Even a gunshot wound that effectively destroys the victim’s heart leaves enough blood to supply the brain with oxygen for ten to fifteen seconds. Although the popular belief that many people fall down upon being shot is generally accurate, experts have determined that this occurs not for physiological reasons, but as a learned response. People who have been shot believe they are supposed to fall immediately to the ground, so they do. Proof of the phenomenon is evident in its opposite: There are countless cases in which people—often people whose mental processes are impaired by drugs or alcohol—are shot repeatedly, sustaining lethal wounds; yet despite the severity of their injuries, they continue to flee or resist for long periods of time. An example is the 1986 shootout between FBI agents and two bank robbery suspects in Miami, a prolonged gun battle in which both suspects and two federal agents were killed and five other agents wounded. Pathologists later discovered that one of the gunmen sustained a lethal heart wound in the first minutes of the incident yet managed to remain ambulatory for close to fifteen minutes, firing at agents and attempting to escape by restarting two cars before finally collapsing. People with bullets in them, even a considerable number of bullets, do not always perform to expectations.
Neither, for that matter, do the bullets themselves. Once loosed upon the innards of a human being, these little lead bits also tend toward the unpredictable. For one thing, bullets often lose their shape. Hollow-point and wadcutter rounds tend to flatten out against tissue, and all ammunition can shatter against bone. Likewise, most projectiles do a lot less spinning and drilling after encountering resistance inside the body; instead, they yaw and tumble, battering tissue and organs along the way. As bullets enter a body, they also become less directional, glancing off bone and
sinew and following the altered trajectories of their own changing shape. This is as true for the smallest slugs as for the larger ones. Out on the street, the big guns—the .38s, .44s and .45s—still get the greatest respect, but the lowly .22 pistol has acquired a reputation all its own. Any West Baltimore homeboy can tell you that when a .22 roundnose gets under a man’s skin, it bounces around like a pinball. And every pathologist seems to have a story about a .22 slug that entered the lower left back, clipped both lungs, the aorta and the liver, then cracked an upper rib or two before finding its way out the upper right shoulder. It’s true that a man who gets hit with a .45 bullet has to worry about a larger piece of lead cleaving through him, but with a good .22 round, he has to worry that the little bugger is in there for the grand tour.
Most big-city medical examiners employ a fluoroscope or X-ray to hunt down the tiny shards of metal alloy that travel to all sorts of unexpected destinations. In Baltimore, that technology is readily available and is occasionally used by a cutter in situations where multiple gunshot wounds or shattered bullets have complicated the recovery effort. For the most part, however, the veterans on Penn Street take pride in being able to locate most of the bullets and fragments without resorting to the scope, relying instead on a careful examination of the wound track and an understanding of a bullet’s dynamics inside the body. For example, a bullet fired into the skull of a victim might not leave the head but instead ricochet off the inside of the skull at a point roughly opposite from the entrance wound; that much would be obvious from the absence of any exit wound. But an experienced pathologist begins his search knowing that projectiles bouncing off the interior skull rarely ricochet at acute angles. On the contrary, such a slug is more apt to strike the bone and then skate along the inside of the skull in a long arc, often coming to rest just inside the bone and a good distance from any point along the original trajectory. It’s esoteric stuff and, in a perfect world, nothing that a human being should ever need to know. Such is the cumulative knowledge of the autopsy room.
The process continues with the removal of the breastplate and the examination of the internal organs. Linked together in the body’s central cavity, the organ tree is lifted out as a single entity and placed on the steel sinks at the other end of the room. A careful vivisection of the heart, lungs, liver and other organs is then conducted, with the pathologist checking for any signs of disease or deformity while continuing to follow wound paths through the affected organs. With the organs removed, the
remaining wound tracks can be followed into the posterior tissue of the body, and projectiles that have lodged in those muscles can also be removed. Bullets and bullet fragments, a critical category of physical evidence, are of course handled with great care, and they are removed by hand or with soft implements that cannot scratch the outer surface and thereby interfere with later ballistic comparisons of rifling marks.
In the final phase of the internal exam, the pathologist uses the electric saw to cut the circumference of the skull, the top of which is then popped upward with a lever-like tool. Pulling from behind the ears, the skin of the victim’s scalp is then folded forward across the face so that any head wound can be tracked and the brain itself can be removed, weighed and examined for disease. For observers, the detectives included, this last stage of the autopsy is perhaps the hardest. The sound of the saw, the cranial pop from the lever, the image of the facial skin being covered by scalp—nothing makes the dead seem quite so anonymous as when the visage of every individual is folded in upon itself in a rubbery contortion, as if we’ve all been wandering this earth wearing dimestore Halloween masks, so easily and indifferently removed.
The examination concludes with a sampling of bodily fluids—blood from the heart, bile from the liver, urine from the bladder—to be used for toxicology tests that can identify poisons or measure alcohol and drug consumption. More often than not, a detective will request a second blood sample as well in order to identify blood at the crime scene or any bloodstained items that are seized in a later search warrant. Toxicology results take several weeks, as does neutron activation testing for gunshot residue, which is analyzed at the FBI lab in Washington. DNA testing, another aid to identification that was introduced in the late 1980s, can credibly match samples of the human genetic code using blood, skin or hair samples and has therefore become the new frontier for trace forensics. But the process is beyond the lab capabilities of both the medical examiner’s office and the Baltimore department. When relevant to a case and requested by a detective, samples are instead sent to one of a handful of private labs used by Maryland authorities, but the backlog can be as bad as six months—a long time to wait for critical evidence.
A single autopsy can take less than an hour, depending on the complexity of the case and the extent of the wounds or injuries. When it is finished, an assistant returns the internal organs to the chest cavity, replaces the brain and skull top and closes the incisions. The body is then returned to the freezer to await a funeral home’s hearse. The gathered evidence—
blood samples, swabs, nail clippings, bullets, bullet fragments—is then marked and bagged for the detective, who will take it to the evidence control unit or the ballistics lab, ensuring a clear chain of custody.
By its very efficiency, the process manages somehow to become less and less extraordinary. But what still has emotional force for even veteran detectives is the autopsy room as a panoramic vision, a sort of Grand Central Station of lifelessness in which human bodies are at varying stops along the disassembly line. On a busy Sunday morning, the hallway outside the cutting room might be filled with eight or nine metal tables and the freezer may hold a half dozen more. To stand amid the overnight accumulation of homicides and auto accidents, drownings and burnings, electrocutions and suicides, overdoses and seizures—that is always a little overwhelming. White and black, male and female, old and young, all come to Penn Street with no common denominator save that their deaths are officially unexplained occurrences within the geographic confines of the Old Line State. More than any other visual image, the weekend display in the tiled room reminds a homicide detective that he deals in a wholesale market.
Every visit to the autopsy room reaffirms a detective’s need for a psychological buffer between life and death, between the horizontal forms on the gurneys and the vertical forms moving between the metal. The detectives’ strategy is simple and it can be presented as an argument: We are alive; you are not.