I began seriously considering forensic pathology as a career during my residency, and to test whether I had the stomach for the job, I called the county coroner and asked to view an autopsy.
Sure, he said, inviting me to attend the autopsy of a young woman who had been shot during a domestic dispute.
Downstate Illinois had no trained forensic pathologists in the early 1980s. The coroners physician was a general practitioner with some pathology training whod taken an interest.
With an air of great authority, he looked over the body of the victim: one shot in the chest, one in the shoulder, one in the hand all had exited the body. He made the customary Y-incision and snipped off her appendix. (Always look at the appendix, he said. That way, if they ask if it was a complete autopsy, you can say, Yes. I even removed the appendix.)
Removing no other organs, he pawed around and determined that the chest shot had perforated the heart while the shoulder injury was a flesh wound.
Police officers attending the autopsy wanted to know the sequence of the wounds.
One, he said, pointing to her hand. No, no, dont shoot.
Two. He pointed at the shoulder injury.
Three. Indicating the fatal chest shot.
I was awed. I had no idea how he knew that and was too embarrassed to ask.
Turns out, he couldnt know. Its almost always impossible to state the sequence of infliction of closely timed injuries, particularly when none is instantly incapacitating. (Even a person shot in the heart could raise a hand in self-defense.)
This doctor, like many others who lack forensic training, had come to believe in his own infallibility. Hed never worked with people who could teach him to recognize what he didnt know.
A few years ago, I attended a national conference and sat next to the coroner of a small county in another state. As we chatted, the coroner indicated dissatisfaction with the circuit-riding pathologist who did her autopsies; the coroner said she had no alternative.
Shed been particularly alarmed by her pathologists handling of a rape/homicide case. Hed suggested filling the victims vagina with a liquid resin. When it hardened, he said, it might give them a tool-mark impression of the offending penis that could be matched to a suspect. The coroner (unlike the pathologist) had some common sense and refused to allow it.
A 2009 report by The National Academy of Sciences criticizes many forensic disciplines for failing to establish either the validity of their approach or the accuracy of their conclusions and recommends the creation of a federal oversight agency charged with promoting scholarly, competitive, peer-reviewed research and technical development in the forensic science disciplines and forensic medicine.
Perhaps the government could fund random, double-blinded studies on penile tool marks, but Im betting this is just another example of a person practicing in isolation wanting to be perceived as an infallible expert and coming to believe he can do the impossible.
email@example.com Dr. Carol J. Huser, a forensic pathologist, has served as La Plata County coroner since January 2003.