Unmasking death’s mysteries; Coroners defy odds to meet workload amid staff crunch

Calgary Herald
Mon Jun 27 2011 
Page: A3 
Section: News
Byline: Jen Gerson
Source: Calgary Herald

The corpses roll in at 9 a.m. covered in white bags that hold the shapes of heads and pairs of feet and stiff arms trapped in recoil at the chest.

One medical examiner and a handful of technicians examine the bodies, noting cuts, bruises, jewelry, clothing, scratch marks and faded tattoos. Everything is removed.

The cadavers are lifted to the table, feet toward the sink. Their backs are propped on a yellow wooden block, chests arching toward the ceiling. The autopsies begin.

Today, there will be six: three in the morning and three in the afternoon.

Anny Sauvageau, promoted June 15 to Alberta chief medical examiner, reads the viscera to determine the cause of death.

It’s a busy office and six internal examinations is considered a typical day, she says. Sometimes there are as many as nine.

The body count has proved contentious in the Calgary office where two medical examiners have quit in recent months, citing frustrations over a heavy workload.

In the midst of hiring replacements for the outgoing examiners, requests to witness Calgary’s office were deflected to Edmonton, the province’s busiest office.

The National Association of Medical Examiners suggests pathologists oversee 325 autopsies per year -fewer than two per day.

Sauvageau -dressed in an electric blue floral-print dress and open-toed brown stilettos that she covers with blue paper footies -said she’s accustomed to overseeing autopsies on all three tables simultaneously.

“In Alberta, we are more efficient. The (technicians and examiners) know exactly what to do where,” she says with a French lilt from being schooled in Montreal.

She never wears silk. Her dresses must be machinewashable.

The Edmonton medical examiner’s autopsy room smells like a neglected supermarket meat refrigerator.

At the centre of the morgue sit three perforated metal tables. At the back, a shelf displays the spoils of death: eight cracked motorcycle helmets never reclaimed and plastic jars filled with gallstones, maggots and beetles preserved in clear brine.

A young man with dark eyelashes has been placed on the table at the end of the room farthest from the sliding glass door.

It will be Sauvageau’s job to determine whether he died by natural or nefarious means.

That he suffered head trauma is obvious. Staples hold the skin of the scalp together.

They’re removed and his head falls open, revealing a missing piece of bone the size of a child’s teacup saucer. Trying to save the man’s life, doctors had removed this section of skull to allow the broken brain to swell and bleed.

The pink organ is lined with black veins and marked with sharp red clots. Its tissues, connections and currents contained everything the man was or ever would be.

“Usually (the brain) is like this,” Sauvageau says, motioning her wrist like a wave. When hit, the organ swells, flattens and softens. “You could squish him and make a soup very easily.”

A technician removes the rest of the skull with a rotary saw and the sound of a snapping twig. The brain is tipped back into the palm of his hand so a scalpel can sever the eyes.

A blood clot sits between the paper-thin dura mater and the skull -indicating bleeding from a vein that was crushed when bone met blunt object. From the inside, a fracture splits the skull like a barren tree growing from the ear.

Sauvageau explains: Trauma near the hat line is more likely to be the result of a fall. So too are fractures on the right, as humans instinctively rotate to their dominant side to shield themselves.

A blow to the left is a clue of foul play: A murderer tends to strike from the right.

The man with the dark eyelashes was likely born in a public hospital, attended taxpayer-funded schools, paid money to employment insurance and, eventually, received the attention of the doctors who failed to save his life.

The autopsy is the last public service he will ever receive.

His death is a likely accident, Sauvageau rules. There are no weapon marks on the side of the head. The site of the wound seems innocent. But the cause cannot be known with certainty.

As in life, “nothing is perfect,” she says.

The Fatality Act demands an autopsy in cases where the cause of death is inexplicable, the result of violence, accident or suicide, the outcome of negligence.

It requires the procedure when someone dies absent the care of a doctor, when she is killed by poison or pregnancy.

More than 70 per cent of autopsies in Alberta in 2009 were performed on men -they are more likely to die of misery, misadventure, violence and wilful self-neglect.

On a neighbouring table, a technician has opened a handsome man with a square jaw and perfect teeth. If alive, he would look young enough to be the father of young children.

The first step is a Yshaped cut that splits the body like butter from the shoulders to the groin. The scalpel sounds like a hidden zipper on an A-line skirt. The cut parses orange fat and tough white connective tissue to reveal the rib cage, which is extracted with the help of the bone saw.

Each examiner has his own order for removing the organs, but he must always keep the same list, lest a step or a stray spleen be skipped.

In this office, the bowels are removed first, leaving more room in the chest cavity. Then goes the heart, squished of blood and placed in a yellow bin lined with a black garbage bag. Then the lungs, liver, spleen, stomach, kidneys and bladder. The weight of each is recorded in red ink on a white board above the sink.

As they are removed, a plastic syringe takes samples of blood from the heart, urine, bile and the gastric fluid. A smaller needle steals the vitreous fluid of the eye. Next, the technician will cut the scalp, pulling at the skin like fine ripped cotton. The saw removes the skull and the water-rich brain, large enough to sit cradled in two hands, joins the rest in the pail.

Sauvageau dissects the organs, looking for the signs that reveal the many ways a human body stops: tumours, clots, bruises and breaks.

She lifts perfect-teethman’s heart from the pail, holding the muscle like an apple. With a scalpel, she cuts parallel horizontal cross-sections the size of quarters along the surface of the sac.

“Ah,” she says.

“This man died of atherosclerosis.

“See that?”

She points to a tube the size of a straight pin in a grenade.

“See how it’s filled with yellow?”

The coronary, the tiny artery that feeds the muscle that controls the heart, is blocked by a gooey thick plaque. Too little blood fed the heart and the man suffered a myocardial infarction -a heart attack -and he died.

The examiner places the heart on a white plastic cutting board and dissects it in slices thinner than an inch.

The heart smells like boiled copper and black blood. It’s the kind of smell that clings to the top of the cleft palate, where the nose meets the mouth.

The inside of the heart is white.

Scar tissue, she explains. Signs of a previous infarction.

The man had a history.

His is the most common cause of death Sauvegeau sees.

She walks into an adjoining office to sign the death certificate, picking up a vanilla Timbit left by the police.

“I know I shouldn’t eat pastries, but I’m starving,” she says. “I know you’ll think, ‘How strange. I’m looking at bodies.’ But it’s difficult work.”

It’s almost noon and she sits for only a minute.

She takes lunch in her office and eats while filling paperwork. Today, her lunch includes soba noodles, raw mushrooms, strawberries, cherries, red peppers and celery.

“When I was newly married, I would talk about what would happen when I died and when he died and he would say, ‘How can you say you love me and talk about my death?’ “

But for her, the process is as mundane and fascinating as delivering the mail, selling houses or drilling an oil well.

“Society puts death out of their life, it’s out of the city. Even the cemeteries are far away,” she says. “For us, it is always there, in the face.”

She’s not afraid of dying, she says. Most medical examiners aren’t morbid. Rather, they are happy people who take care of themselves because they see, every day, the fragility of their own bodies.

Neither is she bothered by death’s smells: the cadaver’s black blood, the shiny sheath that coats muscle. She’s too busy seeking its mysteries.

In death, the body reveals all its living secrets: bad heart, bad habits, bad genetics, bad luck.

In the afternoon, the second wave of cases are carted into the examination room: a severed spine; an alcoholbattered liver that looks like moon sand in a red sack; an unnamed man found floating in the Athabasca River, his abdomen wound with rope and red twine.

When the autopsies are finished, the garbage bags filled with organs are stuffed back into the chest. The bodies are sewn together with white cotton thread and a hooked needle.

It will be left to the funeral homes to make the corpses pretty.

Neither the examiner nor her assistants cut into the bodies’ faces: Those are the fast-fading last recognizable signs of the newly departed’s “them-ness.” They are never touched.

If those faces can be trusted to reveal a person’s last moment, the bodies betray no fear. After all that violence, only peace.

jgerson@calgaryherald.com