Causes of Death Feature

Nine o'clock in the morning is no time for spiritual reflection in the morgue of the Dade County Medical Examiner Department. The first corpse of the day, a pallid woman with three deep gouges above her right ear, is already in place on an autopsy table and seven others are queued up in the walk-in cooler next door. "This should be an open-and-shut case," says Dr. Roger Mittleman, associate medical examiner, as he quickly loads a scalpel with a fresh blade and drags the instrument across the woman's torso in a Y-shape incision. One cut from each shoulder to the center of her chest, then one sure cut down to her pubis.

"She put a hex on her boyfriend, and when she went to sleep, he hit her three times on the right side of her head with a construction stake," explains Mittleman, a slightly nervous man with a stoop suggestive of his years spent leaning over examination tables. Gripping a pair of industrial-size shears in both hands, he chomps through the ribs along both sides of the corpse's sternum. A phlegmatic morgue technician lifts out the breast plate and folds back the thick flaps of skin and saffron-color fat to reveal the glistening internal organs within.

During the ensuing hour, Mittleman and his attendant technicians empty the corpse of its contents, scooping out the heart, lungs, liver, stomach, pancreas, spleen, kidneys, and, after slicing the skull with a small, electric circular saw shaped like a pizza cutter, the brain. The organs are weighed, then examined on a wooden chopping board, and samples of each are stored in small plastic deli containers for detailed analysis.

The procedure is executed quickly and with little discussion. This morning the gentle sounds of the autopsy - the scrape of a scalpel removing tissue from the skull, the woody knock of a knife against the cutting board, the continual snap of a photographer's camera documenting every stage of the study - are often the only sounds that echo through the sterile, fluorescently lighted morgue.

The process is routine for the doctor and his assistants. It's also necessary - particularly in our litigious society, where any death could develop into a multibillion-dollar lawsuit. "Part of the reason for doing a full autopsy is you never know what's going to become an issue," Mittleman explains. "Even food in her stomach could become an issue. You never know when another cause of death will be proposed. It can happen in pretty obvious cases. And it's my duty to defend what I write on a death certificate."

A detailed autopsy may also offer an explanation for death to a bewildered, bereaving family. "The families themselves have a need to know," says Dr. Joseph Davis, who has served as Dade's chief medical examiner since 1958. "We had a lady today, 101 years of age, who died peacefully at home, but one month after a car crash. The family was very interested in finding out what happened. What was the relationship between the death and the auto accident, if any? Or between the death and the medical care she had subsequent to the accident, if any?" To ascertain what happened, Davis says, he had to study the woman's medical history carefully. And open her up.

Aside from allaying legal concerns and providing, literally, a sense of closure, a medical examiner's slicing and dicing can bear directly on the way people live their lives. Autopsies often uncover medical secrets, spurring improvements to public health. "We're finding disease processes that haven't been recognized," says Davis. "We come up with information that is useful in diagnosis and treatments."

The Medical Examiner Department receives every body that expires suddenly or unexpectedly in Dade, including all the homicides, suicides, and accidental deaths. In most of the other cases, a doctor determines a cause of death without having to call in the medical examiners. "If there's no doctor to sign," Mittleman says, "or if for some reason there's a problem, like the family is so emotionally distraught they don't know what to do, then the body may come here and we decide what to do." In all, 18,136 people died in Dade County in 1990. The medical examiners inspected 3637 bodies, determining that about 60 percent of them had died "natural" deaths. A ticket to the county morgue, however, doesn't guarantee you'll receive one of the medical examiner's full-service autopsies. Only 70 percent of the bodies rolled in each year are actually gutted; the remainder simply receive an external once-over.

Autopsied or not, no death in Florida theoretically escapes the state's official computer maw. All death certificates are sent to the state health department, where drones shovel them into enormous number-crunching machines. "We're pretty understaffed right now," moans Felipe Lorenzo-Luaces, a feeble-voiced researcher, from deep within the Office of Vital Statistics at the state Department of Health and Rehabilitative Services. "There used to be seven statisticians. Now we're down to one." Lorenzo-Luaces and his skeleton crew are in the process of compiling the tables for the forthcoming 1990 edition of Florida Vital Statistics, an annual volume that documents, among other things, who perishes of what in the Sunshine State.

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