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"It's just my job. When I go home, I rarely think about it.
That is my precious few hours to 'live.'"
1. The terms coroner / medical examiner / pathologist are sometimes loosely or inaccurately applied in the press and on television. What are you, and how would you describe your job?
A pathologist is one who has sub-specialized in medicine to study disease. These are the guys that diagnose cancer under the microscope, diagnose pap smears and are learned in all aspects of the hospital laboratory.
A forensic pathologist is a pathologist who has sub-specialized yet again to study unnatural deaths. They determine cause and manner of death and usually do an autopsy to come up with these determinations.
To be a forensic pathologist, one needs to first be a pathologist.
To be a pathologist, one must first be a medical doctor.
Also to be fully credentialed, one must be board certified in pathology and forensic pathology.
Total years involved:
4 years college
4 years medical school
5 years, pathology residency
1 year, forensic pathology fellowship = 14 years
A medical examiner is a forensic pathologist. Of course in some remote, areas of the country, some physicians, regardless of specialty are sometimes assigned the duty of 'Medical Examiner,' the guy that goes out and pronounces people dead. However, they are not trained or qualified to do an autopsy. So their function is limited.
A coroner means different things depending on which part of the country you are from. The term coroner comes from old English law and the word Crowner. When people died, the most important question was who got their land and money.
The crowner took control of the property. The crowner was appointed. He had the power to arrest the sheriff if the situation arose.
Our forefathers brought with them many of the old English practices including the Crowner, or coroner.
That's how it began. Nowadays, the coroner can be a sheriff and appointed to this duty, as in California and some other western states. In Nevada, my state, the coroner is appointed by the county commission. Most coroners are not doctors. They can not perform an autopsy. They are however empowered with the ability to sign a death certificate. This makes for a very large problem. Cause of death is not always straight forward, as in a car wreck or gunshot. And even these can be called wrong. So there are non-medical persons doing 'medical things.' These coroners usually do the administration for the office and run the place, but hire forensic pathologists to do the actual work.
In the Midwest, many of the coroner positions are elected. They range from mechanics to photographers to funeral directors, well, you get the idea. If there is a 'real' forensic case, they have to contact a forensic pathologist to do the case.
In Ohio, coroners are elected but are also doctors of one type or other, (not necessarily pathologists). As an aside, general doctors, surgeons, etc. are not trained in autopsy and are unqualified to do them.
I am a forensic pathologist (a pathologist and medical doctor). I am board certified and licensed to practice medicine in the state of Nevada. My boss is the coroner (not a doctor). I determine cause and manner of death. The coroner can 'trump' my determination of manner of death (i.e. Homicide, Suicide, Accident, Natural or Undetermined). He has no basis upon which to 'trump' my cause of death, as this is a medical determination. He cannot make it.
My job is determine cause of death: i.e. gunshot wound of head ... and ... manner of death: i.e., homicide.
I am the one called to the courtroom for the murder trial.
2. How do you deal with a job in which you see death, up close, on a daily basis?
Well, it's not something that you 'just jump into.' It takes a lot of years working up gradually with more and more exposure. I don't want to say that I am a cold bastard, but actually that is an achievement in a way. One of my songs on the first album Tools of the Trade deals with the psychological equipment required for the job. You develop a sense of dark humor and find every opportunity to use it. Also, as long as I don't know any of these people, they don't affect me much. They are either a 'routine' or an 'interesting' case. Every now an again, some decedent will make you stop and think ... but not for very long. If you get bogged down in this type of thing you will not last, even a few months. And I can say that for medicine in general. There is a 'professional,' 'compassionate,' 'poker face' that you develop and that is the one that you portray to the families, courts and public. I can't speak for others, but I would describe my 'true feelings' as ambivalent.
It's just my job. When I go home, I rarely think about it. That is my precious few hours to 'live.'
One thing that helps 'deal' with what I do is talking to you, consulting for CSI, writing songs, recording and having ambition and dreams in other areas of life.
3. With the public's burgeoning fascination with forensics, are you tempted to write a book about it, as other medical examiners have done?
It's crossed my mind every now and then. But I'm too young in the business to really have a book's worth yet. I thought I might call it Speak for You. I think that it would all wrap up into a nice package. Of course by the time I get there, the public will probably have had enough of forensic stuff. We are really over-saturating the market now. Turn on the television, nearly every show has some kind of morgue scene, autopsy or murder mystery going on. Even CSI itself has split into two shows now.
Back to the original question. Each medical examiner has his/her own unique experience/s during their career. For that reason I might some day consider it. I've got some good stories to tell. And just when I think I've seen it all, I'm blown away by what someone has done to themselves or someone else.
4. CSI tends to concentrate a lot on homicides - the more gruesome, the better - as drama pulls in more viewers. What is the ballpark breakdown of the cases you autopsy (i.e., homicide, suicide, accident, natural causes, unknown)? And CSI seems to have a high incidence of deaths in the 30ish bracket. What's the reality of that?
In the real forensic world the breakdown of case types is as follows:
Natural Deaths
Accidents
Suicides
Homicides
Undetermined
As far as age, there is quite a mix, but since natural causes are the largest number of cases that we do, the elderly are the most frequent visitor to the morgue.
But the gamut is everything from a fetus of a week's gestation to 103 years of age.
As far as the show goes, they are only going to use the most interesting cases they can 'create.' Only the 'young and reckless' are going to be trying the stupid things that make for good story lines. So far, after two seasons, no medical examiner is going to see everything 'they; have filmed in one career. The average day is much more routine and non-dramatic. Every now and then you get a damned interesting case. After you collect a few, then you start to think about the book idea. The thing is, it takes an entire lifetime to accumulate enough interesting cases to actually come up with a book.
5. You've stated that you never intended to be a forensic pathologist when you were young, Instead, you were interested in music. How did you end up in your current profession?
I don't know.
I see my life as having no particular direction.
I have many interests. I'd like to pursue them all.
Do we really 'plan' anything? I guess some do, but I never had my stuff together in that neat little pile. You try things. They run their course. You try something else. Maybe it opens up for you. So you go there. You find you don't like it that much, so you create your own niche. Life is just 'happenstance.' Things happen to you and you react to them. How you react determines your path. I don't think it's any more mystical than that.
One thing is for sure. If you don't risk anything, you won't gain anything. You might be secure in a way, but you'll be locked into the mundane.
If you care to read my long bio you will see that my path has been erratic and convoluted. I bumped around until I landed in the right hole. Having both science (biology) and music as interests, something eventually had to happen with both.
I got into medicine, actually, quite by accident. Once I was in, I was trying to find a way out. Pathology was the only interest that I had in the field. Once I discovered forensic pathology, I found my proper place.
6. Do you know what the job parameters are for a real C.S.I. in Las Vegas?
Great Question!!
The CSAs (Crime Scene Analysts) have very little in common with the CSIs on the show. The show has put the CSA/CSI into the center of the action and responsible for a case, which is total unreality.
In real life, the homicide detective is in charge of the case. The CSA is an evidence collector. They are directed by the Homicide Detectives and even myself, the Medical Examiner. They do not question suspects. They do not 'put the case together.' They do not do the autopsy. They are there to take bullets and other trace evidence at my direction, bag them and catalogue them. That's it. That's what they do.
They do not look under microscopes.
They do not compare hair samples, paint samples, bullets or anything like that.
They do not analyze the insects on the body. Nor do they reconstruct a face.
In the real world, there are many, many persons with their own expertise doing all of these things.
The ballistics expert is the only one comparing bullets and matching up guns to scenes.
The trace evidence expert is the only one comparing clothing, hair, paint, metal samples.
The toxicologist is the only one analyzing drugs.
The DNA lab is the only entity that deals with DNA samples, and it takes months for an answer. There is no machine that gives you the answer in 10 minutes like on the show.
Anthropolgists are the only ones dating, aging and 'racing' skeletons.
Odontologists are the only ones comparing dental charts.
Every specialty has there own specialists. No one can know it all.
Grissom is amazing- he does it all. And, he even knows 'sign language.'
A real CSA is a very hard worker. He/she is a 'grunt' in the field. They call themselves Road Dogs, another song of mine. They are basically sophisticated 'gofers.'
7. Do real C.S.I. really hang around the autopsy room as much as Grissom does with Dr. Robbins on the series?
No. Homicide Detectives hang around about half of the time that Grissom does. The CSAs are busy cataloguing in all of the clothing, the bullets and trace evidence. They are around the body long enough to collect this stuff and to take photographs. Then my interaction with them is over. I rarely have a 'real' conversation about the case with a CSA. The Homicide Detective/s and I interact at the autopsy and for weeks to months afterward.
Most CSAs do not like to come down to the morgue. It's too much work for them. It smells and it's gross.
8. Would you say Dr. Robbins is an accurate portrayal of a medical examiner? In what respects yes, or no?
I know Robert David Hall. He is an excellent choice for the Medical Examiner. He 'looks' like the average type and the one that the TV viewers expect.
His character, Dr. Robbins, is basically well done, given the confines of the show. It is not a realistic environment.
The doctor is in charge of the investigation regarding the body. He doesn't have a crime scene analysts doing the case with him, telling him what he thinks and them agreeing with him.
The doctor is the only one in that room qualified to make observations and interpret them. It is his/her case.
I often tell Homicide Detectives and Crime Scene Analysts that they have it wrong. I direct them to go back to the scene and find the missing evidence that I know must be there.
On the show, Grissom is expert in everything and controls every situation. Crime Scene Analysts do not have this function. And doctors do not interact this way with police officials. I do have a lot of comarderie with the police and enjoy our special relationship.
The doctor controls the morgue and makes all decisions and determinations on the case.
The doctor determines cause and manner of death. It may or may not agree with the police. The medical examiner is a 'check and balance' in a homicide investigation.
9. I have a friend who is a nurse, who tells me she rarely watches any medical dramas (such as E.R.) as the inaccuracies drive her nuts. When you watch CSI, what is your impression of it?
I can relate to your friend. The previous questions and answers may give you an idea of my impression.
Part of the reason that I consult is to keep them as well grounded in reality as I can. It doesn't always work. After all, the set up of the lab and the personnel on the show has already been established. And in all honesty, if the show were too much like the real world, it would be too boring to film.
Hollywood has a duty to entertain. This group of writers, producers, actors and support personnel are the best in the business. They know what they are doing. They know what works. There is a reason they are the number 1 drama series for more than two years now.
I do watch the show. Partly to see what lines of mine they have used and to see if they got them right.
Also, I must admit, it's a damned good show. The dramatic tone, the chemistry of the cast, the 'double story line' going on and twists in the show keep me sucked in.
The writing is incredible. I know these guys, and let me tell you, they don't think like the average guy. I wouldn't want to play chess with any of them. They see moves about 5 or 6 ahead.
I've been out to dinner a number of times with Josh and Dave Berman, Carol Mendolson and Anthony Zuiker. It's an interesting conversation. I am always astounded at the mind inside that cranium. It is not of this planet.
You think anybody can come up with this stuff? Try it!!
I must say that they do try. They consult me and often ask … 'would this happen, is this realistic, should we go with this idea?'
I guide them in the correct terminology and 'where the bullet or the knife needs to go' in order to kill a person this way or that way.
They are very concerned with getting this part of the show right.
And for this I give them a B+ to A-
The only thing, as I stated, that is way in error, is the hierarchy of power, the division of duty and the extent of involvement by the CSA (CSI).
I can live with it. It's Hollywood. It's fun. It's only supposed to be entertainment. There's no 'knocking' success.
10. You offer technical advice for CSI. Have the producers asked you for help with CSI: Miami?
The writers and producers write both shows. Most of my stuff ends up on the original, Vegas-based show. Some of it does end up on the Miami show. I don't watch the Miami show, so I'm not sure how much they use for that.
Continue to Part 3
Introduction
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Part 4
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