If These Bodies Could Talk: True Tales of a Medical Examiner

1. WHAT EXACTLY IS FORENSIC MEDICINE?

The answer to that question lies in the term "forensic medicine" itself. There are many definitions out there in all kinds of textbooks and manuals, but I personally prefer Professor Sapozhnikov's rather short and sweet explanation: forensic medicine is "medicine in law." Unlike in many other countries, in Russia forensic physicians are separate from the police and are not under their control, though they do work very closely together. Despite relatively bare-bones budgeting in forensic science departments (morgues are always funded on leftover scraps), this ensures that we remain independent – after all, that independence is the very foundation of forensic science in the first place.

Forensic science is not a new branch of medicine by any stretch. People everywhere have always wanted to know how their bodies work, how they get injured, and why people die. Written records dating back to antiquity and Mesopotamia mention doctors taking part in court proceedings. I would love nothing more than to have a time machine to go back and watch those trials and listen to what my ancient colleagues had to say.

A bit closer to our own era, we might look at early Germanic law from the fifth through the ninth centuries AD in northern Europe, or the Alemannic laws, which already included the concepts of "damage" and "severity of damage" to determine the amount of compensation to be paid to crime victims. That brings us to the medieval concept of "God's judgment" – trial by ordeal – which took precedence over any secular court, when whatever a doctor had to say was the least of anyone's concerns. Or we might learn how the first autopsy was allowed to take place in the French city of Montpellier during the fourteenth century.

Next came the Constitutio Criminalis Carolina under the Holy Roman Emperor Charles V, which especially recognized cases requiring medical expertise, or the work of Ambroise Paré and many other great thinkers, who laid the foundations for forensic medicine as a science.

In the late eighteenth and early nineteenth centuries, as the Inquisition was abolished, several European countries began holding open trials, which often required an expert physician to publicly substantiate and defend his conclusions. This greatly contributed to the forensic medicine's development as a science.

More specifically, what about Russia? Various elements of forensic medicine go back to the tenth century when courts considered a liability for "beatings," "desecration," and "fornication," among other crimes. By the eleventh and twelfth centuries AD, the legal code of Kievan Rus doled out punishments based on whether any bodily injuries sustained were "light" or "severe." At the same time, people began examining dead bodies, attempting to determine the cause of death. Several specialized institutions were created during the 1500s, including the Apothecary Chancery, which, among other things, was responsible for establishing health and sanitation conditions and examining the body of anyone who appeared to have suffered a sudden or violent death.

Here are two examples of how the Chancery worked.

Tsar Michael of Russia wished to marry a maiden named Maria Khlopova, but members of the court were against the marriage, and informed the Tsar that his intended suffered from "falling sickness" (epilepsy). When the Tsar learned that these rumors were likely untrue, he sent his fiancée to be examined by a commission including three doctors, a bishop, and several noblemen, who pronounced her in good health.

In 1677 the Apothecary Chancery ordered the examination of a clerk named Efim Bogdanovan to determine "what illness he had died from." Physicians found that "the illness Efim had was kidney stones, and one of those stones grew large, and as a result, death befell him."[3]

Going to the doctor was a scary business during the sixteenth and seventeenth centuries, as remedies were often more dangerous than the disease itself. It was not unusual for doctors or other well-meaning but uninformed people to accidentally kill or harm their patients. There was the documented case of a doctor named Mikhail Tuleischik getting drunk and accidentally selling a patient highly toxic mercury chloride instead of medicine. And in 1700, a nobleman named Saltykov was poisoned when a servant named Aleksei Kamen mistakenly bought him the wrong herbs. All of this led to a pair of laws in 1686 and 1700, which would later become part of the Complete Collection of Laws of the Russian Empire, "On punishments for those who do not know medical science and due to their ignorance of medicine, cause their patients to die." These were the first laws that considered any punishments for failed attempts to treat sick people.

And now we have arrived at the era of Peter the Great. Peter reformed just about everything he could possibly reform, and medicine, including forensic medicine, was no exception. His Article on Military and Naval Regulations touched on many aspects related to determining the severity of the injury and the cause of death. For example, the Naval Regulations (1720) included the following paragraphs:

"108. Whenever someone is killed in such a manner that he does not die immediately, but only sometime later, it is necessary to determine whether he died of that beating, or of some other disease. In order to do that, following his death, physicians must cut up the body and examine it for a cause of death, and submit a certificate of such to the court in writing, confirmed by an oath…"

"114. Should there be a brawl in which a number of people begin to beat one man, and he dies of a wound or fatal blow or many blows, it must be determined whether those who took part did so intentionally, and who delivered the fatal blow? If this cannot be determined, the death shall be ruled accidental, and they shall be punished for the brawl."[4]

The Naval Regulation included examinations to determine whether someone was faking an illness: "Determine whether they are truly ill, and if there is any false pretense, and issue a certificate."[5] By the sixteenth century, forensic medicine was already capable of answering many questions that are still under the scope of a medical examiner's work, even today. Take, for example, this excerpt from the certificate of a forensic autopsy performed in 1731:

The autopsy was carried out by doctors from the Medical Chancellery based on an Investigative Order to determine the cause of death of Major Apukhtin, who was found dead in a well at his home. The doctors were asked the following questions: (1) "Were they of the view that Apukhtin drowned himself in the well or was he poisoned?" (2) "Did the Major die a violent or natural death, or was it a case of suicide?" A complete examination of the body was conducted. The conclusion was as follows: "… All of the scratches on his body appeared to be from a tree, stone, or a fall… Based on this examination, it appears that the man drowned, which caused a lot of water to enter his stomach along with other damage, and he was neither murdered nor poisoned."[6]

Just like anything else in life, people have at times attempted to take advantage of forensic science, twisting it to try to suit their own political goals. During the late nineteenth century, the tsarist government opened the so-called Multan case, in which forensic doctors gave deliberately false conclusions.

"On May 5, 1892, in the village of Stary Multan in Vyatka Province, the headless corpse of the beggar Matyushin was found. Witnesses said he suffered from epilepsy. Following a forensic examination, which was not conducted until an entire month had gone by, the expert falsely concluded that Matyushin died from a cut to the neck. He attributed cuts on his lower legs to having been hung up to drain his blood out, supposedly 'as during a [ritual] sacrifice.' Based on this, members of the Udmurt ethnic group were accused of killing the man. This conclusion, however, was later refuted by progressive Russian scientists Feodosiy Patenko and Emiliy Bellin. Bellin conducted a series of experiments and was able to prove that based on the absence of any blood on clothes or other signs of having bled to death, the head had been removed after he was already dead, to simulate a ritual killing. Following three hearings to consider this scientific examination, the Udmurt peasants were acquitted."[7]

With time, forensic medicine has grown and developed. Thanks to new research, today, it includes a vast range of cutting-edge knowledge and technology, and is one of the most engaging fields of medicine. The Moscow Forensic-Medical Bureau boasts a highly developed scientific and practical infrastructure with leading experimentation and research. Medical students and those from other specialties work here, alongside numerous fascinating, creative people, including world-renowned scientists and young, innovative experts. Institutions carrying out their own "independent" examinations is a recent fad in Russia, which often gives people the false impression that these examinations are indeed independent, and that their conclusions are unbiased and objective. Alas, that is often not the case – and this is the reason why the independent status of state medical examiners is confirmed and enshrined in federal laws. State medical examiners' salaries do not depend on the contents of their conclusions, and the positions of either party relative to a court case have no bearing on their work.

2. JUST WHO IS A MEDICAL EXAMINER?

Before writing this section, I asked my blog readers to describe to me what, in their minds, is a medical examiner's appearance. As I expected, most of the responses were heavily influenced by stereotypes they had seen on television and in movies. Movies avoid ever showing medical examiners' offices, and instead prefer the drama of a forensic dissection laboratory – where autopsies are performed on dead bodies. In movies, a medical examiner is almost always an aging man, unshaven, balding, and eccentric, with a sweaty face and a wrinkled white coat. He seems to work exclusively in dimly lit basements, with a messy desk covered in old newspapers and half-eaten food, an ashtray overflowing with cigarette butts, and with mysterious stains on the walls, desk, and his lab coat. The character himself is inevitably strange and constantly making deadpan jokes about his work. Rarely does he leave the laboratory, and when he does, he always manages to be casually chomping on a sandwich or a bag of chips, which he will offer to the investigator, only to be surprised when his offer is rejected. Often, he is portrayed as being a bit tipsy and, in older shows, almost always as a smoker. When the investigator asks for his conclusions, the medical examiner will, without fail, wipe his hands on his coat, whip out his notes, and say, in a weather announcer's voice, "Well, it is just as I suspected…" before once again offering the investigator a chip.

But there is yet a second type of medical examiner character in movies, which is quite the opposite to the first one. He is also invariably a man, middle-aged, intelligent, always well-dressed, and he speaks in confident tones that assure you he knows absolutely everything about everything. He needs to establish the exact time of death – and he will, right down to the second. He needs to assess the damage – and he will do so methodically, as the picture of calm, without the slightest shred of doubt. For some reason, he does his job, as well as that of the criminal profiler, which has nothing to do with his position. Occasionally, this type of fictional medical examiner may be a woman – she will be efficient, with her hair in a messy bun, clicking around in high heels as she zeros in on the next task on her to-do list. Regardless of which type of medical examiner our screenwriters have chosen, they often mistakenly refer to the character as a "pathologist," who also happens to take photos of the body at the crime scene, gathers fingerprints, and bags up pieces of evidence. Even more surprisingly, along with the investigators, the character will report on the investigation results to the police chain of command! This is what my readers had to say. Enjoy some of their submissions below:

"I always imagine a medical examiner as a middle-aged man, about fifty-five, and balding with gray hair. He is not married, and he does not have any children. He lives in a small, tiny apartment that belonged to his parents once, which is in shabby condition because his wages are pretty low. He is not very talkative, very calm, and does not have any hobbies because he is always working. He only has one or two friends, who are also doctors, probably people he went to school with. He usually watches television at home. He does not drink much, but he is a heavy smoker. At his age, he is disillusioned with life, has no more dreams or plans. Once he retires, he will continue living the same way he always has."

"He is average height or a little shorter. He is slightly overweight and unshaven. He is always bald, with hairy arms. He has a bad temper, can be caustic toward others, and occasionally even rude. Many think he comes off as a know-it-all. But his friends love and respect him. Of course, he drinks on the weekends and holidays, but he judges others for losing control. He used to drink too much himself but has managed to get his life together. He quit smoking, too. He has weird hobbies that have nothing to do with his job – like studying Esperanto. He is well read and educated."

"He is a large, grouchy man. He hates other people, even despises them a little bit. He looks down on them, even if they are physically taller. He divides the world into red, black, and white, and there are no nuances as far as he is concerned. He could slaughter a pig with a nail file if he had to. He is unpretentious in his food, clothes, music, and movies. People around him do not necessarily respect him, but they are a little afraid of him."

"He is thin, handsome, a ladies' man, a reliable, ordinary guy. He did not start as a doctor, just working as an attendant at the morgue, where his uncle was a medical examiner and took him under his wing. So, after graduating medical school, he returned and never left. He was single for a while, then settled down, got married, had a kid, bought a house, and he has many friends he has known since they were kids… His wife is a good match for him. She is totally the life of the party, so he will never be bored or let his guard down."

"I imagine him as a huge guy (at least six foot three inches, and 260 pounds), who works out at the gym, but he also has a real dark side. He spends a lot of time drinking alone, among the dead bodies, and thinks about the meaning of life and if any of them ever found it. He is lonely and has no family. If he has kids, their relationship is distant. His apartment is dusty, but he has a good stereo system. He listens to either classical music or death metal, no middle ground. He drives a black Cadillac coupe. And has a knife and scalpel collection hanging on the wall. He has a bunch of books about anatomy on the shelf, and a skeleton in the corner. Maybe it is holding a bottle of liquor and has a cigar in its mouth."

"The medical examiner on TV is always a man. He is even-tempered, calm, attentive, careful, not particularly talkative, and often an introvert. He likes to be alone, and only talks to those close to him. He has friends, but just a couple of people (they are friends from school or college). He never talks about work at home or around his friends. He likes reading, good movies, good food, or something creative. Sometimes, when he is in the mood, he might pick up some extreme hobbies – skydiving, for example, just to make himself feel alive. I do not know why, but I do not envision any significant others with him. Maybe there is a woman in his life, but she is not nearby. She comes and goes."