In police vans, undertakers' hearses, and Fire Department ambulances, they are brought here because the circumstances of death are questionable: A 17-year-old boy has been found hanged in a jail cell. An old man is discovered mysteriously dead in his Uptown apartment. A pretty little girl is brought, fatally injured, to a hospital by her mother. Perhaps the 17-year-old boy was beaten to death and then hanged to make it look like suicide. Perhaps there are jimmy marks on the open door of the Uptown apartment, the signs of a killer-burglar. Perhaps the membrane of the child's brain was ruptured when her mother shook her too hard. The man who must decide is the Cook County Medical Examiner, Dr. Robert J. Stein, a chunky, gray-haired man in his sixties. His staff of 104 includes 24 investigators, nine forensic pathologists, 12 laboratory specialists, and three photographers. Not all bodies are given a complete autopsy. In half of the cases, Stein's pathologists content themselves with examining the corpses externally and sending a blood sample to the Morgue lab, where sophisticated machines detect alcohol, tranquilizers, and other potential killers.
Today, Stein inspects the body of young man whose father has called ask that an autopsy not be perperformed. Sometimes such requests are made for religious reasons. Stein accedes if the circumstances are not unusually suspicious and if no cremation permit is requested.
To Stein, this case seems open and shut. The body has been found in a garage, lying on a creeper dolly beneath a car whose engine was running. The garage doors and windows re locked from the inside. A Polaroid photograph taken at the scene shows a rosary clutched in the man's left hand. The investigator's report notes that the deceased had gone to a psychiatrist several years ago, after his younger sister had killed herself.
Pointing out that there are no suspicious marks on the body, Stein notes the pink color of the skin, which is characteristic of carbon-monoxide poisoning. With a huge syringe, he draws a generous sample of blood from the heart and sends it to the lab. Ninety minutes later the report is back: positive for carbon monoxide. Suicide. A full autopsy will not be necessary. If one were done in every case, Stein's staff would have to be doubled.
Until late 1976, Cook County had a coroner rather than a medical examiner. The coroner and his deputies presided over juries at minitrials, called inquests, to determine the manner of death: suicide, natural, accidental, homicide. They were aided by coroners' pathologists (Stein supervised them), who determined the cause of death: gunshot, electrocution, heroin overdose, pneumonia.
In Stein's opinion, separating these functions made error inevitable; today the Medical Examiner makes both determinations.
"Not that we're as good as Dr. Quincy on television," says Stein. People watching Quincy think that the reasons for all deaths can be determined; that we can pick up a bone and say that the person had blue, crossed eyes and was married nine times. Nonsense!"
In truth, ten to 15 percent of the time Stein is unable to figure out the cause of death. And in scores of cases, he must delay signing a death certifite for months until his investigators and laboratory people can shed more light on a case.
Stein's day begins at six a.m., after an hour's ride from his Highland Park home. He drives a Ford LTD equipped with a siren and a red light, which he uses when speeding to a crime scene.
"First I go down to the investigators' office and review all the cases of that night and the afternoon before," he says. "I look at suicide notes, pictures of the body, and any health records that are available. Does the medical history make sense? The investigators say they learned that a victim had heart trouble, but did they talk to his physician?"
At 8:30 a.m. grand rounds are held in the Morgue basement, when bodies are stored in large walk-in refrigerators. An odor, the faintly sweet smell of death mixed with lysol, permeates the entire building. A dozen of Stein 's aides crowds around the carts holding the bodies that will be autopsied this morning; one of the pathologists reads the investigator's report that pertains to each body.
Most of the dead look peaceful, even though their end may have been violent. A young man, shot down in a barroom brawl, appears to be ready to order a drink. A young secretary, shot in the head by a madman who burst into her office, seems surprised at the interruption.
The pathologists on duty spread out to the four autopsy rooms, two tables to a room. Stein goes to one holding the body of the young man found hanged in a police cell.
Stein's autopsy assistant (the German word Diener, which means servant, is falling into disuse), a hardworking man named Douglas Childress, who has assisted with thousands of autopsies in the past 21 years, takes an active part in the post mortem.
With the help of a razor blade and a scalpel, Childress pulls the scalp and facial skin forward, like a skier pulling off a ski mask. A power saw opens the skull and the brain is removed. Making a V-line incision at the top of the chest, Childress cuts down the length of the body to the pubis, parts the center line, and opens the rib cage.
A young woman standing on a ladder takes photographs as Childress cuts away. Stein is dictating into a microphone: "The body is that of a well-developed 17-year-old...."
The brain is sectioned by Stein with what looks like a big bread knife. All the other organs are removed, inspected for damage, weighed, and dissected. Samples of blood, bile, urine, and tissue are sent to the laboratory. In the case of a gunshot death, the path of each bullet must be traced, a tedious and painstaking task that can take four or five hours.
This case is fairly straightforward, but Stein withholds a final verdict. He marks the temporary death certificate "pending further investigation." Stein explains: "I could put down 'asphyxia due to hanging,' but instead I'll send an investigator to the jail to interview the other prisoners. We forensic pathologists have an 11th Commandment: 'Think dirty.' Suspect everybody and everything."
The autopsy has taken 45 minutes--longer than necessary for an experienced man like Stein, but there are pitfalls to avoid: "As I'm dictating I'm thinking, What would a topnotch defense lawyer be asking me at this point? I have to consider how I might answer."
Childress puts the sectioned organs into a plastic bag that he places inside the body cavity before sewing up the skin with a big running stitch. He fills the empty skull with cotton batting. The top of the skull is fitted into place and the "ski mask" of hair and face is pulled back into its proper place. Magically, the youth looks alive again, but he isn't. His is just another of the 8,000 bodies that come to the Morgue every year.