18 Tiny Deaths, page 26
According to the National Association of Medical Examiners, there are four to five hundred forensic pathologists working as medical examiners in the United States. The country needs two to three times as many to sufficiently cover the population, but medical schools are not producing forensic pathologists in great numbers.22
Of the eighteen thousand young doctors who graduate from medical school every year, only 3 percent, or about 550 individuals, choose to train in pathology. After a three-year residency, most of these pathologists work in hospitals or clinical laboratories, with less than 10 percent electing to undergo an additional year of fellowship training to specialize in forensic pathology.
Since Lee established the first training program at Harvard’s Department of Legal Medicine, the number of forensic pathology fellowship training programs in the United States has grown to thirty-nine. At present, there are seventy-eight forensic pathology fellowship positions approved by the Accreditation Council for Graduate Medical Education. Only fifty-four of these positions are actually funded, and about 20 percent are vacant in any given year for lack of a suitable fellowship candidate.
In recent years, an average of thirty-eight board-certified forensic pathologists enter the workforce annually. This number is not enough to replace pathologists who are reaching retirement age and leaving the workforce, much less to expand medical examiner systems throughout the country. There remains a persistent shortage of qualified forensic pathologists in the United States.
Attracting doctors to careers in forensic pathology is difficult. Since medical examiners are typically government employees, the pay is generally less than what can be earned as a pathologist in a hospital or the private sector. The work is frequently unpleasant and often done in facilities that are aging and underfunded. Whether these trends can be changed remains to be seen.
Despite Lee’s abiding belief in the superiority of the medical examiner system as opposed to coroners, it would be inaccurate to claim that medical examiner systems don’t have problems. A search of news stories from recent years will reveal scandals and crises in Boston, Connecticut, Los Angeles, Chicago, Delaware, and many other medical examiner offices.
A study by the U.S. Department of Justice found that investigators examine the crime scene in only about 62 percent of cases referred for medicolegal investigation. The prudent approach to questionable deaths is to have a trained investigator at every scene, every time.23 Fewer than half of the forensic investigations involve an autopsy, and despite what viewers of procedural crime dramas are led to believe, death scenes are processed for criminal evidence in only about 5 percent of investigations.
According to Dr. Randy Hanzlick, past president of the National Association of Medical Examiners, about a third of medical examiner offices in the United States lack a toxicology laboratory. The same proportion lack a histology laboratory, and an equal number lack in-house X-ray services. The absence of these essential tools can lead to cutting corners, needless delays, and other tragic unforeseen circumstances.24
In 2013, an eleven-year old boy died while staying at a Best Western motel in Boone, North Carolina. He was found to have died from carbon monoxide intoxication. Exhaust from a swimming pool pump was drawn into the victim’s room by the ventilation system.25 Two other people had died in the same motel room two months earlier. However, blood tests that revealed carbon monoxide intoxication were sent to a state laboratory by the medical examiner. Results took more than six weeks and were received a week before the child died. A forensic medical center with an in-house toxicology laboratory should have carbon monoxide results in a week or less. Had a warning about a potential carbon monoxide leak into a motel room been raised in a timely manner, a death may have been avoided.
In many instances, the problems affecting forensic medical centers are a lack of resources, a lack of funding, a lack of training and adherence to standards of practice, and a lack of support.
The science of forensic science is always evolving. DNA “fingerprinting” is a good example. Since DNA evidence emerged into the public consciousness in the 1990s, more than 360 people convicted of crimes have been exonerated by DNA evidence according to the Innocence Project. The number of innocent people who were executed or died in prison will never be known.26
The problem with DNA evidence is that the results can be misinterpreted. Several prominent news stories highlight the problem of DNA evidence misused to implicate an innocent person. A recent study by the National Institute of Standards and Technology revealed that 74 out of 108 crime laboratories the agency tested falsely implicated an innocent person in a hypothetical crime.27 DNA fingerprinting is among the areas being given a second look for scientific reliability, along with bite marks, arson evidence, and conditions such as shaken baby syndrome.
The pursuit of truth must be relentless, Captain Lee reminds us. Scientific facts must be followed wherever they lead to clear the innocent and convict the guilty.
Label designed by Frances Glessner Lee for the George Magrath Library of Legal Medicine. Credit: Center for the History of Medicine, Countway Library of Medicine, Harvard Medical School Pathologist Alan Moritz, chairman of the Department of Legal Medicine from 1939 to 1949. Credit: Center for the History of Medicine, Countway Library of Medicine, Harvard Medical School Group shot of the seminar in homicide investigation at Harvard Medical School, November 1952. Frances Glessner Lee sits at the far right. Credit: Center for the History of Medicine, Countway Library of Medicine, Harvard Medical School Frances Glessner Lee and Alan Moritz with items from the Nutshell Studies of Unexplained Death, late 1940s. Credit: Center for the History of Medicine, Countway Library of Medicine, Harvard Medical School Alan Moritz viewing “The Barn,” one of the Nutshell Studies of Unexplained Death. Credit: Center for the History of Medicine, Countway Library of Medicine, Harvard Medical School Alan Moritz. Credit: Center for the History of Medicine, Countway Library of Medicine, Harvard Medical School Frances Glessner Lee as a young child, at the playhouse designed and built by Isaac Scott at The Rocks, along with her dog, Hero. Credit: Glessner House museum The two-room playhouse, with a working wood-burning stove, designed and built by Isaac Scott at The Rocks. Credit: Glessner House museum Frances, around age fifteen. Credit: Glessner House museum The residence at 1800 S. Prairie Avenue, designed by H. H. Richardson. Credit: Glessner House museum George and Frances Glessner’s schoolroom at 1800 S. Prairie Avenue. Credit: Glessner House museum Frances Macbeth and John Jacob Glessner in the library of 1800 S. Prairie Avenue. Credit: Glessner House museum Fanny sitting on the lap of her mother, Frances Macbeth. Credit: Glessner House museum Frances in her teens, playing the violin. Credit: Glessner House museum Frances as a teenager. Credit: Glessner House museum Frances at The Rocks, ca. 1905. Credit: Glessner House museum Frances Glessner Lee with her children in 1906: John on the left, Frances to the right, and Martha on her lap. Credit: Glessner House museum The Glessner family on the porch of the Big House at The Rocks. Left to right: John Jacob, George, Frances, and Frances Macbeth. Credit: Glessner House museum Frances Glessner Lee working on the Flonzaley Quartet model, ca. 1913–1914. Credit: Glessner House museum Frances Glessner Lee working in her workshop at The Rocks. Credit: Glessner House museum Frances Glessner Lee at a meeting of Harvard Associates in Police Science. Alan Moritz is seated to her left. Credit: Glessner House museum Frances Glessner Lee with one of the Nutshell Studies of Unexplained Death, 1949. Credit: Glessner House museum
A NOTE FROM THE AUTHOR
ON A WINTER MORNING IN 2012, I was among a dozen or so editors touring the State of Maryland’s state-of-the-art forensic medical center in Baltimore. We all worked for Patch, an organization of hyperlocal news sites owned at the time by AOL-Huffington Post. Through covering the news at my site, I became acquainted with an individual active in my community, Mike Eagle, who worked as the director of IT for the Office of the Chief Medical Examiner. I asked Mike to give us a tour of the state’s new facility, which he was kind enough to do.
We met with the chief medical examiner, Dr. David Fowler, for an informal, off-the-record chat in a fourth-floor conference room. In the next room, behind a door labeled “Room 417 Pathology Exhibit,” was the famous collection of eighteen incredibly detailed dioramas known as the Nutshell Studies of Unexplained Death.
I knew all about the Nutshell Studies and their creator, Frances Glessner Lee. At least I thought I did. I first wrote about the Nutshell Studies in 1992 for American Medical News, the weekly newspaper of the American Medical Association. At the time, American Medical News paid very well for feature stories with a medical interest angle, such as doctors with unusual hobbies. I wrote articles about a medical motorcycling club, a rather genial biker gang of doctors and allied health professionals, and a surgeon who studied ancient Egyptian medical texts.
Of the thousands of stories I wrote over the years, the Nutshell Studies is the one that stuck with me. I had come to know the previous chief medical examiner, Dr. John Smialek, and a handful of others at the OCME by return visits to see the Nutshell Studies. Friends and family, knowing about my connection, periodically asked me to arrange a visit to see the dioramas. Every time I looked at the models, I noticed new things. The Nutshell Studies never ceased to amaze me.
After meeting with Dr. Fowler on that winter morning, Mike led our group around the dazzling 120,000-square-foot forensic medical center. We saw the brightly lit two-story autopsy rooms—each a huge, gleaming, voluminous space—the biosafety suite with smaller autopsy rooms under negative pressure, the radiology room with a CT and a low-dose full-body X-ray machine, and the histology and toxicology laboratories. It was all very impressive. The OCME of Maryland, regarded as one of the best in the United States, had a stellar facility to match its reputation.
While showing us Scarpetta House, the studio apartment–like forensic investigator training facility on the OCME’s fourth floor gifted by novelist Patricia Cornwell, Mike mentioned to our group that the agency had an opening for a new position—an executive assistant to the chief medical examiner who would serve as public information officer for the OCME. They were looking for somebody with media experience, ideally with a medical background, who had a basic grasp of the law and was comfortable dealing with police, lawyers, and the public. The OCME never had a public information officer before, so this was something new.
My background seemed to fit the criteria. I had been an EMT-paramedic and even completed most of nursing school before sidling into journalism. I worked in and around hospitals for years. Police and lawyers don’t rattle me. Would I like to work in the same building as the Nutshell Studies? Yes, please.
I got the job. The leap from journalism to forensic medicine isn’t as far as it might seem. Both fields are dedicated to establishing facts: who, what, when, where, why, and how. Both require critical thinking and a skeptical attitude. Medical examiners, in a sense, write the last chapter of a person’s life.
It didn’t take long for a variety of diorama-related tasks to be added to the miscellany of my duties. Jerry D, the keeper of the secret Nutshell Studies solutions, asked me to change the light bulbs in the dioramas as they burned out and showed me where the keys to the cabinets are kept. There is no manual or instructions for the dioramas, so I learned a lot about them. When filmmakers and photographers requested access to the Nutshell Studies, they were directed to me because I was the only person willing to take the time to accommodate them. I met members of Frances Glessner Lee’s family when they came to visit and was honored to share a fancy dinner with two of her grandchildren—John Maxim Lee and Percy Lee Langstaff—during the Francis Glessner Lee Seminar in Homicide Investigation. My understanding of Frances Glessner Lee deepened by engaging with people like William Tyre, executive director and curator of the Glessner House museum in Chicago.
Although there was no formal title, I became the de facto curator of the Nutshell Studies. I collected images, artwork, and documents related to the models. When the dioramas, fragile seventy-year-old artifacts at risk of irreparable damage, underwent conservation by experts from the Smithsonian American Art Museum in preparation for their first and only public exhibition, I was present to observe at every step. The examination of the dioramas by conservator Ariel O’Connor and her team revealed an abundance of previously unknown information about the composition of the materials Lee used and how she constructed the models.
When people see the Nutshell Studies, they often ask the same questions. How did Lee get involved in forensic science? How did she choose the cases to depict in the dioramas? Why didn’t she go to college? What was she like as a person? Although I’d known about Lee for twenty-five years, maybe knew more about her than anybody else on earth, I didn’t know the answers to those questions.
Lee has been the inspiration for a documentary, a coffee-table picture book, at least two collections of poetry, and even a plot arc on a popular forensic science television drama. Her life story had never been told. Articles about Lee and the Nutshell Studies that I read in print and online were riddled with errors and misinformation. Lee is depicted as a rich old woman who made morbid dollhouses. I knew she was so much more than that. She was an agent of change: a reformer, educator, and advocate.
The need for Lee’s story to be told became increasingly obvious. Who could be trusted to tell the story fairly, honestly, diligently, and thoroughly? Who could be relied upon to present the facts without trying to make Lee serve an agenda? The only person I’d trust is me. So I undertook this assignment out of respect and obligation to Lee’s legacy.
Lee demanded that investigators relentlessly pursue the facts to determine the truth and follow the evidence wherever it leads. The telling of her own story deserves no less. I approached this subject as a journalist, reporting on historical events. I have endeavored to present the facts without speculation or embellishment. I don’t know if I could ever have met Lee’s exacting standards of perfection, but I hope that I have done her justice.
READING GROUP GUIDE
1.Before Lee and others began reforming the field of forensic science, coroners regularly committed malpractice either through ineptitude or corruption. Do you think cases like these still occur today? How can this be avoided?
2.Lee came from an elite Chicago family that was famous for its patronage of the arts. Discuss Lee’s (and her brother George’s) childhood. How did it influence her as an adult?
3.When nine-year-old Lee needed to have her tonsils removed, one doctor recommended coating her tonsils in cocaine before removing them, while another recommended using ether as an anesthetic. What was your reaction to these dangerous medical practices?
4.Lee navigated a world run by wealthy men with ease, even gaining the respect and friendship of a few. Discuss the ways she formed relationships with them. How did she go about earning their trust?
5.A large part of Lee’s success was aided by her wealth. In what areas was she successful without the influence of money?
6.Characterize the relationship between Lee and Dr. Magrath. In what ways were they similar? How were they different? Was their relationship mutually beneficial?
7.Many of Lee’s projects, especially the Anatomography in Picture, Verse and Music, blended scientific studies with artistic creations. Do you think this sets Lee apart from many of her contemporaries? What are the benefits of combining these two seemingly incongruous styles?
8.Moritz dedicated a book to Lee and even asked her to be the editor of a medical journal. Given the gendered prejudice of the time—women weren’t even allowed to attend Harvard—discuss the significance of Lee’s efforts being recognized by a prominent man in the field.
9.Lee was zealous in her protection of the medical library she cultivated for Harvard. Why do you think that is?
10.Despite her huge role in the development of the Harvard Medical School, Lee’s promotion to Consultant to the Department of Legal Medicine was not acknowledged in the school catalog. Why do you think, after all her work, she could not be publicly recognized? Can you think of other instances in history when women’s achievements went unrecognized? Can you think of a modern occurrence?
11.Lee wanted all attention to remain focused on legal medicine and chose to stay out of the limelight. Do you think this forwarded her cause? In what ways would public recognition have been beneficial?
12.Some have noted that Lee did not have many close associations with other women and seemed to prefer to collaborate with men. Many of her greatest accomplishments were achieved in partnership with men—Lee and Magrath, Lee and Moritz, Lee and Gardner. Why do you think she may have sought the company of men over that of other women?
13.Women like Evelyn J. Briggs and Kathryn B. Haggerty were eventually incorporated into the forensic training program. What challenges do you think they faced as women in a primarily male environment? Discuss the ways Lee made them feel comfortable.
14.The venture to instill a medical examiner system in each state has been slow-going: as of 2019, out of fifty states, only twenty-two have medical examiner systems in place. Do you think Lee would see this slow transformation as a victory?
NOTES
ABBREVIATIONS
ARM Alan R. Moritz
CHM Center for the History of Medicine at Countway Library, Harvard University
CSB C. Sidney Burwell
FGL Frances Glessner Lee
GHM Glessner House museum
RAC Rockefeller Archive Center
NOTES
1: Legal Medicine
