Showing posts with label Morgue. Show all posts
Showing posts with label Morgue. Show all posts

April 8, 2020

The Dead Don't Know The Difference Between Morgue or Trailer Outside,The Living Do

                         New York City Deploys 45 Mobile Morgues as Virus Strains Funeral ...

In life, Colleen Dilger’s 80-year-old grandmother was “a very social animal” who “never spent a moment by herself.” But the memorial service commemorating Sandra Stein following her death from cancer on March 26 is likely to be a much less social affair.

Due to coronavirus social distancing measures, the funeral home in Buffalo, New York, where the service is being held, is offering only two visitation options: Mourners can either walk past the casket one at a time, or drive by in their cars.

“It feels so incomplete because she always had family around her,” Dilger told me.

Dilger’s experience is quickly becoming the new normal. To help curb the spread of the coronavirus across the country, a number of US states have issued stay-at-home orders and banned gatherings of more than 10 people, including religious services. 

You can’t use ventilators without sedatives. Now the US is running out of those, too.

Thus, funeral professionals and religious leaders now have to weigh a family’s need to mourn and the importance of conducting funeral rituals against both the safety of the larger community and potential legal consequences of violating state orders.

As a result, many funeral homes are severely restricting the number of people allowed to gather for visitations, memorials, and funerals, or offering alternative options like livestreaming. And even when a few close family members are allowed to attend a service in person, they’re often still required to maintain 6 feet of distance between one another at all times.

Which means the coronavirus that has interfered with so much of life is similarly interfering with all aspects of death. “The normal healing process has been disrupted,” Rabbi Elana Zelony of Congregation Beth Torah in Richardson, Texas, told me.

“The deceased doesn’t know the difference during this period, but the living do”
Memorial and funeral processes have changed in subtle but important ways since the coronavirus struck America.

Jeff Jorgenson owns funeral homes in California and Washington state. He told me that the timeline of services is now longer and the precautions he and his team take are much more thorough, but that most funeral homes still accept the bodies of people who have died of Covid-19.

For example, before the outbreak, Jorgenson would retrieve the deceased by going to a hospital’s security or admitting office and having a staffer accompany him to the morgue. But on a more recent hospital visit, he discovered that the process had gotten a lot more complicated.

“I had to go through screening, and then screening sent me up to admitting. Admitting sent me back to security, where security validated that I had been screened, and then I could go to the morgue,” Jorgenson told me. “It was two extra steps, really, but it added 25 minutes to transferring the person into my care. If you repeat that for three bodies, you’ve added about an hour and a half to your day.”

But that lengthened process only happens if a hospital and a funeral home can arrange a pickup. In New York City, the epicenter of the outbreak in the US, that’s not a guarantee.

Already, funeral homes are overwhelmed with the amount of bodies they’re taking. “There is just not enough capacity in the funeral homes in Queens and Brooklyn to handle the number of people dying right now,” Patrick Kearns, who owns the Leo Kearns Funeral Home in Rego Park (a neighborhood in Queens), told the New York Daily News.

When they do pick up a body, sometimes it’s not lying in the morgue, but rather in a refrigerated trailer outside of the hospital. The US government is expected to send 85 additional trucks to the city in the days ahead.

If the deceased’s family can’t arrange a transfer to a mortuary within eight days, New York City officials organize the burial or cremation process. That may include burying the body in a temporary grave in a public park until more space opens up in funeral homes.

For those families who are able to get their loved one transferred to a funeral home, there may still be delays in holding a memorial service. A funeral home in the city can’t hold more than three services a day, which allows staff to clean and disinfect in between families.  

New York City’s funeral situation is much more dire than in most parts of the country, but there are challenges even in less hard-hit areas.

John Wenig, the president of Wenig Funeral Homes in a tight-knit community in Wisconsin, knows almost every client he has — which is why it was so hard for him to tell a woman whose husband died after 60 years of marriage that the funeral home couldn’t provide the services she wanted.

The reason has less to do with capacity than with state and federal guidelines. Basically, touching the body in any way — kissing, handholding, hugging — is highly discouraged to prevent the transfer of Covid-19. The social distancing rules are even more important, since visitations, memorial services, and funerals tend to draw large crowds. With most states restricting gatherings larger than 10 people, it’s impossible to hold such an event.

“That makes it hard on the grieving process for the whole family,” Wenig told me. “The elements of grief that are needed and most appreciated is the closeness of families coming together — the hugs, the kisses, holding each other. That is not happening right now, simply because families need to maintain the 6-foot distance.”

Wenig allows his clients to do small visitations and funerals, but is postponing all large memorial services until the summer at the earliest. “The deceased doesn’t know the difference during this period,” Wenig continued, “but the living do.”

Jorgenson also acknowledged the emotional hardship of these situations, but he is unapologetic about taking the necessary precautions.

“At this point in this pandemic, it’s my responsibility as a funeral professional to my community, and [to] the world at large, to not cause harm,” he said. “And if not causing harm in my community means you don’t get to see your dad ... I’m sorry, this is bigger than you. That goes against most funeral professionals’ core being, but it’s the right thing to do.”
After losing a loved one, millions of Americans turn to their religious communities for support and comfort. But social distancing measures are changing what that support and comfort looks like.

Rev. Bill Parnell, a leader in the Episcopal Diocese of Massachusetts, told me that many people in the 175 worshipping communities he helps oversee are struggling with the restrictions social distancing has put on their grieving process.

For instance, a retired priest died from the coronavirus two weeks ago in Cape Cod, leaving behind his wife, who is also infected. The priest’s family couldn’t visit him while he was sick, nor can they attend his funeral service because of travel and space restrictions.

“That’s just heartbreaking,” the reverend told me. “I can’t imagine what that must feel like.” It’s harder because now that church services have moved online — where attendance has actually grown, Parnell said — there’s no physical community to help console the grieving family.

Pastor Rob McCoy leads a communion ceremony after an online Palm Sunday service in Thousand Oaks, California, on April 5, 2020. Apu Gomes/AFP via Getty Images
Zelony, the rabbi in Texas and the first woman to lead a Conservative movement synagogue in the state, has had a similar experience.

“I’m definitely grateful for the technology, but it’s so awkward,” she told me. “It’s much harder to read the body cues. I can’t hand them a Kleenex or give them a hug.” That bothers her, as “one of my jobs is to give people hope and support.”

Zelony also said that religious burial practices have been disrupted. Jews in the Conservative movement traditionally pour dirt into a loved one’s grave until it covers the top of the casket. That was easier to do when there were 50 to 60 people at a ceremony, she told me, but it’s much harder now, since no more than 10 can attend. “It made me notice the absence of having many community members to help,” Zelony added.

Families also can’t observe shiva, the weeklong mourning period in Judaism, as they did before, Zelony said. During this time, family and friends would normally stop by the home of the deceased’s family to offer food and condolences. But that doesn’t happen in the same way now, when few people are traveling and large gatherings are discouraged. “It’s just not possible in the same kind of way,” the rabbi said. “I’ve seen Jews take comfort in the traditions of mourning, and now they feel cheated.”

Many Muslims feel the same way. Imam Ibraheem Bakeer, from the Islamic Society of Greater Kansas City, told me that it’s customary in Islam for friends and family to gather and pray over the body of the deceased. Because of social distancing, that can’t happen — and it’s also why Bakeer is restricting visitations to no more than three people at a time.

Bakeer said he’s faced a lot of backlash for that decision. “It’s very tough, but our job is to convince these people and give them the conviction that we are in a bad situation and in critical circumstances,” he told me. “We can’t do the regular things, and they have to understand this.”

Still, he understands their frustrations. “It’s an emotional thing,” Bakeer said.

The CDC recommends several measures to help prevent the spread of Covid-19:

Wash your hands often for at least 20 seconds.
Cover your cough or sneeze with a tissue, then throw it in the trash.
Clean and disinfect frequently touched objects.
Stay home as much as possible, and do not go out if you are sick.
Wear at least a cloth mask in certain public settings.
Contact a health worker if you have symptoms.

“Death is on everybody’s mind”
Alua Arthur is a “death doula” based in Los Angeles. Death doulas, sometimes called end-of-life doulas, are trained nonmedical professionals who offer emotional care and logistical planning and support to both people who are facing death (often in hospice) and their loved ones.

Arthur provides her clients with companionship and emotional support in their final days, as well as practical help taking care of the myriad administrative tasks surrounding death and estate planning. That support may involve just being a person to talk to or even opening mail when such a thing seems too hard in trying times.

But the coronavirus has upended that dynamic. Instead of being in the home of a client, Arthur uses FaceTime or other technology to stay in touch from home. It’s nowhere near the same, as she struggles to pick up on the nonverbal cues that allow her to do her job the best.

But the hardest part, she told me, is watching her clients and loved ones struggle with the uncertainty of death, especially as the coronavirus rages.

“We have grief compounding grief,” Arthur said. “We have the grief around the type of death that they envisioned that they can’t have, or the type of dying process the family envisioned that they don’t have. We have the grief around what the death could look like, and then we have the actual dying that’s happening, and then the grief around not being able to bury them or memorialize them in the way they wanted.”

She believes this grief is more widespread than most let on. Covid-19’s ubiquity in our lives means “death is on everybody’s mind, when it wasn’t before,” Arthur said. adding that there’s “a sense of, ‘Oh, shit, I might die from this.’”

Countless people now have to get creative in the ways they grieve and mourn.

“It’s hard to find a new ritual and give it meaning,” Arthur told me. “It’s hard because you might have to break the mold [of a traditional memorial and funeral service, which requires] removing judgment about what we’re doing or not doing.”

“This isn’t about thinking outside the box, it’s about creating a whole new box — and that’s hard when we’re anxious and fearful and uncomfortable,” she added.

But whatever form it takes, remembering the ones we love the most may be one of the most important things any of us do during this time.

March 3, 2020

One More Crisis in America: Overflowing Morgues! Do You Need To Care?

 Credit...Sara Naomi Lewkowicz for The New York Times

Say you are found on your bathroom floor, on the grassy knoll of someone else’s front yard, in the berth of your tractor-trailer, in your own bed, at the foot of a bridge, under a car wheel, in the car, caught in the bend of a river, collapsed in the bar, alone in the remains of a scorched kitchen. Your death is sudden and unexpected, a death that no one plans for but that approximately half a million of us will experience this year in America. No death is special, but this kind of death requires special care, procedurally, from a number of people you will never meet. The procedural aspects of your death, which you will never see, begin with a phone call.

One afternoon in the summer of 2018 in Cleveland, a man returned home to find his wife slumped over her computer keyboard. She was in her 50s and had been in poor health, but nothing seemed urgent or life-threatening. It looked as if she died while shopping online. Her husband called 911.

When police officers arrived at the house, they weren’t entirely sure what had happened. It looked maybe like a cardiac episode, or a seizure, or an overdose. The woman had been taking a long list of prescription medications, and in Ohio, amid the ongoing opioid crisis, most untimely deaths with no obvious foul play are marked for further investigation. The officers called the medical examiner’s office, and Erin Worrell picked up.

As a medico­legal death investigator, Worrell serves as “the eyes, ears, and nose,” as she puts it, of the team that determines cause and manner of death for the official record. It’s often said that death investigators are “the last of the first responders,” in that they are called only after a life-or-death situation has reached its definitive conclusion. 

Roughly 30 minutes after the officers called, Worrell arrived and began the standard investigation for a scene of this sort. She asked the husband when he last talked to his wife, when he came home, what her medical history was, whether he had any concerns or suspicions about her cause of death. She inspected the woman’s body to see whether her lividity patterns, which indicate the position of the body at the time of death, matched the husband’s story. She talked to the police officer to check her information against his, and she inspected the house for anything telling, like drug paraphernalia, weapons or an open gas valve on the stove. She took photographs all the while and made copious notes for the case file. Worrell confirmed what the detective suspected: Because there was no clear natural cause of death, the woman would need further evaluation and possibly an autopsy.
 Generally, if death is suspected to be unnatural (accident, homicide, suicide) or of special interest to the state (natural disaster, mass fatality or death in custody), the body belongs, temporarily, to the local coroner or medical examiner. Those officials evaluate and report the cause and manner of death, notify law enforcement and any federal agencies that may be involved in an investigation, like the D.E.A. or the Postal Service, and sign the death certificate (which is what declares a person finally, legally dead) before returning the body to the next of kin.

 While they perform similar official tasks, medical examiners and coroners don’t have identical job requirements. Medical examiners must be forensic pathologists — doctors with medical-school training, plus a pathology residency and then further training in forensics. Sometimes coroners are forensic pathologists, but more often they are general physicians or non­physicians who work in other professions; typically, the requirements are significantly laxer. 
No matter whether a state or a county-run on the medical-examiner system or the coroner system, in a vast majority of cases, only a forensic pathologist can perform an autopsy of a body that appears to have died of unnatural causes; coroners who aren’t forensic pathologists outsource that labor. Eleven years ago, the National Research Council issued a warning that there were fewer than 500 forensic pathologists in the United States, a number that couldn’t cover even half the annual deaths that require an autopsy. (For scale, there are more than 12,000 dermatologists.) In the years since the opioid epidemic has increased its caseload so drastically that the system is threatening to collapse. In the last 10 years, medical examiner’s offices with a glut of cases have lost accreditation with the national supervising association. The bodies in their districts are often shipped to other offices — which then become overloaded and risk losing accreditation in turn.
 There are coverage deserts, huge (mostly rural) parts of America that lack ready access to autopsies or trained death investigators. For a month in 2015, anyone who died in Montana had to be transported to South Dakota or Washington if an autopsy was needed; in Wyoming, bodies often have to cross state lines because there are no forensic pathologists nearby. For several years, Oklahoma’s overloaded medical examiner declined to perform autopsies on people over 40 who died of unexplained causes; the office still does not perform them on anyone who seems to have died by suicide. Chief medical examiners of New Jersey, Los Angeles County, and Cook County, Ill., (all offices serving millions of people) have resigned in protest over intolerable caseloads and insufficient funding and resources.
 But the problem in Ohio is especially dire. Over the past few years, news outlets reported that bodies there were being stacked two to a gurney and piled in refrigerator trailers to catch the morgue overflow. Worrell’s boss, the Cuyahoga County medical examiner, Thomas Gilson, compared it to a flood in an interview with The Wall Street Journal. “We’re just really awash in drug deaths,” he told the reporter. Cleveland has one of the largest and best-equipped facilities in the county, but it had a refrigerator trailer parked out back too, just in case. It was a rare public-facing cry for help from a community of professionals who, despite being crucial agents of public health and safety and stewards of our final days on earth, remain largely out of sight. Prominent members of the field, like Gilson, have been striving to demystify their work and its stakes: When death investigators and forensic pathologists don’t have the time and resources to do their jobs thoroughly, avoidable deaths follow.
 Autopsy results would show that the woman who died at her computer was another opioid death, part of the epidemic that was crushing the system. When the time came to remove the woman, Worrell took the husband aside and suggested that he step out; they had to put his wife in a body bag, which he didn’t need to see. He looked startled. “Can we pray?” he asked finally.
“Sure,” Worrell said immediately. “We can pray. I’ll get anyone you want to come and pray.” She called in the detectives, as well as the contractors who were there to pick up the body and transport it to the medical examiner’s facility, and asked them to stop what they were doing. She set down her notepad. Some neighbors and friends had come to the house after hearing the news, and together they all stood and held hands. They recited the Lord’s Prayer.
 Afterward, Worrell and the contractors resumed the routine. They lifted the woman into a body bag, zipped it shut and loaded her into the van, which made its way to an office park in University Circle where Gilson and his teamwork. The van went around back, to the wide bay door that serves as the entrance for what I once heard a medical examiner call his “silent clients.” Through that door is the morgue.

Every morning the staff reviews cases to determine if an autopsy is necessary.

Credit...Sara Naomi Lewkowicz for The New York Times

 Every morning the staff reviews cases to determine if an autopsy is necessary. Credit...Sara Naomi Lewkowicz for The New York Times
  Elizabeth Mooney’s office.

Dr. Elizabeth Mooney’s office.Credit...Sara Naomi Lewkowicz for The New York Times

At the Cleveland office, every morning begins with a staff meeting. Around the table are all the forensic pathologists, along with at least one representative from every team that touches a body during its journey through the system: death investigators, morgue technicians, trace-evidence technicians, fingerprint specialists, toxicologists, drug chemists. At 8:30 a.m., Gilson sweeps through the door to the conference room and shuts off the lights.
 One by one, the cases that have come in since the meeting the day before appear on a projector screen. Death-scene photos flash past in a slide show while a deputy medical examiner, a thin, studious man named David Dolinak, reads aloud each case report. At this point, the coordination begins: If the deceased is a John or Jane Doe, the death investigators will work with a series of specialists to try to confirm identity and next of kin. The pathologist doing the autopsy may request to inspect some items in the trace department, like a vial or bullets recovered from the scene. Before the team moves on to another case, the initial determination is made: “We’ll do an external examination” or “She is for autopsy.”
Gilson invited me to chat after the meeting, and I followed him to his office, a windowed executive suite furnished with a giant wooden desk, a microscope, a tidy blue sofa and mountains of folders and papers. Gilson’s manner is sober yet affable; he is the only pathologist in the office who prefers silence to music while performing an autopsy, but he ends staff meetings each evening with his personal maxim, “Celebrate the day.” He has a record of taking poorly functioning offices and restoring their accreditations and standard of care. He came to Cleveland in 2011 after a series of scandals led to a staff overhaul. 

“I really feel like forensic medicine is kind of this undiscovered continent in public health,” he explained. “It has so many implications: gun violence, the drug crisis, natural diseases like the flu.” Gilson often points out that the C.D.C. statistics on injury and mortality are compiled from information that originates in offices like his, and that the level of investigation they do on each case means they have a much richer, more granular compendium of information and data than can be communicated in C.D.C. reports. “This is actually where all of that information is stored,” he said. “And how do you use that fact to start to develop prevention strategies?”
In 2012, Gilson’s office was among the first to put out the first public-health warning about a rapid rise in unexpected heroin overdoses. A young toxicologist had noticed that heroin was quickly spreading throughout the county, to neighborhoods and populations that had never struggled with it before. With other municipalities, the office formed a task force to study the epidemic as it evolved in Cleveland and the surrounding areas and began sounding the alarm. It found that a high percentage of overdoses happened in the presence of someone who could have intervened before paramedics arrived, so it worked with the cities to start training and better distribution for naloxone, a drug that can reverse a narcotic overdose. It also found that many people were overdosing shortly after being released from prison — prompting law enforcement and local prisons to educate inmates about the risks before their release.
 Nationwide, the medico­legal death investigation system, as it’s called, is the primary source of data that drives our understanding of what’s killing us that shouldn’t be. Gilson regularly appears on local news programs to warn about timely risks, like drownings in the summer, and the death investigators alert city planners when they spot an intersection where car accidents are common. It was a medical examiner who, in 2015, confirmed the first measles fatality in more than a decade — a diagnosis that turned up only through an autopsy, because the victim had no typical measles symptoms — prefiguring the measles epidemic that has plagued the U.S. in the past year. Coroner reports helped the C.D.C. link more than 50 unexplained deaths to methylene chloride, a chemical common in paint strippers, which led to an E.P.A. ban on consumer sales of the chemical.
 After mass shootings, acts of terrorism or natural disasters, medical examiners or coroners are put in charge of the bodies at the death scene, working to identify them, matching bones to their mates, gathering medical information that might indicate what weapons were used and how and compiling the investigative data they draw on as expert witnesses in criminal trials. (Many offices have complex mass-fatality preparedness plans, developed in tandem with local government, and run regular drills.) They are also seen as key players in bioterrorism-response plans by state and federal governments, because they, along with hospitals, are the fastest reliable identifiers of a new toxin or disease that has entered the population.
 The rate of autopsy in hospitals is now under 5 percent, so a majority of public-health information drawn from autopsies is coming from the medical examiner-coroner system. The information the system gathers provides the raw data that epidemiologists use to study everything from food-safety policy to patterns of domestic violence — like the 2008 study published in The Journal of Emergency Medicine showing that nonfatal strangulation by an intimate partner was a major indicator of future homicide. 
The trouble, Gilson explained, is that most coroner and medical-examiner offices are so overloaded that forensic pathologists are struggling simply to finish their cases within the time frame mandated by the National Association of Medical Examiners (NAME). Even if an office can come up with the money to furnish an attractive salary for a forensic pathologist, there is often no one to hire. Stressed and disheartened by the workload, forensic pathologists change careers or retire early. Gilson pointed to David Fowler, the former medical examiner of Maryland, who retired early at the end of 2019, citing insufficient staffing and funding.

In 2013, NAME published the results of a survey of 68 offices in the U.S. that serve populations greater than 300,000; while 97 percent of the offices expressed interest in a medical-examiner-based surveillance system for infectious diseases, only 13 percent were identifying and reporting infectious-disease cases through the existing reporting methods, because of lack of money, lab-testing capability, and staffing concerns. In 2017, testifying before a Senate subcommittee, Gilson called the shortage a “national crisis in death investigation,” reporting that his profession was in “dire need.” When I spoke to him in February, he said it’s only getting worse.

After we spoke in his office, I followed Gilson up to the trace-evidence department. He was about to demonstrate an autopsy for a group of visiting prosecutors. The deceased was an elderly man who hanged himself, and Gilson wanted to inspect the rope.
 The man was laid out, naked and mottled, with the rope still attached to his neck and coiled neatly by his head. As Gilson greeted Daniel Mabel, the forensic scientist staffing the trace-evidence department that day, he asked, “Do you have the gun for the other guy?”
Mabel shook his head, then explained to me that he was working on the case of a black teenager found with a gun in his hand and a gunshot wound to the head. Detectives thought it was a homicide, but Gilson and his team thought it was more likely a suicide.
“You know,” Gilson said, “that’s a rising trend, suicide among young African-American males, that I haven’t heard a lot about.” He lifted the rope from the man’s neck and turned it over in his hand, inspecting its weave and weight. “We tend to think about suicide as older white guys or middle-aged white guys, which is still true. But if nobody’s following trends. … ” He waved his hand toward the morgue, where we had just seen a black teenager who had arrived the day before with a self-inflicted gunshot to the head. When his age was read aloud in the morning meeting, there was a collective intake of breath.
“Thirteen?” someone asked as if hoping the number were wrong.
“I don’t want to harp on this,” Gilson said, setting the rope back on the table, “but if you overburden the system with case­work, the surveillance function is lost.”

Dr. Elizabeth MooneyCredit...Sara Naomi Lewkowicz for The New York Times
One April Saturday in Cleveland, the weekend staff — two investigators and one pathologist — were going quietly through the afternoon’s work when someone called to tell them that the coroner of a nearby county had died. This news was met with surprise and apprehension. The coroner was a forensic pathologist who handled that county’s autopsies. Until the county could find a replacement, Cleveland would have to pick up his cases, even though the office was already pushing NAME’s caseload limit. Like many offices around the country, Cleveland’s borrows pathologists or hires freelancers to come in for a week or two to relieve the staff, but now it would most likely have to hire a new full-time pathologist, which could take years.
“We’re getting to this precipice where we’re not going to have enough people to do the grunt work,” Gilson later told me. “There are eight doctors in my shop. Only one of them is under 50. She’ll be all by herself in 10 years!”
The most obvious cause of the forensic-pathologist shortage is the substantial pay gap between their field and other medical specialties. “Forensic pathologists are some of the lowest-paid physicians in the country,” said John Fudenberg, the coroner of Clark County, Nev., who is not himself a forensic pathologist but leads a team of them. “They go to more school than a lot of medical doctors, and they come out and a lot of them are starting at like $150,000 a year. They could go into clinical pathology and make nearly twice that!” Physicians often leave medical school hundreds of thousands of dollars in debt, which makes it difficult to justify further training in exchange for a lifetime making a fraction of the average physician’s salary.
Most medical schools do not promote or discuss forensic pathology as a possible career path. Last year, only 44 out of 24,399 active residents in sub­specialty programs in the U.S. undertook forensic-pathology training. “It wasn’t even an option in medical school,” Todd Barr, a forensic pathologist working under Gilson in Cleveland, told me. “Pathology was barely even taught. I think I had a forensic mind already, back then, but nobody ever said, ‘Hey, you ought to think about forensics.’ And I wish they had.” It took him 13 years of practicing medicine to find his calling in forensics because he never knew about it.
There’s little consensus about what can be done, beyond better pay, to remedy the shortage. Some suggest forgiving student loans or increasing the number of visas available for forensic pathologists from other countries. A contingent of medical examiners would like to see the coroner system done away with entirely because it lacks standard qualification requirements. Many sparsely populated counties don’t have the budget or the workload to sustain a trained forensic pathologist. Ross Zumwalt, then the chief medical examiner for New Mexico, told NPR in 2011 that if you die near a state or county line, “the space of a few yards” can determine whether a death is well handled. “On one side of the border,” he said, “you have a statewide medical examiner and competent death investigation; the other side of the border may be a small county coroner with few resources and little training.” Often, coroners in less stringent counties receive very little training in death investigation before beginning their duties. In many places, like the state of Pennsylvania, the only requirements are to be a legal adult with no felony convictions who has lived in the county for one year and to complete a basic training course.
Several people I interviewed pointed to a subtler problem, which may lie at the root of the low salaries and institutional neglect: Americans are suspicious of anyone who deals voluntarily with the dead. Even doctors can be wary of “the gore, the dirtiness of it,” says Elizabeth Mooney, a deputy medical examiner, and colleague of Gilson and Barr’s. Forensic pathologists aren’t there to help people “get better,” which subverts the common expectation of a physician’s task. Among physicians, she says, there’s a misimpression that because they don’t deal with living patients, forensic pathologists have an inferior understanding of clinical medicine. A number of doctors told me that the field receives less research funding and support because of the assumption that those dollars would make more impact elsewhere.In reality, though, spending money on the dead is spending money on the living. In Cleveland, the medical examiner’s office is the first to recognize when a new synthetic opioid hits the streets, and it works closely with the D.E.A., the Postal Service and local law enforcement to identify connected overdoses and the supply chains that cause them. That office helped trace three infant suffocations to a single maternity hospital that treated all the mothers; while nurses told mothers to place babies on their backs to sleep, the nurses themselves frequently placed them on their sides. Several mothers imitated this when they went home, and their babies suffocated overnight. Investigators reached out to the hospital to draw their attention to the problem.
Medical examiners often testify at trials for homicides, domestic violence, drug trafficking, assaults, and other lethal crimes. Worrell, who has since moved to the Denver medical examiner’s office, told me the story of a bedridden older man who was neglected and abused until he died, in what she could tell had been torturous conditions (his bedsores had become infested with maggots). The man’s wife and adult children, who were his caretakers, suggested blandly that he died of natural causes. Later, Worrell pulled his social worker’s notes and found years of documentation of his abuse. “I had to take probably a half an hour and sit outside and not do anything,” she said. “I was just like, I can’t — I just — felt so bad for that guy. But then at the same time, one of the greatest parts of our job is that I’m his voice.”
I paused here for a second to ask what that meant. “That’s just my mindset,” she replied. “I see that, and I’m like: OK, I’m here for you. I’m your voice. I’m going to protect you. All those people that mistreated you and left you there to rot and die? [Expletive] them. We’re gonna get ’em. Me and you, buddy.”
She sat back in her chair and smiled. “And I did. They all pleaded guilty. The whole family got charged.”
Cuyahoga County’s Office of the Medical Examiner has one of the oldest forensic pathology training programs in the country, and several times a year it hosts death-investigation training for law enforcement officers, prosecutors, and first responders. A few days before taking the training myself, I met Christopher Harris, the office’s communications specialist, outside a warehouse of mock death scenes. A dummy dressed in a hoodie was sprawled under a picnic table on AstroTurf covered in blood, with a pistol near his rubber hand; another dummy in a house dress lay on the floor of a fake kitchen with the oven door open. These sets were built for the final test, in which students assess each scene and make an initial determination.
“You’ll do this on Tuesday after you take the training,” Harris said, guiding me through each room. The idea is that death can fool you if you don’t know what you’re looking at, and despite the garishness of the stiff-limbed dummies, the improbable redness of their blood, the point is made. I mistook a particularly gruesome-looking accident for homicide and an overdose for a natural death.
On the morning of the first day of the death-investigation training, we received a quiz. The questions ran in this general direction:
 Fill in the blank: “A torn gunshot wound that can be put together again is ______________.”
True or false: While processing a hanging scene, the ligature should always be removed from the decedent on the scene.
One by one, the pathologists took the lectern. Mooney taught us how to quickly distinguish between a stab wound from a blunt weapon and one from a sharp tip. Another doctor covered drownings; a third, hangings. We learned to recognize the way bullets will stipple the skin while entering the body versus exiting and how the body looks after poisonings, deaths in custody, bludgeonings, car accidents, hypothermia, hyperthermia, fire. We learned to recognize the common forward-slumping position of people who die from opioid overdoses, which is sometimes referred to as prayer position. We learned to look at a corpse and its damage or rot as a story — the last story a person will ever tell, and once he or she needs help communicating.
This work is unpleasant to think about for most people. But Americans’ unwillingness to devote time and money to studying the dead — our supposition that the story, or the parts of it that matter, stop with the heartbeat — absolutely fails to imagine the intimacy with which the living and the dead remain connected. The dead tell us how we’re dying, how we’re living, who among us gets a better shot at a whole and healthy life and the ways in which we remain vulnerable to one another and to the vicissitudes of an unpredictable world. Our epidemics, the commonality of our despair, our continual mistakes, the progress we have yet to make, the wrongs we have yet to correct — all these are mirrored back to us by the dead.
In late 2019, news outlets began reporting on a study commissioned by the Congressional Black Caucus showing that the rate of suicide among black American teenagers was soaring. More than a year had passed since Gilson and I stood near the body of the 13-year-old in his morgue, so I called him to ask how he felt about his warning finally reaching the public consciousness.
He reiterated what he said then: that public-health studies tend to work with data gathered by offices like his a year or more earlier. He wondered whether the government had “missed a time to intervene much sooner.”
As it happens, the newest data in that study was two years old. Information about all the teenage suicides since — including the boy I saw in the Cleveland morgue and many hundreds of others — is still wending its way from medical examiner and coroner’s offices all over the country to the C.D.C., from which it will make its way to policy­makers, academic researchers, news outlets and finally teachers and parents. Perhaps it will arrive sometime in 2022. How many more will have died by then is anybody’s guess.
As it happens, the newest data in that study was two years old. Information about all the teenage suicides since — including the boy I saw in the Cleveland morgue and many hundreds of others — is still wending its way from medical examiner and coroner’s offices all over the country to the C.D.C., from which it will make its way to policy­makers, academic researchers, news outlets and finally teachers and parents. Perhaps it will arrive sometime in 2022. How many more will have died by then is anybody’s guess.   
Adamfoxie: I omitted the name of the bodies. They are real and they all have names and a story behind them. Still, this story I am presenting here has to do within the limited space of a blog to impress upon the reader what these morgues are going through. Death is going to touch all of us. That is even more guarantee than paying taxes. The morgue waits for all of us unless you are in a local in which the body is kept in the home. In the United States mainland that would be the way, bodies are handled. 
One thing we learn from Hurricane Maria in Puerto Rico, of what happens when you try to hide the numbers in a disaster area or you don't have the facilities to take care of sudden deaths due to a hurricane, earthquake or another natural or human-initiated catastrophes. Paper towels thrown to people that have no home and no food will never be enough. But then if the government does not care then those bodies will pile up like in a nightmare hellish movie on the screen. To say you don't care about this subject then you have no feelings towards the end of life of people close to you. I gave a family member about what to do with me. Not something I think about but take 5 minutes to settle this will alleviate unnecessary hurt for the love ones left behind.
Adam Gonzalez

March 1, 2019

Breaking News}} FEMA Denies PR Help To Help Process The Accumulation of Bodies

Image result for bodies accumulation in Puerto Rico

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Bodies piling up in Puerto Rico's morgue
Bodies piling up in Puerto Rico's morgueBodies piling up in Puerto Rico's morgue

Washington — Although the Federal Emergency Management Agency denied Puerto Rico's request to dispatch forensic units to Puerto Rico to help process a mounting backlog of bodies, the island's government has received a much-need reprieve. The fiscal board which controls spending in the U.S. territory will allow Gov. Ricardo Rosselló to use $1.5 million in funding to curtail the backlog in the island's morgue. 

The current backlog of bodies at the Forensic Sciences Institute, which is the island's version of a medical examiner in the mainland, is part of a systemic issue that has been plaguing the U.S. territory for years because of mismanagement, underfunding and understaffing. The death toll and chaos of hurricanes Maria and Irma exacerbated the situation, which has forced many families to wait weeks before receiving the bodies of their loved ones.   

Rosselló told CBS News the seven-member fiscal oversight board — created by the 2016 Puerto Rico Oversight, Management, and Economic Stability Act, known as PROMESA — accepted the $1.5 million disbursements to fund the human resources department of the morgue in San Juan. Rosselló said the morgue could only have one pathologist on duty to process bodies from the entire island on some occasions. 

"The Board considered the Forensics Institute's requests for budgetary assistance a top priority, and has worked for months with the Institute and other government officials to identify the appropriate offsets in spending to allocate the requested resources," a spokesperson for the board wrote in a statement to CBS News. "We are with the people of Puerto Rico and we will continue to work with the Institute to support this essential function of government."

Transcript: CBS News interviews Ricardo Rosselló, Puerto Rico's governor
Wife desperately attempts to claim the husband's body amid backlog at Puerto Rico's morgue
Rosselló had said that the backlog couldn't be stabilized without immediate assistance from the federal government, particularly the Department of Health and Human Services (HHS) and FEMA. But in a letter obtained by CBS News dated Feb. 20, FEMA denied the Puerto Rican government's request to deploy a second Disaster Mortuary Operations Response Team (DMORT), citing the lack of an "immediate disaster-related threat." 

In the letter, signed by FEMA official Michael Byrne, the agency noted that a DMORT deployment in the summer of 2018 had helped Puerto Rico's morgue reduce a backlog of 240 bodies by performing 188 autopsies. Byrne said FEMA's team conducted an assessment of the backlog in the island's morgue and provided the Puerto Rican government a list of recommendations to address "underlying issues"— including an insufficient number forensic pathologists, a lack of adequate equipment and the need to implement "new processes." 

But the FEMA official said these issues could be not be "attributed" to the natural disasters that struck the island, which triggered the first DMORT deployment.
"These and the other courses of action ... address systemic problems resulting from issues and shortcomings that pre-date the disasters and/or cannot be attributed to the effects of the disasters," Byrne said, presumably referring to hurricanes María and Irma. 
First published on February 28, 2019 / 10:12 AM

September 17, 2018

PR Governor: We Need to Solve The Century Old Problem of Colonialism

 Last time Puerto Ricans Tried Independence, the dead ones are all Puerto Ricans. Wether it was the  wrong way or not for history to judge but when you take away people's sence of belonging and independence they will try to break through even if they deon't have the weapons and manpower but they have death and death sometimes can speak volumes and can also win wars 🦊Adam
Puerto Rico Gov. Ricardo Rosselló argued Saturday that residents of the US territory are treated like "second-class citizens" and said "we need to solve the century-old problem of colonialism in Puerto Rico."  
In addition to calling for more resources to help rebuild after Hurricane Maria, the governor told CNN's S.E. Cupp, "there's another thing we need: We need to solve the century-old problem of colonialism in Puerto Rico. The truth of the matter is ... we are treated as second-class citizens." 
During an interview on "S.E. Cupp Unfiltered," Rosselló, a member of the New Progressive Party, which seeks Puerto Rico statehood, said that all US lawmakers should be able to answer the question, "Do you support the notion that the United States, being the standard-bearer of democracy, should have more than 3 million of its citizens disenfranchised from voting or having representation?"
As a US territory, Puerto Rico does not have statehood status, although its residents are American citizens. As residents of a territory rather than a state, Puerto Ricans can't vote for president in the US general election. The territory has a nonvoting delegate in Congress, called a resident commissioner.
    Rosselló defended the accuracy of the death toll of nearly 3,000 residents that was associated with Hurricane Maria by researchers and adopted by the Puerto Rico government as the official death count, but which President Donald Trump has falsely claimed is not accurate. 
    "I reject the notion that this is somehow a conspiracy or that it is not true. It is the most scientifically accurate estimate that we have from what happened here in Puerto Rico," the governor said. 

    December 23, 2014

    Unclaimed Dead Awaits a long Final Send Off at LA County Cemetery


    Clear shipping tape covers the oversized ledger, holding together the corners. Its 1,000 pages threaten to overwhelm the three large flat-head screws that clamp the spine. Inside, names and dates fill row after row in near-perfect script.

    This is the book of the unclaimed dead.

    Unclaimed dead: In the Nov. 9 Section A, an article about L.A. County's unclaimed dead said that the Department of Public Health oversees the Department of Decedent Affairs. The Los Angeles County Department of Health Services oversees the Department of Decedent Affairs. — 

    They die in hospitals in Torrance, in nursing homes in Long Beach, on the street in Los Angeles.

    About six bodies arrive each day at L.A. County's cemetery in Boyle Heights. There, Albert Gaskin gives each body a round metal tag with a cremation number.

    As he has done for more than three decades, Gaskin records the tag's number and the dates of the cremation and the cremation permit in the ledger. The name comes next. Then date of birth. And sex. Race. Date of death.

    JULY 13, 2011.

    JULY 9, 2011.






    On a second page, there's a location of death or coroner case number. And there's a space for a signature — that means the body has been claimed.

    On Wheelock's entry, and most of the others, the space is empty.

    Wheelock is on Page 289 of the book, which is kept in a safe in a chapel-like room at the county crematory with other books listing the unclaimed dead buried at the cemetery. The smallest book, a "Register of Burials," dates from Jan. 1, 1896, to April 30, 1902. Recent books contain about a decade’s worth of names.


    The first cremation in the latest book was recorded Oct. 29, 2005. Those cremated today are added near the back of the ledger. Two hundred sixty-one pages in, the names of those cremated in 2011 begin.

    Ira Johnson, 77. Robert Lyman, 64. Luther McKenney, 74. Farther down the page are newborn twins Cassidy and Cameron Stansbary, who did not make it through their first day.

    Until The Times digitized the handwritten record of the unclaimed dead of 2011 to create a searchable database, only those people whose cases were handled by the coroner — about a third — could be found online.

    Officials from the Department of Public Health, which oversees the morgue and the Department of Decedent Affairs, said they are working to digitize many of their records.

    Los Angeles County's unclaimed remains of 2011
    Los Angeles County's unclaimed remains of 2011
    But that won't happen before December, when the ashes of more than 1,400 people cremated in 2011 will be buried in a mass grave in the Boyle Heights cemetery. It's a lonely annual ritual attended mostly by local media and county employees.

    For the unclaimed dead of 2011, time is running out.


    Wheelock, who grew up in Southern California and graduated from San Bernardino Valley College with a degree in electronics, loved trains.

    In the 1990s, he moved to Oregon and became a volunteer with Train Mountain in Chiloquin. The mountain stretches over 2,000 acres of pine forest with more than 36 miles of track, about 7 1/2 inches wide. It is one of the largest hobbyist railroads in the world.

    Wheelock even owned a small, gas-powered locomotive — "big enough that you can actually ride on," a fellow enthusiast said.

    He was on the trip of his lifetime when he died at 10:30 a.m. on June 9, 2011.

    He started at his home in Oregon and headed north to Seattle. From there he traveled east to Chicago. Then south to New Orleans. And west to Los Angeles.

    When he found the right train and car at Union Station, he sat down. And then he grabbed his chest. Passengers in the train tried CPR. So did paramedics. But Wheelock died.

    "It came at a horrible time," said his son Aaron Wheelock, who couldn't afford to come get his father's ashes. The county wouldn't ship them to his home in Idaho, he said.

    If relatives can be found, they are notified by the morgue or the coroner that their loved one's body is available for pickup by a mortuary. If a family can't afford the mortuary fees, the county handles cremation.

    The cost is typically $352 for a case handled by the coroner and $466 for others. Although that must be paid before the ashes can be taken, in some cases a family can ask a county supervisor to waive the fee.

    Some families simply don't want to pick up relatives, said Joyce Kato, an investigator at the Los Angeles County coroner's office.

    I think I would want to be cremated the next day. 
    I just don’t want to be laying around with 
    people moaning and worrying.
    - Albert Gaskin, who has worked at the county crematory since the late 1970s
    "We see that more and more every year," she said. "They don't even feel that they're obligated to make arrangements for a long-lost sibling."

    In some cases, Kato said, family members are just interested in the death certificate, which gives them access to property, bank accounts and life insurance.

    For others, no relatives can be found.

    By late last month, of the 1,868 dead who ended up at the crematory in 2011, only 440 have been claimed.


    Gaskin helps take care of the cremations, the ashes and the book of the unclaimed dead.

    He starts as early as 4 some mornings. He picks up bodies from hospitals and takes them to the crematory on the hill in Boyle Heights.

    Gaskin has been at the crematory since the late 1970s. He jokes that he's 19. But really he doesn't want to say how old he is. He's past retirement age, but stays on because he enjoys the job and he feels like he's taking care of people. In some cases, he's the last one to care for the person before he or she is put into the ground.

    "Maybe next year," he said about retirement. (He chuckled because he says that every year.)

    It doesn't feel like work, he said. "I feel I'm doing a service and I enjoy it."

    He'll probably opt for cremation after he dies, he said.

    "I think I would want to be cremated the next day," he said. "I just don't want to be laying around with people moaning and worrying."

    And he'd like to be cremated by the county.

    "It's like if you go to a doctor, you'd want to go to a very good doctor because you know he's going to take care of you," he said.

    But he added that he'd pay for the cremation and his son would claim his ashes.

    In some pages of the book, the writing changes. Gaskin goes on vacation. Another worker records the names, adding flourishes on top of the C's.

    Cornelius, David. Born Nov. 4, 1940. Died Oct. 2, 2011.


    The ashes to be buried this year belong to the old and the young. About two-thirds are men. More than half are white.

    One hundred thirty-seven are babies. Some were stillborn; others lived for a short time. Instead of the brown plastic boxes that hold adults' remains, babies' ashes are stored in small paper bags, neatly folded like wallets and placed in metal drawers.


    Cremation: FEB 16, 2011.

    Permit: FEB 9, 2011.


    B/G (baby girl).

    Born: 2-6-2011.

    Sex: F.

    Race: A.A.

    Died: 2-7-2011.

    Related story: L.A. County's unclaimed dead: How we reported the story
    Related story: L.A. County's unclaimed dead: How we reported the story
    All the names of the unclaimed dead will eventually be online, said Andrew Veis, assistant press deputy for County Supervisor Don Knabe.

    Knabe makes a point to attend the burial ceremony each December.

    "The whole issue here," he said, "is at least these folks are getting a respectful burial."


    When coroners are unable to find relatives they sometimes submit their request to, an online group of about 600 volunteers who scour public records for possible family.

    Megan Smolenyak, an independent genealogist based in Haddonfield, N.J., founded the group, which draws up a report of likely relatives and submits that to the coroner or medical examiner who asked for help.

    Smolenyak called unclaimed people a "quiet epidemic."

    "A lot of times you get to the heart of it and it's some silly little feud," she said. "You don't have to mend bridges. Just keep in touch."

    When a body ends up at the crematory, Gaskin places a wide board about 5 feet long under it, then puts it onto a metal gurney.

    He wheels it into the furnace room. The place is stale with dust. The room is noisy and hot from the furnaces. 


    Gaskin takes a long metal pole with a flat "T" top. He rests the top of the pole against the body's shoulder and together with another man slides the body into the brick furnace. And the furnace's door slides down.

    The metal tag with the cremation number waits on the door as the body burns.

    Gaskin turns around and heads out of the room to retrieve another body. There is always another body.

    Twitter: @gaufre

    Times staff writer Maloy Moore contributed to this report.

    Copyright © 2014, Los Angeles Times
    More information
    To claim the ashes of an unclaimed person, call the L.A. County Morgue at (323) 409-7161. The ceremony honoring the unclaimed dead will be at 9:30 a.m. Dec. 10 at the Los Angeles County Cemetery, 3301 E. 1st St., Boyle Heights.

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