Primary Sources

J Reifel

There is an art to reading the coroner’s report. While there is a modern school of literary thought that holds that there is nothing beyond the text, our reading of medicolegal documentation holds up that report as a flag, or a tiny bundle of Victorian letters from a great aunt to her lover, for us to reveal her first in her nightdress, then corseted, naked, and (living or dead) at the abortionist’s. Everyone gives away something of themselves in their choices of word and image, even when trying their hardest to be asymptotically objective. We should appreciate this, even considering how hard they try to hide themselves and the cold fact of mortality in some sort of bland rigor. These writers have lives and histories beyond the morgues and examining tables, beyond even their dictation and transcription; as sterile as a morgue may seem, the weed of humanity explodes through the cracks. But as always, it is in the straining of the form that we find its naïve artists.

The first pages of the autopsy report are facts and figures, the statistics that underline not the relationship, but the absence of any relationship between you and your remains. There is no modern medical text indexing your character against the weight of your liver. But there is already subtlety hidden between the kilos and centimeters. Take the example of the salaryman coroner who literally flees from home to office, and writes almost wistfully of the “ripe and glistening order of the healthy organs” with their sizes and weights “entirely within normal and appropriate ranges.” This is a writer searching in another’s body for the order and stability lacking in his own existence.

Just as arresting opening lines are the red meat of literary criticism, rips, gashes, and penetrating trauma are similarly the entry points to our brand of literature. Wounds are the broad strokes. They are so full of information and temptation that the single skill that the professional most gains through training and experience is the ability not to dive down the gunpowder-stippled rabbit holes of first impressions. But still, holes in the body—natural or unnatural—have the loudest voices and the ones most likely to be transcribed. It is the edges of wounds, however, that are the Rorschach Tests of the genre. The differences between a laceration and an incision are psychological, not visual. Though they are almost the same to the untrained eye, the professional easily distinguishes between them—but no two ever see these edges in the same way. An incision is a cut, necessarily by another object. A laceration, however, is a tearing in the skin, from deceptively clean to pirate-sail ragged. But we must wait for the coroner to make their observations, and then, only then, our senses prick up, and we dash ahead in search of the metaphor. Most often, the key word is “resembling.” As in, “the semicircular edges resembling the lunar crescent;” “the exposed tissue resembling torn pastrami;” “an irregular wound patch suggests the oracular involutions of the ileum’—the last sounds medical but is actually just a metaphor comparing skin that failed like 1980s spandex to the twists of goats’ intestines tracing the past and future history of the hunter-gatherer who traces them. But, of these examples, the “lunar crescent” is the most telling: not just pretensions of (and to) a romantic sensibility, but of dissatisfaction with the coroner’s job itself. There are many reasons for one to be dissatisfied with a career, failure at one’s first choice being the worst and most common. On close reading, medicolegal texts are shot through with these broken ambitions, whether the writer is the garden-variety Failed Surgeon^[1] or the more rarified and entirely more desperate Failed Poet^[2].

Reading closely, it is hard to miss the various interior monologues (the pun is basically unavoidable). The most common subject is most often the one we are trying to avoid thinking about, and for our writers it is not mere death that they cannot look away from but luck, simply because so many deaths combine elements of comedy and tragedy. It is one thing to be beaten to death; it is another to be beaten to death with a bible during a faith healing.

A classic illustration of this hidden philosophizing is the voice of the above Failed Surgeon, riffing on the proximity between wound and undamaged structure: “Penetrating trauma through the longissimus capitis but avoiding the internal jugular by 2-3mm while appearing to have skirted the retromandibular vein without transection”—You were lucky, the writer is saying. You deserved to die with the first cut, but the knife had a different idea. Or the Universe. But he is led on by this very logic to a conclusion: that there is, revealed by his internal examination, a God (in the Universe). And finally he admonishes, Let’s hope you believed in Him…before the “complete transection of the lingual and external carotid arteries causing exsanguination and death.” And as for the conclusion that this is in fact a Failed Surgeon—why include the relatively petite vessel supplying the tongue when the gusher next to it was more than enough? Because he can’t help going over the anatomy as if he were preparing for some rarified end-to-end anastomosis. On another case he writes, “Appendix is absent and healed sutures suggest a rupture and emergency repair, scar is fluted and irregular. Healed hernia shows similar irregular scarring but no suggestion of an emergency procedure.” Sloppy, he’s saying, imagining his own immaculate and imaginary handwork, his own surgery career limited to one mandatory rotation and epic fantasy, often played out on the bodies of his underwhelming bed partners.

An author’s mind tends to show through most readily in their choice of metaphor, and metaphors are more common in medicine than we might expect. “Coffee-grounds vomit” is a thing, “rice-water diarrhea” is a thing, but there are no references in any known diagnostic manuals to “HO-track electrical burns” (a model railroad reference), or a “variegated Phalaenopsis contusion” (an orchid varietal reference). And while there is the classical “arachnoid hemorrhage,” which loosely resembles a spider’s web, when it gives way to a “Peter’s Twinspot hemorrhage” (birdwatching), and when one further learns that all three usages are from the same individual, we see an Enthusiast^[3] whose hobbies have entirely gotten the better of him.

It is fundamental to forensics that any aspect of the body can speak volumes. People have been convicted, rightly or wrongly, by a few hairs under a fingernail, a bite mark, or the contents of a dead and still-digesting stomach. But equally, the descriptions of these pivotal details can give away so much about their authors. Those same stomach contents can range from “recently ingested fried chicken and appropriate side dishes,” from an Autodidact^[4] social climber who doesn’t want you to know he can identify collard greens, to “what was determined by bouquet be a large quantity of mouthwash, imbibed probably as a cheaper alternative to alcohol,” and of course “very probably a Syrah, of unknown but unremarkable vintage,” because, at the end of the day, a wine snob is a wine snob is a wine snob.

Another example, regarding the bladder of a body discovered in a shower, notes that “the bladder retains no urine, suggesting that death was very rapid although more exact estimation is impossible because of place of death and the potential modern habit of voiding during ablutions.” This author is a prig and Self Loathing Moralist^[5]: Firstly, if your are unconscious for any period—as opposed to being dead for the same period—your kidneys keep working away. Bodies who were long unconscious before death often have remarkably full and distended bladders (something else to be gleefully noted, and sidetracked by the usual lofty comparisons—“the size of a child’s football,” or “a medium cantaloupe,”—as is noted the fact that the bladder had the same volume as the decedent’s brain, which has to carry some kind of judgment). But the most telling phrase above is the “modern habit,” suggesting other attitudes, supposing the bladder was empty because the deceased was peeing in the shower, which should be totally unremarkable. The only thing truly modern about it is that this person had a shower to pee in at all, but the language harkens to some earlier, pleasanter, and more mythically civilized time when young men died in war, old men in their beds, and the middle aged only occasionally, but in top hats, while dueling. Women didn’t die at all, or pee in the first place.

And where women are concerned, don’t get the Old Medicolegal Boy’s Club started on the vagina. We find references to a “violated portal” and the “veil-like tearing of the periphery of the inner sanctum”—transforming an assault on a woman to the Roman destruction of the Second Temple. Whole careers are made here. The face is the gross portal of most people’s personality, but it is somehow a dead zone for the coroner’s report. This is because so much of the technique of both medicine itself and the writing of such a particular document is the rigor of sterility and distance. It is vital to be dispassionate of agony when necessary, and ideally also of prejudice. Not so those few inches of vagina and periphera. Freud wasn’t right about much, but he knew the very existence of sex drives some people to distraction, and fear of sex doubly so. In one case we are lucky enough to have a hand-penciled hard copy of the case file, where the Id and its Repression have clearly duked it out on his page. His? Unquestionably. One barely needs the modern science of literary analysis to be sure the writer is male. Regarding internal examination, we find evidence of his gender tacked to every available surface like the notes of some cellar-dwelling lunatic connecting cutouts from the evening tabloids to the worldwide conspiracy (to keep him in that very cellar). But most importantly, we find a most telling erasure: the “inner sanctum” above is actually rendered as “inner sanctum sanctum sanctum,” i.e. written, crossed out, rewritten and re–crossed out no less than three times, and finally, shamefully replaced with “pre-cervical tissue.” Finally, in the course of the single concluding paragraph we find no fewer than six different constructions surrounding the same substance: “semen,” “male semen,” “male human semen,” “semen, presumably human” (no, really), and “robustly fertile seminal fluid with spermatozoa in great profusion”—the last one isn’t just clearly uptight in a high-collared, nineteenth-century way, the Self Loathing Moralist is actually jealous.

Most of all, humans have the tendency to inflate themselves, to brag, and it is quite impossible to brag without giving yourself away. The most common bit of grandiosity is the medical examiner who conceives themselves as Artist or Aesthete^[6]. A handgun plus automobile are transformed in a ballet: “The initial trauma to the hand penetrated completely and carried distal bone fragments into the fatal head wound caused by the same bullet, of which fragments were recovered. While grey matter and pooling blood and saliva in the open chest wound suggest that this high velocity injury occurred later [sic]. This is confused by the subsequent gross trauma to the lower extremity and repositioning of the body when the vehicle rolled forward and down the embankment. Uniform fine glass particles and dirt were found in all wounds and areas not covered by clothing. This dirt was found to be microscopically similar to samples from the automotive scene.” The writer imagines himself there, a conductor, his podium perched on the edge of the darkened road, his baton counting one-and-two-and-three and calling to the road-raging assailant in the next car to fire…and-one-and-two-and-three again—but also to the bullet passing through the hand on two-and to the cerebrum on three-and the foot on the brake and the windows’ shattering and the car to roll-and-roll-and-two-and-three. If you watched the writer carefully while he recorded his notes, you could see him shifting his weight foot to foot, waltzing away.

In the end, everyone has that one case where they bare their soul. For one (The Autodidact) it was autoerotic asphyxiation, if only because of the art on the walls and the specifics of the baroque harpsichord concerto left spinning on the turntable. For another (The Self Loathing Moralist) it was a near oil slick of a lost, lonely, self-abusive soul that only in near total putrefaction had managed to hide the shame that the two of them shared in almost perfect parallel. For both the Failed Poet and Failed Surgeon it was a case of Old Success murdered by Young Failure (or was it the other way around?)—in one case from the layers of anatomical overkill and the other the sturm und drang of bloody impasto—but in both cases simply the “Success” itself in tabloid headline.

There is one final case that raises the most difficult questions of interpretation, describing the dashed line that the Armchair Prophet^[7] follows as he opens his own chest with “the standard Y-shaped incision” and provides the scales where he weighs his glistening organs, hopes, and dreams. The report is a long one, due to the legion of wounds and medically significant conditions. It finally resolves on a single unknown, or a single issue of interpretation. But first we must examine the enormous amount of known and precise information about that unknown: “High velocity spatter”—thus a bullet, 11.69 grams, thus a forty caliber, intact but only mildly deformed, thus a trajectory that is also a hero’s journey. But it is that journey that becomes a manifesto of sorts. The bullet “skirts the upturned edges of the pre-existing laceration and passes almost unnoticed through neither the pectoralis majoris nor the anterior deltoid,” but through nothing at all: “a piece of connective tissue whose Latin name is unknown or unnamed.” Is he asking for credit to be placed where it is due? Should this bit of flesh then be christened for its discoverer? The bullet? The firer of the gun? Regardless, we follow the bullet’s epic across this meaty threshold, through the Tests, Allies, and Enemies of the internal organs, inflicting only “the mildest bruising on both superior lobe of lung, descending aorta and pericardium demonstrate only contact without rupture,” again a case of nearly laughable good fortune. “Distributed hemorrhages indicate overpressure but no critical injuries can be detected, even with total reflection,” reflection here having a twofold meaning—the technical term of peeling back surgically dissected tissue and the philosophical one of thoughtful consideration. The “shield of the diaphragm is pierced but otherwise intact,” as is the late stage adenocarcinoma—the massive and deadly tumor that “has fully occluded the colon and would have caused continual and excruciating pain.”

But in fact it was the “evidence of healing at the periphera of the chest lac” with “partial healing of diaphragmatic injury” and the “almost unbelievable toxicology and oncological pathology reports,” as well as “the order of magnitude difference between the time of death as noted by rigor and livor mortis, etc…and time of injury.” Because the finally, finally dead man had somehow staggered through the last week of his half-life with the bullet that should have killed him, the cancer that should have killed him weeks before, and a belly full of Vicodin, sleeping pills, and three types of brand-name alcohol. Without dying, until he finally did. And without taking a shit. Also, possibly, for weeks. Which made it difficult, if not impossible, to state without reservation what were the cause and manner of death.

But again, the writing was in the rewriting, and the erasures. The “unhealed pre-existing laceration,” the liver “demonstrates areas of fibrosis and varying degrees of advanced necrosis”—this is a subtle distinction, but the whole “varying degrees” thing clouds the issue—not one death but several half deaths, not the “potential final rupture of portal vein leading to hemorrhage and death.” Because the final erasure is the one never seen, from the original handwritten notes, where capitals did in fact indicate something like a title, “UNDETERMINED HOMICIDE,” the manifesto in the end reduced to this single line, striking through one word and underlining the next and crying out, in the voice muffled in his white-coated heart of hearts: I divide the truth from fiction, I divide the darkness from the light, I speak the difference between murder and suicide, and what I cannot know, none can, not even the dead themselves.

All of which is right there on the autopsied page, provided you know how to read it.

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^[1] The Failed Surgeon was located a rural hour outside Norfolk, VA, and was the latest cadaverous aesthete in a long line of cadaverous aesthetes. He was a ‘collector’ whose taste in objects was entirely determined by the sweet spot of his income level, from erotic Japanese miniatures to trophy hunts. He had a vast number of hardbound catalogues of others’ collections and dreamed, dreamed, of one day collecting wine.

^[2] The Failed Poet, for the record, wrote no poetry and read none. All of his lyrical energy was thrust forward into the angle by which his dense and lustrous black hair diagonally crossed his forehead. It was, in truth, both the only classically poetic and bearable thing about him.

^[3] In actuality the same individual as Failed Surgeon.

^[4] Author of two unpublished novels (excerpted as eleven unpublished short stories), one unrecorded progressive rock opera, one unplayable and unrecorded quintet for strings and horns, and exactly one (unpublished and un-peer-reviewed) scientific paper investigating which overpriced cologne best combats the various odors of his profession.

^[5] Remarkable solely for having the longest commute at over two hours of any of these authors and of having proposed marriage to five different women, having been rejected on each occasion and having known three of these potential brides for less than eight months (and having been the employer of the other two).

^[6] The majority of the above.

^[7] Although the least religious of the group.

© J Reifel 2018

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J Reifel received a BA in Visual Art from the University of California at San Diego. J Reifel has worked as a screenwriter, with multiple produced feature films, and now works as a writer and chef in New York City. J Reifel’s story “The Ballad of Team America” was recently published in the online journal Catch and Release, from Columbia University.