Review by Virginia Tressider

Working Stiff: 2 years, 262 bodies and the making of a medical examiner
By Judy Melinek and T J Mitchell

Judy’s Blog/Homepage: http://pathologyexpert.blogspot.com.au
Judy’s Twitter: https://twitter.com/drjudymelinek

Maggots start with the eyes. Flies prefer moist places to lay their eggs – groins, armpits, mouths. But the eyes are their favourites. If the weather conditions are right, a female fly can lay thousands of eggs in the eyes of a corpse within hours of the death. They start hatching within a day, and feeding. They prefer vital organs, so they dig into the body. Some eat their way across the skin, others burrow down, looking for the soft tissues. They can reduce a human face to a skull in ten days. You can see them crawling through the remains of the nose and ears to get to the brain. There won’t be any hair to obscure the view. Not because they’ve eaten it (maggots don’t like hair), but they’ll have burrowed under the scalp and eaten the follicle. With nothing to hold it, the hair just drops out.

Of course, things will be different if you had a pet cat. While a dog might watch over your corpse for days, starving, cats are opportunistic scavengers with no such sense of decorum. They’ll get stuck in straight away, starting with your eyeballs and lips.

If you miss out on maggots or Chairman Meow, you can still depend on bacteria to bring the gross. When you die, bacteria go on a feeding binge, eating up the proteins that made up your cellular structures. The abdomen turns green: that’s the ‘good’ gut bacteria you’ve lovingly encouraged with yoghurt and probiotics, invading the surrounding tissues. Your skin begins to look like black and blue marble as microbes spread through the blood vessels, rupturing blood vessels along the way and releasing their contents. There may be red or white putrefactive blisters. If your skin is intact, you become basically a balloon filled with foul-smelling bacterial gases.

There, we’ve got that out of the way. If that description made you queasy, this probably isn’t the book for you. It is, though, a worthy addition to the surprisingly large body (sorry, couldn’t resist) of popular non-fiction about post mortems.

It’s a varied field, ranging from this one – a sort of tales from the frontline police procedural equivalent – to the almost poetic (or over-written, depending on your taste), like F. Gonzalez Crussi’s Notes of an Anatomist and Three Forms of Sudden Death, through to the meditative and melancholic, like Pauline Chen’s Final Exam. Both of these take a broader view.

Gonzalez is a philosophy buff – and it shows. For him, an essay on death is merely a jumping-off point for a meditation on the human condition. Abnormality, for Gonzalez, illuminates normality. A three-year-old with progeria illustrates some of what constitutes normal human ageing. The epidemiology of SIDS makes it clear that medicine, though far more effective than once it was, still has major limitations. Hermaphroditism gives us an insight into the frail and contingent nature of sexual identity. Gonzalez has a particular interest in teratology, and returns to the subject of ‘monsters’ repeatedly. The macabre sits comfortably with his baroque – bordering on gothic – literary style. His essays are brilliant, enlightening and … infuriating. I find myself reading them with mounting impatience, muttering, ‘Will you just get to the bloody point?’. Highly recommended for the content, but for the way that content’s presented, not so much.

Chen’s a different matter. A transplant surgeon, specialising in livers, she too goes beyond tales of autopsies to a larger concern. In her case it’s the way that doctors confront death, and how medical training, in teaching doctors to treat the disease rather than the patient, equips them with vast technical competence but robs them of the ability to empathise with the people they’re treating, or even deal with their own fears of death.

She takes us back to her early training in gross anatomy. Her first dissection continues over many weeks, and many pages, as she learns to identify every bone, every muscle. It’s a procedure, and a description, that’s almost shocking in its intimacy. She recalls her surprise, when she starts work on the hand, at discovering that her elderly cadaver has an elegant manicure. The corpse starts to become a person to her. It’s the body she will know best – more than any patient she ever treats.

Chen finds it hard to view death as merely a clinical event. As the child of Taiwanese immigrant parents, she grew up regarding death as a matter of fate, and her culture shapes her feelings about death.

So too with Melinek. A ghastly childhood trauma, her father’s suicide, has irrevocably influenced her view of death. It’s also given her empathy for the people who cared about the bodies she examines: she knows what it is to experience sudden, dreadful loss.

One of her cases involves finally determining the identity of a John Doe who’d been in an unmarked grave for 15 years. ‘It’s not about the bones’, she tells his sisters. ’It’s about the living. … I do it for you.’

The morgue goes the extra distance for these sisters, who insist that they’re not leaving until they’ve had a ‘viewing’ like the ones funeral homes offer. Out of almost nothing but good-heartedness, a trolley and some cloths, a lab technician conjures up a passable facsimile, and the sisters leave satisfied.

We learn some fascinating stuff along the way with Melinek. Like that if you decide to jump from a tall building, you’ll likely encounter protrusions along the way that will tear you to pieces before you land.

Melinek was working for the New York Chief Medical Examiner’s Office when the planes hit the World Trade Center. We learn a great deal about the herculean task the medical examiners undertook. An unsentimental, non-US reader might have preferred fewer references to the (undeniable) heroism of the first responders, but she’s from the US, it’s her main market, and she was intimately involved, so it’s forgivable. And she redeems herself in my eyes by admitting to a glorious bit of ignorance. She wonders why the people running the food tent are always talking about praying. Not knowing much about Christian denominations, she’d always assumed the Salvation Army was a salvage company.

If you want a lot of enthralling but gruesome information, packaged up in a colloquial style and moving along at a cracking pace, this one’s worth reading. Particularly if you want to know how all the blood can disappear from a human body that has no external wounds. DAMN, that was cool.

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Virginia Tressider

Virginia Tressider is a science writer and editor who used to be a philosopher, and still can’t quite kick the habit. She collects  nerdy t-shirts and taxidermy, and is available for freelance jobs.

Virginia’s Twitter: https://twitter.com/tweetingtechno