Under Closer Examination

by Jennie Lloyd


Rust grows like a rash inside the Oklahoma Medical Examiner Offices. It’s the crusty orange-brown fringe surrounding sinks and flaking tile, the metal arms of high- wattage medical lights, and doorway frames. The air is muggy, heavy with ammonia, cold.

Despite the rust, the lack of funding, the outdated buildings and a shoestring staff, the ME Chief Administrative Officer Amy Elliott insists their investigations are anything but slapdash.


The ME Central Division building in Oklahoma City—a ’70s goldenrod concrete affair with few windows—is tucked into well-groomed landscaping on the University of Oklahoma extension campus on Stonewall Avenue. Behind the trees and neatly trimmed grass, the building is rapidly corroding from within.

“Everything has been cleaned every single day, but it’s rusting,” Elliott said.

Elliott is a surprisingly sunny face for a forgotten agency. In her early 40s, she is a curvy, blonde, and bubbly woman, comfortable surrounded by papers and folders, at home in her bamboo-wallpapered office. She has a small, outdated radio tuned to a local easy-listening station. She’s a friendly worrier, and talks about praying for the ME Office often. Prayer, perhaps, is one of the agency’s only hopes. The other is the state legislature, fickle and unforgiving as a god.

Hear a death investigator discuss her day-to-day life of bloated corpses and overdose victims.

The downdraft vents on all three autopsy tables are broken. These vents are designed to pull the smell and the germs and particulate matter from bodies down and away from doctors and morgue employees. Dozens of dead bodies sift through each week in various stages of decomposition. When you work with the dead, you want—you need—a downdraft. If a pathologist were to crack open the head of someone who died unknowingly of say, meningitis (a highly contagious disease that turns the brain a telltale shade of green), every breathing person in the office would be at risk of contracting the possibly fatal illness. But that hasn’t happened. Yet.

* * *

The ceilings show splotches of yellow from water damage. The facility has 33 active leaks. When it rains, Elliott told me, the back half of the building’s lights flicker out. Autopsy reports, which should be sealed in a fireproof, locked area, are stuffed into rows of scuffed metal filing cabinets lining the hallway.

In the x-ray room, a space no bigger than a shower stall, holds a ’90s-era x-ray machine and supplies for developing film. The dim overhead lights are partially covered by dark, peeling paper. The wall tile is lined with dark mold. Processing solution sits in abandoned jugs.

“It’s just gross,” Elliott, who’s had experience working in a Chicago mold testing company before said. “I wouldn’t want my grandmother coming through here.”

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In the histology lab, where sample body tissues are tested, mold grows wildly under the sinks. Thin slices of brains and livers are stacked in thick, clear Petri dishes below a dripping water leak, a bucket propped in the ceiling above. The facility is 18,000 square feet; to meet accreditation standards, they’d need 45,000. In 2009, the Oklahoma ME Office was stripped of its accreditation by the National Association of Medical Examiners. To regain endorsement, they also need to bump their staff level to 85 employees from 61. The Central Division office employs four full-time doctors; they need 12. They also need to acquire new equipment. You can also visit doctortoyou.com.au for more information.

After two years on the job, Elliott said the office’s eye-watering, rancid-meat funk doesn’t bother her anymore. But on bad days, when she goes home with the smell of decay clinging to her clothes and shoes and hair, it still bothers her husband.

On the morning of May 16, Elliott didn’t initially notice anything amiss when employees discovered the morgue cooler’s temperature was slowly rising. The cooler keeps bodies at a crisp and steady 43 degrees, but the more than 40-year-old machine gave out sometime before the first of the staff arrived around 6:30 a.m. Normally, an alarm is set to go off when the cooler temp rises above 43 degrees, but as they found out, the alarm was broken too.

“I don’t know if we can even repair it,” Elliott said, her eyebrows knitting during a tour of the facility later that afternoon.

Two refrigerated trucks, specifically built and paid for by the state of Oklahoma for mass disasters, were parked near the garage in the back of the ME office. Each truck can hold up to 20 bodies. The cooler held 28 bodies when the refrigeration shuddered to a stop. By the evening of May 16, one truck was already full, while another handful of bodies remained in the slowly warming cooler. Another five bodies came in throughout the day. By the time the sun had set, 33 bodies were at stake, four of them children. One was the body of a woman who jumped to her death from the top of the Chesapeake Arena.

Both trucks were padlocked. Video ran, lighting was added, and the trucks’ wheels were fitted with blocks. The ME Office couldn’t control how many more bodies would show up. The Oklahoma City Thunder was set to play the LA Lakers that evening, and Elliott was worried.

“I’m just hoping that everybody chills at the game tonight, that nobody gets crazy,” she said. “Be nice tonight, we don’t have any room.”

That night, they got lucky. Five days later, though, a gunman shot into a crowd after another Thunder-Lakers game. Eight were injured but nobody died. They got lucky then, too.

Elliott stood in the grass and watched two journalists walk through their live 6 p.m. reports in front of the brightly lit trucks. Thick power cords snaked under the doors to the ME Office. She wasn’t sure the aging building could support the enormous power drain the trucks imposed.

“I’ll be doing some praying tonight,” Elliott said more than once.

She threaded her way through the makeshift morgue, around the reporters waiting on their cues, and back through the squeaky black door that closed with a tight thud. There, in the hallway near the garage where bodies are loaded and unloaded from transport vehicles, is where the heavy, earthy smell of putrefaction urges most visitors to pull a white surgical mask over their mouth and nose. Small caravans from the state legislature come through periodically to marvel and point at the disarray in the ME office. They all reach for masks, Elliott said.

A guard in a small office near the garage watched the local news on a small television set. The reporter, delivering a live report on the other side of the black door, popped onto the screen. She pivoted toward the camera and stepped in front of one of the white mass-disaster trucks behind her. The guard and Elliott looked at one another and shook their heads.

The cooler is 42 years old, and the necessary replacement part dates back to the 1970s. This kind of malfunction has never happened before in the ME Office. Though such craziness is becoming more and more routine.

* * *

By nightfall on May 16, the place was buzzing with flies. Not only was the cooler not cooling as it should, a “decomp”—that’s what they call a body in advanced stages of decomposition—had also just arrived. The flies, Elliott said, “come in with the person. Some are in the fly stages, some in the maggot stages … We have a lot of flyswatters. It’s a little bit unnerving because you know where those flies have been.”

An ultraviolet bug zapper droned in the corner of the echoing, chilly autopsy suite. Underneath one of the three dented, wiped-down metal tables is a shallow drainage hole with a wide halo of chipping concrete.

“This is not a fit place to be working,” Elliott said. “The Chief [Medical Examiner Eric Pfeiffer] said there’s probably meth labs in Oklahoma that look cleaner than this.”

“We’re doing too much with too little,” Elliott said. “We do the best we can do.”

Monday is the busiest day in the morgue. Doctors don’t conduct autopsies on Sunday, so Mondays run long. On Monday, May 7, the office took in 16 bodies. One of its four doctors was in court; another worked all weekend and had the day off. The other two doctors handled 16 bodies between them.

Monday, May 14, brought 15 more bodies. One homicide can take an entire day for one doctor. Even without an autopsy, it may take a doctor more than two hours to do a thorough viewing of a body. Every detail counts in these investigations. Once a body is cremated or shipped out of state, that’s it.

“They’re gone,” Elliott said. “And we don’t want to exhume a body. So [the doctors] have to be extremely thorough while the body’s here.”

As the bare-bones staff handles an influx of bodies, paperwork piles up on their desks. “You can’t leave a body,” Elliott said. “They have to be in and out of here as fast as possible. So all this paperwork sits; every day the pile grows.”

* * *

Forget CSI. Most states aren’t spending much money on their death investigations. Stellar, well-funded facilities—like Nevada’s ME Office, the basis for the CSI franchise—are a rarity. Anemic, substandard operations are the rule. Many states still employ the coroner system.

Despite the dilapidation, Oklahoma is a little ahead of the game in the field of death investigations. It’s one of only 16 states with a uniform, statewide medical examiner system. Other states use a coroner system, and some use a combination of both.

In states with a coroner system, the person who decides the cause of death and signs the certificates is an elected official. In South Carolina, the only requirement for a coroner is a high school diploma.

PBS’ Frontline, and ProPublica teamed up for a year- long exploration of the nation’s death investigations, and presented their findings in February. They uncovered a shocking array of obstacles that keep states like Oklahoma from conducting death investigations with any kind of precision.

A disturbing part of the problem is a lack of expertise. Elliott said there are between 400 to 500 forensic pathologists nationwide. Long hours working with dead bodies and exposure to horrific and violent deaths is a grisly job, and it’s one that requires a stomach of steel and a brain filled with specialized knowledge. Pathologists can earn anywhere from $75,000 to $200,000 per year, but other staff make much, much less. While Oklahoma’s morgue salaries may be competitive with the rest of the nation, prospective doctors see the buildings and turn up their noses.

In the Tulsa ME Office, two doctors work full-time. They take turns working the weekend. “The thing that’s holding the ME Office together is the dedication of the employees here,” Elliott said. “I would estimate probably 85 to 90 percent of my employees could go somewhere else—could make more money in better conditions with less work. Yet they stay.”

Time, like money, is a challenge. There’s never enough of it to autopsy every body. A full autopsy can take an entire eight-hour shift for one pathologist, while a viewing—where a doctor closely views the body but doesn’t open it up—can take two hours or more. Autopsies are a time-intensive search into the human body; to save their pathologists time, most ME Offices have set age limits on autopsies. For an uncomplicated case, an autopsy won’t be performed on a body over the age of 60 in many states. Oklahoma lowered its autopsy age limit to 40. Each year, the ME Office handles more than 16,000 cases statewide, views about 3,500 bodies, and carries out 1,600 autopsies. The medical examiners also must sign off on every cremation that occurs in the state. About 11,000 cremation permits are issued annually.

But when a doctor takes the stand in a trial, attorneys jump on the agency’s lost accreditation with glee. “ ‘You lost your accreditation,’ they’ll say, ‘So why should I believe this report at all?’ ” Elliott explained. “It gives [attorneys] a lot of ammo.”

* * *

“It’s the place nobody wants to think about, nobody wants to talk about until they get mad,” former Tulsa ME field investigator Stacy Williams explained. [Williams now works for This Land Press.]

As an investigator, Williams worked her share of weekends with a phone and 26 counties—a geographical area populated by 1.94 million people—in her jurisdiction. For two years, like a bureaucratic grim reaper, Williams calmly collected the information, photos, and bodies of the newly deceased all over Green Country. Name a high-profile death, murder, or suicide in the past few years and she likely worked it.

Cops and firefighters, she said, call ME investigators “weirdos.”

“We speak for the dead,” she explained, saying she took 20 calls in an average weekend. “It doesn’t sound like a whole lot, but each one you have to research everything, contact a doctor and hospital for records, talk to law enforcement, you have to do this and that.”

Doctors come in over the weekend to play catch-up on autopsies, which means investigators work, too. Williams said she racked up hours and hours of comp time, but couldn’t take any time away due to staffing shortages.

For those who work in the morgue, separating the human side of the ME Office’s struggles from the scientific angle is a daily struggle. The longtime employees form tight, supportive bonds through grim camaraderie and gallows humor. Firefighters and police officers have access to special psychological resources for help in dealing with work-related trauma. No such programs exist for ME office workers. “We have a regular employee assistance program like any job, where you can set up a meeting if you’re having trouble at home,” Williams said. “That doesn’t really cut it. When you’ve seen a baby beaten to death you’re gonna need a little more.”

* * *

Elliott was praying for the legislature’s approval on a proposal to lease a building on the University of Central Oklahoma campus. A new building would mean renewed hope of regaining accreditation. But lawmakers are now scrutinizing the “master lease” program that would’ve helped the ME Office gain a new space with good ventilation, downdraft tables and updated machinery. The program is a way for colleges to carry out renovations, constructions, and repairs by pooling their resources, such as bonds and other funding. Elliott and Chief Pfeiffer, who have pleaded the agency’s case at the state capitol dozens of times, are stuck in another waiting game.

The Office is also waiting on an emergency $1 million appropriation by Governor Mary Fallin, who toured the facility a year ago. But the money hasn’t dropped into their budget yet. When they do see the appropriation, they plan to buy digital x-ray machines, so they can kick the ’90s-era film x-rays to the curb. “Only one man in the tri-state area knows how to fix ’em,” Elliott said.

In the meantime, Pfeiffer, an experienced pathologist from Minnesota’s Mayo Clinic, has motivated the staffers to clear up much of the backlog. One 73-year- old doctor netted 2,000 hours of comp time getting through a pile of reports. But people can only push so hard for so long. The backlog is slowly returning.

Once you’re dead in Oklahoma, the modern technology that’s filled your everyday life falls away. The ME Office will chill your body on a metal cart, the wheels of which have been soldered back on more times than anyone can count. Once you’re dead, your body is locked into a cooler that may or may not be broken. You will be overseen by technicians likely exhausted from too much overtime. They will cut you open or peer at your tissues through a microscope within 48 hours, but your grieving family will wait months for an official report. Your death file, the last vestige of your bureaucratic life on this planet, will gather dust while ME workers mow the lawn, prop buckets in the ceiling, coax and rig the obsolete machinery, and examine the fresh bodies that turn up in a steady stream.

At the uneasy crossroad of science and commerce, Oklahoma’s most gruesome state agency carries on—despite the budget cuts and long hours and rusting building—with the malodorous and tender business of death.