The autopsy tells a story | 09
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Hey, it's Nancy. Before we begin today, I just wanted to let you know that you can listen to Crime Beat early and ad-free on Amazon Music, included with Prime. If you're a fan of crime dramas, you're likely familiar with what forensic pathologists do, or at least the Hollywood version of what they do.

In reality, things are a lot more complicated and take a lot more time because their role is to investigate death itself. So in a way, they become a voice for the deceased. I'm Nancy Hixt, a senior crime reporter for Global News.

Today on Crime Beat, I take you inside the medical examiner's office to understand the science behind their investigations as they determine how and why a person has died. This is The Autopsy Tells a Story. On this podcast, I give you unique perspectives and a behind-the-scenes look at the cases I've worked on.

You've heard from detectives, expert forensic crime scenes investigators and forensic interviewers, crime analysts, undercover officers, sketch artists, and even jurors who have helped bring justice and closure to victims and their loved ones. They work tirelessly to uncover the truth, and they're responsible for giving a voice to the voiceless,

In each story I've shared, where a homicide has occurred, I've explained the critical role autopsies play in an investigation. In this episode, you'll hear from an expert in this field, forensic pathologist Dr. Sam Andrews. He's worked in Canada, as well as in the U.S., in New Mexico, Texas, and now in California. My name is Sam Andrews, and I'm a forensic pathologist.

And what that means is that I am a medical doctor who specialized in pathology and then sub-specialized in forensic pathology. And forensic pathology is essentially the study of not just deceased individuals, but live and deceased individuals, and to document and interpret injuries.

In Canada and the U.S., there are mixed death investigation systems. And we call them death investigation systems because their structure varies depending on the jurisdiction. In the medical examiner system, the medical examiners are friends of pathologists. Whereas in the coroner system, the coroner doesn't necessarily even have to be a physician.

Okay, I have to make sure I have this straight. So a forensic pathologist has to be a medical doctor. And if you're a medical examiner, that means you would be a forensic pathologist. But a coroner can vary greatly and would not necessarily have that same education as a forensic pathologist and a medical examiner.

Correct. In those lay coroner systems, they call them, where they're not even required to be a physician. Their backgrounds vary.

And some, most, don't have any medical background. Some don't have any law enforcement or legal background. It can be quite varied. And sometimes it's, I don't want to say insulting, but to call me a coroner, I don't like. And I understand that it's confusing. People don't understand the difference. So I just try to educate and tell them that I'm actually not a coroner. But I might work in a coroner jurisdiction.

You know, I was going through some stories to just, you know, go back through stories that I've done with you. And I came across one where this was years and years ago. And we were talking about the impact of movies and television, crime dramas and creating unrealistic expectations among the public because of what they see on TV. It's not as bad as it.

Once was, you know, many years ago, probably when you first talked about it. But in a lot of the TV shows, which I don't watch and I know television is television, but for me, it's just a little hard for me to take. And a lot of it is comes down to time. You know, the things that they're able to do in an hour long television program isn't at all real. A lot of the techniques and a lot of the things that they show are

when examining a body or when doing an autopsy or trying to interpret findings just isn't real. The biggest thing at the time, I think, when I talked was DNA, examining DNA. That results don't come back in 45 minutes. DNA is collected, it's examined, it's an intensive process that takes usually several weeks,

And so that was, you know, so that's an example of what was expected by the public in seeing these types of programs. And so there's a lot of things that, you know, we see on television that just isn't real because they are functional abnormalities or they are as a consequence of something that I can't see at the autopsy. But that television needs to look like you can determine it.

That came up just recently in one of the cases that I was sharing that I covered. And one of the interesting details that came out was talking about time of death. So I had looked at the court exhibit that was the autopsy report. It had the date and time of death field filled out.

But that was actually when the police attended the scene because I was talking to the prosecutor and he said, you know, the medical examiner isn't able to determine that exact time of death, but they have to put a time in there. And this became an issue in this case because the person who was accused became obsessed with that time. And at that time, he had already fled the province.

So he was trying to say, well, I wasn't even around at that time. So maybe you can talk a little bit about that, because I think a lot of those unrealistic expectations come from what people see on those dramas on TV. Absolutely. And that's a great example that you bring up is on television. They essentially teach us that the, you know,

police or the medical examiner in the corner can determine, you know, this person died at this time or within this timeframe. And that's not realistic. I will ask when was the last time they were known to be alive? And when was the time we were found dead? And then I will say it's any time in that time period, because there are too many variables to accurately pinpoint time of death.

In this case, this was in the winter. So there wasn't, you know, the presence of bugs and insects and stuff like that. Does that change when there is the presence of insects and things like that? Does that allow you to become more precise or is it always that general time where you're looking at footprints of life?

I always keep it more general because, again, you bring up insects. Now, insects have a fairly defined lifespan. But how was the body found? Where was the body found? What was the environmental temperature of the body? Was it out in direct sunlight or was it in the shade or was it in the snow in the winter? That may delay the presence of insects and them going through their lifespan.

So just like those type of clues may give you an indication, you have to really consider all the variables and you can't necessarily take all those variables into account on any case because we don't know them for the most part.

So, although there are things like the decompositional process we see in the body, things like insects and maggots that develop because of their lifespan, they can be used as a rough estimate, but it's just that. It's a rough estimate.

Most of the cases that I would share on this podcast would be about homicide investigations. So it's common for me to explain how an autopsy has taken place and to explain the results of the autopsy and how that plays into each investigation. But I know that there are a lot of cases that aren't homicides where you're called in to investigate and do an autopsy. So maybe you can explain what the range of those scenarios would be.

You're actually correct. A lot of the ones that people think that we

essentially are homicides. But that actually typically is a small fraction of what, as a forensic pathologist, I examine on a day-to-day basis. Most jurisdictions, whether they be provinces, states, counties, have certain legislation that outlines what cases are reportable to the medical examiner or coroner. And I want to clarify and say that just

Just because a death is reportable to the medical examiner or the coroner doesn't mean it is a death that the medical examiner or coroner will actually investigate.

We can't investigate every death in every jurisdiction. There's just too many people that die. And, you know, a lot of deaths are elderly. And if there's no suspicious circumstances or no circumstances that, you know, point to an otherwise unnatural death, we don't need to examine these individuals because resources are limited.

So, although homicides tend to be a small proportion of what we do, the largest proportion of what, as a forensic pathologist that I investigate and examine, are natural deaths. But they are natural deaths of people that were killed.

essentially otherwise healthy, or that the death was sudden and unexpected. And that's kind of the phrase that we tend to use on a lot of the death of examiners are, it was sudden and unexpected. Even though they may have some medical history, they weren't expected to die, you know, when they did. So these are...

make up the vast majority of what I see on a day-to-day basis. The other big category that we're seeing now in pretty much every jurisdiction here in North America are the drug-related tests, particularly fentanyl and methamphetamine. The big drugs we're seeing now. And those are, you know, they...

a very age range of individuals that are just dying. And that would fall into that category of suspected poisoning deaths. And that is a good proportion of what we're seeing now, unfortunately.

And do those autopsies require added toxicology results, or is that something that you are able to tell right away, or does it require further testing? No, those deaths do require further testing. A lot of those deaths, particularly in the younger population, the autopsies are

really unremarkable because of the numbers of potentially drug-related deaths we're seeing now and the shortage of friends of pathologists. You know, autopsy in these cases is varied by jurisdiction, unfortunately. I was trained and I practiced to the standard of, you know, almost any, you know, potentially drug-related death, I will autopsy.

The rationale or the reason for that is because of the limitations of the autopsy, if I don't do an autopsy and my toxicology testing is negative, then I don't really have an answer for why the person died, not having done an autopsy. So you do the autopsy to make sure there isn't any other problem.

natural disease or potential injury that could have caused the death of the individual while you're waiting for toxicology. And in certain circumstances, a person may die with a drug on board and not of the drug. So you want to get the most accurate cause of death as you can so you do the autopsy.

I was well into my career here when you were the medical examiner in Calgary. And so a lot of the cases that I've shared on the podcast, you were the medical examiner for. Can you talk about some of the cases that stick out the most? I know we were just before we started recording talking about the tragic death of a woman.

a young girl and the mother was accused in the case. People will remember the case of Asat Meghamedova and her daughter Amina. You know, in Calgary, most of the homicides were high profile because they weren't that many. Whereas in some of the other jurisdictions I've worked, you know, the homicides are kind of a whole common, there's another one today kind of thing. That's unfortunate. You know, it's sort of a

It doesn't say a lot about our society, but in Calgary, it's better, I guess. And so it came in as a homicide, which just, like I said, by definition tended to be high profile. But because of the nature of this one, it was just a little bit more unusual. The other thing that stood on my mind is this young girl was strangled.

Strangle with a scar, which, again, it's a very intimate type of violence. And what isn't really well understood by the general public is that strangulation deaths aren't a quick death. If you're able to maintain consistent pressure on the neck so that you're obstructing oxygen blood flow to the brain, then

someone will go unconscious in roughly 10 seconds. But you have to maintain that consistent pressure for up to, or for almost three to four minutes, if not longer, before someone actually dies. So it's not a quick death, and you have to maintain that pressure. If there's any sort of struggle between the two individuals, then that struggle could potentially

release that consistent pressure so that it resets almost so they don't become unconscious as quick as if the pressure was consistent. And so it's an intimate type of violence, but it's also a type of violence that has to be maintained for several minutes. And in this particular case, like I said, because of the mother-daughter dynamic and how the daughter was sort of out of control and the mother was pushed to this point of strangling her daughter,

She would have had to maintain that pressure on her daughter's neck for several minutes, which to me as a parent is hard to imagine. And I can't imagine what drove her mother to that point. I can't imagine what she had been going through. The other aspect of this case, which was unusual and stuck out in my mind, was the trial portion of it. My...

participation in the trial was fairly limited, just obviously just describing my findings and my interpretation of the injuries. But, you know, her mother had gotten quite ill and had cancer and how it got, it was dragged out because of her underlying medical condition. And that sort of just stuck on my mind because it was a little unusual. ♪

And if anybody is interested in learning more about this particular case, I shared this story back in season three of Crime Beat. It was episode 14 and it was called Tormented by Trauma. Just like such a sad case. And, you know, while you're sharing these details of this case, what sticks out to me is, you know, when I'm sharing these stories,

We try to almost hold the listener's hand because we don't want to give too much graphic information. We don't want to overwhelm people, but we want to provide enough information so they understand the gravity of what happened. But your job is to only focus on those horrific details, like day in, day out, like you're

that's your job. You see the very worst of the worst and you have to take in that information. How do you deal with those details? Even this case, you just gave the example, just knowing how long that mother would have had to be strangling her own daughter for. That's a lot to take in.

Right. And that's a good question because actually I get asked that quite often. It's how do you deal with what you see daily? Because I –

examine dead people every day. And that's, you know, for a lot of people, that's difficult, you know, in itself. But then when you see some of the trauma, not necessarily inflicted trauma, such as, you know, homicides, but just some of the motor vehicle trauma, some of the, you know, suicide-related injuries, you know, it's

It's hard. Don't get me wrong. It does affect you. But what I am able to do, and I think one of the reasons I have been doing this as long as I have and plan to continue on for several more years, is I'm able to compartmentalize what I'm seeing. And when I walk out of the door of the office at the end of the day,

That's where what I see stays. I know a lot of people in specialty areas such as yours who are experts in their field will say that they can compartmentalize. And I would guess 90% of the time they probably do. But are there exceptions to that in your situation where you have found certain cases more difficult to do that, that just happen to weigh on you for whatever reason?

Yes. No, absolutely. Don't get me wrong. There are cases that bother me. And I think that's to be human. There's been a couple that come to mind. One was, I think it was a seven-year-old little boy that I autopsied in New Mexico. I looked at this little boy and thought, that could be my son. But he was...

sleeping in his bed, and someone else in his family had some gang-related ties, and there was a drive-by shooting, and this little boy took a bullet in the head that went through the wall of his bedroom and just randomly hit him. That one bothered me. I said part of it was because I had a child of similar age,

but just the needlessness of his death and that he was just a little boy sleeping at night. That one that I did struggle with in terms of just because of the circumstances. The other one that bothered me was actually a Calgary death. And it was a

Young family, I believe they were living in Dalhousie, and the father of the husband sounded like he had a psychotic break. Ended up stabbing his downstairs tenant, his two daughters and his wife, and then himself to death. And again, I think that that case just bothered me because...

He had apparently showed signs, from what I recall, of having some early onset sort of mental health issues and didn't quite get the care he needed before having the psychotic episode. And there were four lives lost because of something that he couldn't control. The scene from what I did not go to but was described to me was quite horrific.

The two girls were sort of huddled with the mother, I recall, as she looked like she was trying to protect them, but wasn't able to. And again, from what I recall, it looked like there was a young baby in the house that wasn't killed, but it looked like he was on his way to kill her as well. Like I said, I wasn't at the scene, and I'm sure the scene was...

more traumatic than my examination of these individuals, these bodies, you know, in the autopsy suite. And the second case that you were talking about, like as you're describing what happened, like I, it's like I can just see the whole scene playing in front of my eyes because that day sticks out to me more than a lot of cases do. It was, I can remember veteran police officers just, you know, with decades of experience just

broke down at that scene and when they brought out the baby like it you don't forget those moments and then i just think how much closer you are to that you know i i was reporting on it um and covering what happened and you're the one who's who's investigating and examining the bodies of these victims it was it was horrific it was and i think had i gone to the scene

it probably would have affected me a lot more. Because the scene, and you mentioned that the senior detectives that were affected by this case. The scene, because you can sort of put together or have an idea of what happened. And I...

I'm examining the deceased in an autopsy suite that is essentially, it's not sterile, but it's a sterile environment. And that sort of helps, I think, a little bit because I'm not seeing the context in which the individuals are killed. Are there certain situations that you do request to go to the scene or where you would find it beneficial to go to a scene? Or do you always just maintain that clinical autopsy setting?

No, you know, there are certain deaths where going to the scene can help put everything into context, can help understand the circumstances of the death. A good example are potential child abuse related deaths. You know, if there's trauma to a child, going to the scene could help identify possible causes.

or weapons or things that a child might have been struck against. Alberta has death investigators that work in the medical examiner's offices. And these are trained, certified death investigators. And in a lot of the corner jurisdictions, particularly where I am now, the death investigation, scene investigation, is done by a police officer or a sheriff's deputy. And

It's different. Police look at different things at a scene, whereas a death investigator, trained death investigator or a forensic pathologist are looking at certain other things. And so sometimes they don't always match up. And so in those strange circumstance type deaths, it's good to have a perspective of someone that's trained in death investigation because you're looking at different things.

What are some of the biggest challenges that you face, roadblocks or difficulties that you have to overcome in your job? Right now, it is the lack of forensic pathologists. That's what it comes down to. The shortage of forensic pathologists practicing in hospitals.

And I do think it exists a little bit in Canada. I haven't been there a number of years, so I can't speak specifically. But in the United States here, there is a huge problem because of the lack of forensic pathologists. And because of that, the quality of death investigations are poor.

becoming questionable in certain jurisdictions. I've tried to maintain a high standard, but I know that with the sheer numbers of deaths who are being asked to investigate, things may get missed, corners may get cut. That's just reality for anybody that's overworked. And that's happening a lot in North America.

And you would think because there are a lot of shows on TV that show maybe a more sensationalized version of what you do, that that would attract new people to the field. But is it because of the level of education that's required or what would be that stopping people from getting into this field?

I think there was a bump of interest, you know, with all the television programs. I think there actually was. But just like you said, I think a lot of people don't realize, A, that we're physicians, that you've got to go to med school. And then the numbers of years of training is daunting and a little put-offish for a lot of people. And then I think it's obviously multifactorial. And I think one of the – a lot of people that go to med school –

don't want to treat the debt. They don't go to med school to treat the debt. How do you overcome that? Because I know I, you know, there's been several homicide detectives who told me, you know, they go to attend the autopsy and they've struggled with that. They have a hard time with it. Um,

So and I'm sure you've seen them struggle with that when they're witnessing the autopsies. So, you know, it's it's it's graphic. It's, you know, bad, traumatic, awful circumstances. But beyond that, you're just the basic person.

physical response? A lot of the trauma doesn't bother me anymore. You know, I've seen enough of it that you just kind of, okay. The smells, you know, yeah, they, especially when the bodies first come out and you get that first couple of whiffs of the decomposition. But then, you know, I kind of focus in on

well, I'm here to determine why this person died. You know, this is, this is what I'm here for. And you kind of get focused on, on the examination and trying to make that determination. And you forget about the smells and the maggots and how greasy and gooey everything is. Just because you, you know, I have a job to do and people are depending on me to try to figure out why this person died. And so I just kind of forget about it. You know, just go,

go about what I need to do so that I can provide the best answers for the family, for the public, for the law enforcement.

It's interesting because you said a lot of people, when they realize the amount of education and that they have to become a medical doctor, and then they go down that path to become a medical doctor, and they choose helping save lives rather than examining the bodies of those who have already passed away. But I would love to hear what you find the most rewarding part of your job. Like you said, you can give answers and answers.

I mean, these bodies tell a story, right? The injuries tell a story. Everything that you're examining in the autopsy, which, I mean, you're learning information that tells a story in every case that you're a part of. Absolutely. And I think what's most rewarding is providing answers to grieving families. The biggest question I get is, did he or she suffer?

And sometimes I can answer that, honestly, but sometimes I can't. There are certain deaths where after the autopsy, after toxicology testing, after looking at tissues under the microscope, after any other, you know, ancillary testing that I deem necessary, I don't have an answer. It's frustrating to me. And so I can't imagine how much more frustrating it is to the loved ones when I say, I don't know why your loved one died.

And that happens, not regularly, but it happens because of the limitations of the autopsy. So when I am able to provide them with answers and say, your loved one, this is how they die, that is rewarding to me. Are there other, you know, advancements in technology that are impacting you or could potentially, you know, help in the way that you do these autopsies?

Yes. So we talked about DNA a little earlier. So the DNA testing, we were talking about it in relation to the crime shows. One of the duties of the medical examiner coroner is to

identify deceased individuals. And back when I was in Calgary, you know, we, uh, it wasn't all that common and, uh, we've had to send DNA samples to a lab in Vancouver, um, and waited several weeks for any results for identification. And that, um, now there are, um,

rapid DNA tests that can be done essentially within the day for identification purposes. So that's been a pretty major advancement in the practice of death investigation, but specifically more in the practice of forensic pathology. And this is kind of an area that I have a particular interest in, is utilizing what they call advanced imaging in patients.

Death investigation, and specifically what that, you know, in practical terms, what that means is the use of a CT scan in the post-mortem setting is becoming more common. The deaths where a CT scan could potentially supplant an autopsy are a lot of the traumatic deaths.

motor vehicle deaths and we don't autopsy every motor vehicle death don't get me wrong but you can get more information from a post-mortem CT scan the other big category are a lot of the natural deaths so if we have an individual that again apparently suddenly died with no medical history then

then sometimes the CT scan could show things like strokes, could show things like heart attacks and certain complications of a heart attack that can cause bleeding in the sac around the heart or what they call aortic dissections where you separate the layers of the aorta and it causes bleeding. So you can see certain natural disease processes that on the CT scan that would preclude the need for an autopsy.

Most, all suspicious deaths and homicides would benefit from a CT scan, but they wouldn't replace the autopsy. You'd still do the autopsy because usually there are things you can collect that have an evidentiary value that you wouldn't be able to if you just CT an individual. So there are a fair number of deaths that could be replaced.

The ones that aren't replaced are a lot of those deaths where it's a functional abnormality or where there aren't really findings of the autopsy. And those could be things like drowning deaths, seizure-related deaths, cold exposure-type deaths. Because of the sheer numbers of drug-related deaths we're starting to see, we're

These subset of those drug deaths could potentially be CQ'd and not autopsied. And I think that's kind of one of those advances that we have to embrace as a profession because of the lack of forensic pathologists to do these examinations. And that's kind of, I think, where we're headed now in a lot of places in North America.

Who else requires the information when you're doing these examinations? Like, who else do you need to provide them this information to beyond investigators or beyond the family members? The big one that comes to mind is vital statistics. So because essentially all deaths are...

are categorized and documented cause and manner of death are provided to them so that they can determine how populations are dying in certain jurisdictions. One of the other areas that I think people don't realize that, you know, the medical examiner corner has an impact on is public health. So usually deaths, particularly infectious disease type deaths are, you know,

first sort of encountered by the forensic pathologist in one of these death investigation systems. And it's sort of a recognition of, Hey, I'm seeing, you know, these consistent types of death. Maybe there's a new, you know, infectious disease out there that we've got to be looking at. So we, we do play a role in public health, but in New Mexico prior to training there, they, they,

They discovered a viral infection called hantavirus that resulted in a lot of respiratory difficulties and certain deaths in particularly rural New Mexico, and particularly in people that were sweeping road drums because this virus was aerosolized as people were cleaning out areas that may have hantavirus.

rodent droppings. And so that was first encountered by one of the forensic pathologists in New Mexico. He sort of started seeing more new deaths and saying, hey, what's going on here? And so they did, you know, I believe they called it GDC, and that started the process of recognizing Hantavirus and its impact on the public. So those public health measures are important.

What we do, even though we are dealing with those that no longer benefit from it, it could have implications for the public and in saving lives. You know, you mentioned that there are some risks when you're a high profile forensic pathologist such as yourself that you can leave yourself open to whether it's a lawsuit or added, you know, scrutiny in the public or the media. Talk about that and the impact on you and your career.

It's an area that's been a challenge for me and it's been hard to accept. And I think we talked earlier about the severe shortages of forensic pathologists. And I think this area that you're bringing up could be one of those factors impairing our ability to attract more to the field. And because we...

interact with the legal system, then some of our cases, particularly about the high profile homicides, um, really are under intense scrutiny, um, not just by, um, law enforcement and the legal community, but also the courts. Um, and that is, um,

can sometimes cause problems. For me particularly, there was a case that I did while I was working in Travis County, Texas, which is Austin, and I missed something. The night before trial, I was reviewing the photographs, and I missed something. And I let the district attorney know, and she let the defense attorney know,

Um, I testified the next day and, um,

I admitted my mistake. I did what the court demanded of me, and that was get on the stand and tell the truth. And I admitted my mistake. And that, even though it didn't change my conclusions as to the cause of death, caused all sorts of problems for me personally. The judge was upset. It ended up being in the newspapers and television, and it

raise questions of my reliability as an expert in forensic pathology. Thankfully, it hasn't impacted my career to the point where my career ended, but it has harmed my career. And that is disappointing because we are human, mistakes happen. But ultimately, my conclusions are

And so having that level of scrutiny is something that people don't necessarily want to deal with.

Another jurisdiction that I worked in, there were false accusations made by a family that I was doing something illegal. And those accusations have now been dismissed. But even though they were false and I wasn't doing what I was accused of, those stories are sensational. And they ended up in the media and they could have ended my career. And so it's

it seems that, you know, friends of pathology because of what we do and what we deal with and the interaction with not just sort of the various stakeholders in the community maybe leads us to be a little bit more targeted in things that are, can be problematic. And that, you know, for me has been the hardest part of what I do. You know, it's not the,

It's not the trauma. It's not what I see that other people do to each other. It's been sort of this component of it. And that's something that I'm still dealing with. But besides that, I love what I do and wouldn't think twice about doing it again.

Well, I really appreciate you taking the time to have this conversation and just giving us a glimpse into your career and the challenges you face. Thank you so much for this glimpse behind the scenes into your career as a forensic pathologist. I really appreciate your time. My pleasure. Thank you for listening. Crime Beat is written and produced by me, Nancy Hixt, with producer Dila Velasquez.

Audio editing and sound design is by Rob Johnston. Special thanks to photographer-editor Danny Lantella for his work on this episode. And thank you to Jesse Wisner, our Crime Beat production assistant. And thanks to Chris Bassett, the VP of Network Content, Production and Distribution and Editorial Standards for Global News.

I would love to have you tell a friend about this podcast. There are five seasons of stories you can listen to and share. And if you can, please consider rating and reviewing Crime Beat on Apple Podcasts or wherever you listen. You can find me on Facebook at Nancy Hicks Crime Beat and on Instagram at nancy.hicks. Thanks again for listening. Please join me next time.