Saturday, 29 January 2011

SIDS: Point of view of pathologist and detective

Samantha Yale Scroggin / Staff Writer / Santa Maria Times
January 24, 2011

Dr. Robert Anthony, right, the sole forensic pathologist for Santa Barbara County and Det. Todd Henslin examine brain tissue under a dual-view microscope at the county coroner’s office.//Eric Isaacs/Contributor
Dr. Robert Anthony has learned to finesse his response at cocktail parties to the question of what his job is within the medical field.
Anthony said that if he truthfully answers — “I take people apart as my job” —  people “look at you like you just sprouted a second head.”
Instead, he simply tells people he’s a pathologist, “and you hope they drop it.”
Those who push Anthony for more information end up taking a step away from him when they get their answers, he said, but are usually ultimately intrigued by what they hear.
“I’m the specter of death, and a lot of people don’t like that,” he added.
Anthony, who is the sole forensic pathologist for Santa Barbara County and handles all the county’s autopsies, and the four detectives within the county’s coroner’s bureau deal with a topic on a daily basis that most people would like to keep as distant as possible — death.
An interest in solving the puzzles that sometimes surrounds death can be a motivator for these people to enter this line of work, but Anthony and the detectives are not immune to being affected by the smell of decay or the agony of breaking the news to a family of a loved one’s death.
At the end of each workday, they return home to their own families, and must find balance between the intense and sometimes gruesome nature of their jobs and their home lives.
The work
Nearly every death in Santa Barbara County that doesn’t happen in a hospital is reviewed by the coroner’s office, according to Detective Rick Miller with the coroner’s bureau.
If the death is the result of natural causes and the deceased person was being treated by a doctor for ailments prior to death, sometimes the person’s attending physician will list a cause of death.
If a doctor is unable to provide a cause of death, Miller said, the coroner’s bureau will do an exam on the body and conduct an in-depth review of the person’s medical history.
The coroner’s office detectives can be called out at anytime of the day or night to investigate suspicious deaths, which typically happens a few times a month.
“We’re trained on how to look for the specific indicators,” he said.
Anthony will do an autopsy on the body unless the cause of death is obvious to the eye.
Anthony said he performs about 150 autopsies each year. The process involves the inspection and dissection of a body after death to determine the cause of death.
“The case load here is crazy,” he said. “We just work together.”
Half of the death certificates in the county are signed by physicians, Anthony said.
Doctors, unlike Anthony, must determine a cause of death in order to sign the death certificate, he added.
“They have to have a reason. They can’t put down ‘I don’t know’.”
Anthony said the coroner’s office is usually able to determine a cause of death, with the exception of 2 percent to 5 percent of cases.
“It can be frustrating because we like to answer those questions,” he said. “But you can only do what you can do.”
“Death, as in life, sometimes leaves unanswered questions for us all,” Anthony added.
The most common cause of death in the county is heart disease, he said.
The number of cases that funnel through the coroner’s bureau keeps those who work there extremely busy.
“It’s bad and you don’t have a choice,” Anthony said of the workload. “You’ve got to do what you’ve got to do.”
“Literally, I’m involved with everything that comes through the office,” he added.
The investigators are important, Anthony said, because they make suggestions to him and provide him with useful information about the deceased person, such as if the person was an alcoholic.
The challenges
The tough aspects of investigating death are numerous.
In addition to the constant cases coming in that must be dealt with, there is the emotionally troubling element of the job, the grieving families who often are unsatisfied by the answers to their questions. Then there sometimes is the stomach-churning smell of decaying bodies.
Sgt. Sandra Brown, who oversees the coroner’s bureau, said that families of the deceased often have questions the investigators are not able to answer.
Even after autopsies are conducted, the investigators do not always have the answers the families want to hear, Brown said. In cases of suicide, families are sometimes in denial, she added.
“Sometimes we’re talking to family members half a dozen times before the family starts wrapping their minds around that,” Brown said of suicide.
Serving as a counselor of sorts comes with the territory.
“We’re compassionate but a lot of times we have to be blunt,” Brown said.
She said those in the bureau go through the grieving process along with the families.
“I really have to keep in touch with my investigators and make sure they’re doing OK,” Brown added.
Cases can become especially unsettling for an investigator with close ties to a case, she said, such as if the detective has a child the same age as a victim.
“This job can get very dark and sad,” Brown said.
Those in the office try to have fun together and enjoy each other’s company, she said, “but emotionally, it’s very draining.”
Miller, who spent 10 years with the Air Force before joining the Sheriff’s Department full time in 1995, came to the coroner’s bureau in 2008.
He recalled that he was upset as a patrol deputy when he discovered a man who had hanged himself next to his dog, who was also hanging. However, working in the face of death became easier for Miller.
“You start getting more used to dealing with it,” he said.
Miller’s job sometimes includes informing families about the death of a loved one, a “horrendous” task that he said he does “very carefully, because you never know how people are going to react.”  Sheriff’s deputies outside of the coroner’s bureau also make death notifications.
Miller said he’s had people faint at the news or come after him, while others remain calm.
“ A lot of times they have no idea it’s coming,” Miller said.
Sometimes, the investigators bring a chaplain with them.
“Sometimes that helps, sometimes it doesn’t,” he said.
“You don’t look forward to it,” Miller said of making death notifications. “But it’s part of the job.”
Miller, who has a grown son, said he especially dislikes working cases of Sudden Infant Death Syndrome (SIDS), as do the other detectives.
Anthony said that when dealing with the death of a child, there are somber faces all around, “and everybody’s on edge.”
“The violent death of a child particularly is probably one of the most distressing things we have to deal with,” he said.
If the coroner’s office doesn’t do its job, though, prosecutors, the court and the jury can’t do theirs, Anthony said.
Anthony compared a job in the coroner’s bureau to working in a mobile army surgical hospital.
“You need humor to keep your sanity,” he said.
If the investigators internalized their work, they could have nightmares and alcohol and drug abuse problems, Anthony said.
However, by maintaining their sense of humor, “we survive, we keep going,” he said.
Anthony said that when he first started in the field, he was mildly to moderately repulsed.
“It was always the smells that got to me,” he said. “But I kept having the question. I kept having to go back.”
“After awhile, it’s just part of the business,” Anthony added.
The reasons to stay in the bureau
Todd Henslin, a detective with the coroner’s office, had experience dealing with death while working as an emergency medical technician, a volunteer firefighter and a patrol deputy for 13 years before spending the last four months in his current role.
He said working as a detective in the coroner’s bureau is challenging and interesting. Each case presents a mystery for the detectives to try to solve.
“It is intriguing in a sense to kind of see how things work in the body,” Henslin added.
Fellow detective Miller also said the job is interesting, noting that he’d rather investigate death than reviewing someone’s bank records, for example.
“Right now I have no plans on going anywhere,” he said. “I’ve learned  a lot.”
Anthony, the county’s forensic pathologist, said his interest was piqued by the field of toxicology while doing blood analysis in the military.
He met a forensic toxicologist who invited him to work with him, and he started down his career path.
“For me, it’s the puzzle. It’s the question. It’s coming up with the answer,” Anthony said. “And every case is unique.”
“It’s not a boring job,” Anthony said later.
Working in the field of death also provides a unique perspective on life.
Brown, who is in charge of the bureau, said her job makes her realize how short and precious life is.
“I enjoy everyday, and I’m very blessed for knowing that,” she said. “I enjoy, I think, smaller things than I used to.”
Henslin said his work encourages him to act with a little more caution and to look out for health risk factors among his loved ones.
“You kind of look at your own mortality,” he said.
Finding balance
Humor and a close bond among those in the office help them keep a healthy mindset.
And perhaps the occasional video game session or glass of wine.
Henslin said he tries not to dwell on his cases or take the work home with him emotionally.
“Luckily, I got a long drive home,” he added.
Exercise and being around people can be good outlets for stress, Henslin said.
Henslin said his job is one he chose to do.
“You take pride in your work, and you take pride in giving people as much answers as you can.”
Miller said he likes to play Xbox to unwind from work.
After hours, “I’m really good at separating myself from work,” he noted.
He is thankful for his understanding wife, who puts up with his unpredictable hours.
Anthony said he avoids conducting autopsies on those he knows beyond much more than a one-time meeting.
In those situations, a forensic pathologist would be called in from another county, he said.
Anthony said his work has always been a large part of his life, and he even took his children to the office when they were young.
When his son was 7 or 8, he showed him a plane crash victim.
“He thought it was great and he’s gone into law enforcement,” Anthony said.
In his off time, Anthony said, he relishes local wines, including visiting area vineyards.
“I’m a big wine collector and I enjoy the wines of Santa Barbara County,” he said.
His dark sense of humor coming through, Anthony added, “the wines smell a whole lot better than my job does.”

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