Questions for Roberta Geiselhart and Owen Middleton

Learn more about my research In November 2008, Roberta Geiselhart and Owen Middleton answered visitors questions about medical examination.

Your Comments, Thoughts, Questions, Ideas

Andrew's picture
Andrew says:

When you are doing an autopsy, does it still feel like you are working with a person or does it feel like the person is gone and you are just going through their old stuff? Is that hard?

posted on Thu, 11/06/2008 - 2:16pm
Owen Middleton's picture
Owen Middleton says:

If you asked different medical examiners this question, you would probably get a spectrum of answers. Most would probably reply something to the effect that the person is dead, and therefore the characteristics that made that person an individual are gone. However, the examination still gives the examiner a glimpse into what life may have been like for that person.

I think it is important to understand all that an autopsy entails. All autopsies should begin with a review of a wide scope of information regarding that person including medical information, social information, anything that might help the examiner in determining how the individual came to die. Sorting through the information can reveal quite a bit about an individual. The examiner and the deceased may have never met, but there is still a human connection with which the examiner can associate. So although the individual is dead and all that is left is the physical remains, one still has the sense that this was a person, and thus should be treated with the dignity another human deserves.

The remainder of the examination can amplify that sense of individuality. As the body is examined the scars of living and the effects of disease, that would be covered by clothing in everyday life, become evident. If considering only the internal examination of an autopsy, then it would be easy to suggest an examiner is only exposing and examining organs without considering the individual, as it is a technical, surgical procedure, one step followed by another until complete. Even within those steps are reminders that the body belongs to a person. Every attempt is made to complete our examination such that relatives can pay their respects as they deem suitable when we are done, because we understand the importance of that person to the family. While it might appear as though the medical examiner simply examines the remains of an individual, it is the compilation of all of the information attained about the person that will hopefully lead to the answer as to why he or she died.

Some deaths are easier to associate with, making it more difficult to perform the examination. It can be easy to find common ground with the deceased… age, hobbies, city… all sorts of variables can be compared. It is how one copes with those associations that determines how difficult an examination will be. The more difficult deaths tend to be those of children, who have little control or insight regarding factors leading to their death. Generally, an examiner will have sympathy for the decedent and the family, but it does not hinder the ability to perform the examination and determine the cause of death. At the end of the day, I think you would find that most medical examiners have a true appreciation for life and are glad they could help answer the question as to why someone died.

posted on Wed, 11/12/2008 - 1:51pm
Anonymous's picture
Anonymous says:

What do autopsys help you with?

posted on Sat, 11/08/2008 - 4:12pm
Owen Middleton's picture
Owen Middleton says:

Autopsies can find evidence (such as in a case of a homicide) or help us to find a natural occurring process in the body that explains a sudden death. Many times the autopsies we perform anticipate that there will be legal action later and we document all injuries so the courts have a full understanding that only the injuries sustained near the time of death caused the death, and other findings are purely incidental. At times this makes a difference for family members as insurance looks at the manner of death and death benefits may be different depending on the manner (natural, suicide, homicide, accident or undetermined). Sometimes it is documenting a lack of findings that is important, such as if a death is suspicious but no injuries are discovered at the autopsy. Findings in accidental deaths might be reported to various agencies leading to changes to prevent such deaths in the future, such as has develped with regulations for baby cribs.

Even if we suspect a death is due to natural disease, our examination might prove to be very important. We might find previously unknown natural disease that can have effects for surviving family members, in which case we encourage those family members to visit their doctors. A medical examiner's office might be the front line of detection for an unusual infectious disease, where we would notify the state health deparment. The autopsy findings might reveal a completely different cause of death than what was suspected, allowing us to answer questions for the family and provide feedback to a decedent's doctor to help with future patients.

Overall, an autopsy helps us to answer questions.

posted on Wed, 11/12/2008 - 2:15pm
Sparky's picture
Sparky says:

if a body is in an air tight casket and in like 15 years you open it up, how long would the body stay the way it is? or will it decompose right away? (like the rumors say)

posted on Tue, 11/11/2008 - 11:37am
Roberta Geiselhart's picture

I can’t comment on the air tight casket situation. We have seen exhumed bodies and the condition of the body truly depends on the type of environment the body was being maintained. Bodies that aren’t immediately buried will mold but the chemicals used in embalming usually holds off the decomposition to some degree. What I have seen most with exhumed bodies is the water that leeches into the casket causes more disfigurement to the body than anything else. The type and quality of embalming dictates what the body looks like years after death. It seems that no casket is water tight so I doubt if airtight is even possible to attain at this time. The best person to answer this type of question would be a funeral director.

posted on Thu, 11/13/2008 - 12:34pm
Joe's picture
Joe says:

What inspired each of you to become medical examiners?

posted on Tue, 11/11/2008 - 10:54pm
Owen Middleton's picture
Owen Middleton says:

I can't say there was one thing in particular that inspired me to become a medical examiner. I love science and I knew that I wanted a career in medicine. As a medical student I rotated through various medical services, including the medical examiner's office. While I liked almost every field of medicine to which I was exposed, it was my exposure to forensic pathology that really let me know what I wanted my career to be. The medical examiner job brings aspects of all the other fields of medicine into what I do, with a bonus of helping to solve real life mysteries.

posted on Wed, 11/12/2008 - 2:27pm
Roberta Geiselhart's picture

I rather fell into this career. I have always been the type of person that needed to know more and more and disliked working in an atmosphere that was stagnant. At times during my former career as a nurse I found that my mind really wasn’t being challenged. This career has allowed me to use many skills that I learned in nursing school and as a nurse that I just didn’t have time to use while working in ICU. Here at times I function as a confidant, counselor, chaplain, teacher and at the end of the day feel like I have helped much more at times than when I worked as a nurse. I have been fortunate to work in an area where there are so many twists and turns to investigate and have been allowed to do that, making no day the same. It also has helped me to put life in perspective and remember that all challenges are really just little things and I truly am thankful for each day I am given. Medical Examiner work is so much more in the forefront in the recent years and it is amazing what people are asking of us which makes the work so much more dynamic!

posted on Thu, 11/13/2008 - 12:36pm
Julia's picture
Julia says:

Have you ever found any strange objects in your investigations, either ingested or otherwise?

posted on Thu, 11/13/2008 - 6:41pm
Owen Middleton's picture
Owen Middleton says:

Sometimes people die with creative "crack" pipes or other possessions nearby, but I have never personally found anything unusual in someone's stomach (just pills and poorly chewed food).

posted on Tue, 11/18/2008 - 5:38pm
Roberta Geiselhart's picture

People will ingest just about anything. We have found a lead charm in a young boy who ended up dying of lead poisoning as the charm was made out of lead. Sometimes people ingest solvents that not only are aromatic (strong smelling) but can be problematic when we have to dispose of those gastric(stomach) contents. We always have to be on guard so to speak to collect items that may have been ingested to assist our toxicologists with getting us answers.

posted on Thu, 11/20/2008 - 6:27pm
EWatson02's picture
EWatson02 says:

About how often do you call in a specialist, such as a forensic anthropologist, or odontologist?

posted on Thu, 11/13/2008 - 10:03pm
Roberta Geiselhart's picture

Fortunately we only have to call on an anthropologist or odontologist about one or twice a year. Primarily, anthropologists help us with the bone cases and odontologists can help with dental identifications and bitemark evidence on bodies.

posted on Thu, 11/20/2008 - 6:27pm
cx's picture
cx says:

What is the most rewarding case you ever helped solve?

posted on Sat, 11/15/2008 - 8:23pm
Owen Middleton's picture
Owen Middleton says:

I have had the fortune to have two cases where my findings actually helped emergently save the life of a sibling. One was an abusive situation and the other was an infectious disease situation.

posted on Tue, 11/18/2008 - 5:41pm
Roberta Geiselhart's picture

There was a case where we could not find a cause of death on a young child who had been sick with a common cold. This was bothersome not only for us but the family understandably was in agony(because they were concerned that the doctors that cared for the child missed something and also they were concerned for their other children). Our neuropathologist found a brain tumor to explain why the child died (brains usually are fixed in formalin for several days before we can carefully examine them so we didn’t have a cause of death immediately after autopsy).

posted on Thu, 11/20/2008 - 6:27pm
VivaLaAJ(:'s picture
VivaLaAJ(: says:

Whats the weirdest thing you've found in someone's stomach???

posted on Sun, 11/16/2008 - 5:48pm
Owen Middleton's picture
Owen Middleton says:

Similar to the answer to the previous question... a poorly chewed bratwurst from a Twins game is about as unusual as it has been for me as far as stomach contents. Usually if someone puts an object in their mouth and it leads to death (other than medications), it is because the airway gets blocked.

posted on Tue, 11/18/2008 - 5:47pm
Roberta Geiselhart's picture

The strangest thing I recall is someone who was a body packer who had swallowed more than ten plastic fingers tips of gloves full of cocaine. One opened and caused sudden death due to acute and massive cocaine ingestion.

posted on Thu, 11/20/2008 - 6:26pm
Anonymous's picture
Anonymous says:

Do you ever get sick when doing an autopsy? The reason I ask is because in my biology lab, when we were working with fetal pigs, I could barely hold down my lunch. I am not much of a scientist myself, but my father, three of my uncles, and my sister are all doctors. My mother is also a nurse as well as my grandmother. I am wondering how long it took for you to figure out this was going to be okay with you, because I don't think that I would ever be okay with it.

inquisitivly yours,
M. Benz

posted on Thu, 11/20/2008 - 7:00pm
Owen Middleton's picture
Owen Middleton says:

I have only become "sick" from an autopsy one time, and that was the first time I saw one performed. I was working in a hospital during a college summer break when I was invited to watch a hospital autopsy. For whatever reason, I could feel myself becoming light headed and had to leave the room for a few minutes. Everything was fine when I returned to the room and I have not had any problems since.

posted on Tue, 11/25/2008 - 8:55am
kayla and madi's picture
kayla and madi says:

What kind of training did you have to go through to become a medical examiner? And how long did it take you?

posted on Sun, 11/23/2008 - 1:52pm
Owen Middleton's picture
Owen Middleton says:

A medical examiner is a doctor and therefore the training is like that of most other doctors. Usually this means four years of college followed by four years of medical school. Where the training differs from most other doctors is after graduation from medical school. While some doctors do continued training after graduation, known as residency, to be family medicine doctors, pediatricians, surgeons, or other specialties, a medical examiner usually does four years of post-graduate training in pathology followed by an additional year studying only forensic pathology. Pathologists are the doctors who look at surgical specimens, cell samples, or laboratory samples to help a patient's doctor determine what disease might present. Pathologists also perform those autopsies that are done in a hospital to evaluate natural disease. A medical examiner is thus a pathologist who has at a minimum one additional year of training, known as a fellowship, to learn to perform forensic autopsies. The usual length of time to become a medical examiner is now thirteen years after high school (4 years of college, 4 years of medical school, 4 years of pathology residency, and 1 year of forensic pathology fellowship).

posted on Tue, 11/25/2008 - 9:17am
Roberta Geiselhart's picture

The training for Medical Examiner Investigations is primarily on the job as their is no true course work that you can do to prepare you specifically for this line of work. Hennepin County Medical Examiner's Office requires a 4 year degree or advanced experience in related fields to apply for investigator positions. Mortuary science, public health, biology and chemistry degrees are all represented in our current investigative staff.

posted on Wed, 12/03/2008 - 11:31am
Anonymous's picture
Anonymous says:

do you ever just have to go with a hunch because there wasn't enough evidance?

posted on Fri, 11/28/2008 - 4:42pm
Roberta Geiselhart's picture

Investigations relies on gathering many, many pieces of information and evidence. A hunch really doesn't apply but I think the person that is successful in medical examiner investigators is the person that essentially can see what is wrong or right with a given picture (set of information/photos, evidence, etc.). There are times that we can not prove how someone died which is very frustrating not only for our staff but for the family/friends. Science is advancing and fortunately some of those types of deaths will be explained as science advances.

posted on Wed, 12/03/2008 - 11:35am
Anonymous's picture
Anonymous says:

Under what circumstances does the medical examiners office become involved in a death? Is it all the time or just in some specific cases?

posted on Tue, 12/16/2008 - 6:37pm
Roberta Geiselhart's picture

In Minnesota there are state statutes that indicate which cases/deaths that we are to investigate or be made aware of. Essentially they are the unexplained (those deaths where someone is healthy and dies suddenly without diagnosed medical problems), un natural deaths (suicides, homicides, accidents and undetermined manners). If you'd like you can view the statute here and look at the Chapter 390.

posted on Fri, 12/19/2008 - 1:34pm
Anonymous's picture
Anonymous says:

What do you do with unclaimed bodies?

posted on Tue, 12/16/2008 - 6:37pm
Roberta Geiselhart's picture

Fortunately we rarely have unclaimed bodies. There are two distinctions that we need to make to discuss these situations. Those bodies that we can not identify and therefore are unclaimed and those that we can not locate family or the family refuses to get involved in taking care of arrangements.

If a body is unidentified we appeal to the media and essentially ask for the public to assist giving details on the height, race, sex of a person. We then screen with other details…….type of scars/tattoos, any previous surgeries, etc. It takes a lot of time and you’d be surprised at the number of calls this generates. If a person, after that process remains unidentified we will do many special studies…… such as full body x-rays, blood type, dental exam by an odontologist (forensic dentist) and then put the person in several of the databases for these types of people………such as NAMUS.gov, theyaremissed.org. We also have an active Doe Network that assists us in working to look for the identities of unknown decedents. If we exhaust all of these methods we will then work with a local funeral home to bury the decedent as unidentified. In the past twenty years in Hennepin County two identifications of previously unidentified remains were identified after burial.

If a body is unclaimed because a family member(s) don’t want to be involved we work with a funeral home and either the decedent’s own money or county client resources to get funding to bury. Usually a funeral director arranges a burial plot and works for free to assist us in accomplishing that process.

posted on Fri, 12/19/2008 - 1:36pm
Anonymous's picture
Anonymous says:

How long after death can organs from a dead person be donated? How does that process work from your office?

posted on Tue, 12/16/2008 - 6:38pm
Roberta Geiselhart's picture

Organs with the exception of heart valves must be taken prior to someone being taken off life support or within minutes after the heart quits beating. Usually organs are considered for transplantation after brain death has been established. Our office is contacted when an impending death is going to occur and where the family is opting for organ donation. We gather many details and make sure appropriate evidence is gathered before we allow this to occur but do everything we can to make sure this can occur. It is beneficial for both the donor and recipient family.

posted on Fri, 12/19/2008 - 1:37pm
Anonymous's picture
Anonymous says:

What is the difference between a medical examiner and a coroner?

posted on Tue, 12/16/2008 - 6:39pm
Owen Middleton's picture
Owen Middleton says:

The term medical examiner generally refers to a physician who has undergone specialized training in forensic pathology and is appointed to the position of medical examiner by a governing body, such as a county board. A coroner is an elected position that any individual can run for depending on the requirements established by the governing laws. For instance, in Minnesota several medical examiner offices are established for help with death investigation, but there is not a medical examiner in every county. Counties without a medical examiner therefore have a coroner in charge of death investigation, who will request the help of one of the medical examiner offices when he/she feels that an autopsy is necessary. Minnesota law currently requires that county coroners be physicians, but this is not true for other states around the country. If a county has a statute for a coroner position and there also happens to be a medical examiner in that county, then the medical examiner could actually have both titles of medical examiner and coroner.

posted on Mon, 12/22/2008 - 5:42pm
Elena's picture
Elena says:

How do you become a specialtist at forensic science?

posted on Thu, 01/01/2009 - 10:31pm