Indiscreet

08.22.14

The Dirty Secret Doctors Don't Want You To Know

A new book about a doctor’s first year as a medical examiner reveals all sorts of grisly detail, but none so alarming as a trade secret the rest of us are perhaps better off not knowing.

Doctors are much weirder than anyone realizes. We are people who, despite ourselves, find ourselves drawn to the sick, the dying, the permanently bruised. It surely is perverse. It surely edges into a morally indefensible territory. It surely however gives a certain type of feller a thrill, dark and shameful though it may be. You know that unusual illness your grandmother had a few years ago? The one with the fever and the rash and the kidney failure that eventually killed her? You all call it a family tragedy—we doctors call it a great case.

Before consulting the rabbis and priests for moral pronouncements, however, please realize that we aren’t the only ones—take the undertakers. They too love a good death, a brilliant corpse, a riveting sequence of unfortunate events. Their eagerness for the extreme and the extremely awful may surpass even our own, so pleased are they with their restorative skills. One only need read the classic book by the poet-mortician Thomas Lynch, The Undertaking: Life Studies from the Dismal Trade, to appreciate how far pride of place has migrated.

For those who want a deeper look at this sort of psychopathology (from which I too suffer, gravely), the two involved professional groups have met up in Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner by Dr. Judy Melinek and her husband, T.J. Mitchell. Melinek is the fledgling medical examiner in question, choosing to pursue that macabre branch of medicine that determines how newly dead people died—murder or accident or suicide or old age. Their timing is apt: The medical examiner is now a hot commodity in TV-land. Countless shows, from Quincy to Bones to NCIS: Everywhere, have a usually crusty, sometimes sexy, but always aloof medical examiner at the center of the drama. 

Melinek and Mitchell write about Melinek’s time a decade ago as a training doctor in the New York City Medical Examiner’s office, where she did autopsies on decomposing men tossed into dumpsters, children scalded to death, various drug addicts who shot too much heroin, bodies that washed ashore or fell a distance to splat onto pavement, and those found—because of the rotting smell—dead in their apartment. The details are vivid and somewhat unimaginable; they also run together. To offset this potential monotony, the authors weave through the many vignettes the sad personal tale of Dr. Melinek’s own father’s suicide as a youngish man of 37, even mentioning the Medical Examiner’s description of her father’s autopsy.

The book is at times fun, at other times chilling, but it also can be quite glib. For example, in the chapter entitled “Death at the Hand of Another,” the authors describe Dr. Melinek’s excitement as she determined the relationship between a bullet’s trajectory and the inferred sequence of events that killed a man. “‘That is so cool!’ I proclaimed to Barb and Renee, the tech, when I saw the point of my probe emerge from the dead man’s flayed brow.” Another story, this one in the chapter uncomically titled “Stinks and Bones,” refers to a mostly decomposed anonymous body with a penis “clinging valiantly to the front of the pubic bone”—a comment perhaps better left unwritten or unsaid anywhere in society—except perhaps the autopsy table.

Make no mistake though—this sort of insider jargon, glib though it may be, is absolutely the coin of every hospital’s realm and indeed could be said to make any health-care facility more functional by giving practitioners a chance to blow off verbal steam. Every group, under pressure, needs its own strange barks and twitches, from U.S. senators to defensive linemen to the guy rewiring your cable box. Not surprisingly, MedSpeak is a very coarse, very colorful, very cruel argot that doctors learn to speak from the first days of medical school, perfect after a decade or so and practice religiously—right up to that moment in middle age when they find themselves surrounded by friends and loved ones who occupy not chairs and sofas but rather hospital beds and CT scanners. Then the jollity of gallows humor, the need to show sang-froid despite the obvious impropriety, yields to the frigid touch of one’s own impending doom.  

What the authors hint at with their coy descriptions of the very dead, but seem to avoid meeting head-on, is the aforementioned up-is-down doctor problem—our trademark love of illness. Within that passion for decrepitude, unstated but never out of view, is the working premise for the whole deal: that somehow we can look death square in the eye because we are not eligible for the squad—a new sort of diplomatic immunity really worth fighting for.

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‘Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner’ by Judy Melinek, MD & T.J. Mitchell. 272 p. Scribner. $20.61. ()

And the deeper we go—by, say, becoming a forensic pathologist or a pediatric oncologist—the more confident we are that this hyper-haunted house experience will strengthen our diplomatic immunity, as sure as Dr. Oz’s latest tonic will strengthen other sorts of immunity. Shucks, if we keep it coming, we may never die! Alas, however, this run-straight-into-darkness strategy is, just like gobs of blueberries, completely ineffective at warding off trouble. 

Perhaps, though, it is best that the big awful secret remains hidden from the public, out of Working Stiff and everywhere else. No one really wants to know just how excited a guy can get when he makes a difficult diagnosis, his thrill at being right, his satisfaction at seeing a rare disease even if it kills the person whose hand he shook warmly just a day or two ago. In this moment when transparency is all and seemingly every story must be told and every secret bared, it actually may be time to re-introduce the concept of opacity.