What Really Goes On In The Morgue

I invited my buddy, Garry Rodgers, back to TKZ for a fascinating behind-the-scenes trip to the morgue. He’ll hang around for questions/comments, so don’t be shy. Now’s your chance to ask an expert something you might need for your WIP. Enjoy!

Most living people never visit the morgue.

Most never think of the morgue except when watching TV shows like CSI or some new Netflix forensic special. The screen may show in hi-def and tell in surround sound, but it can’t broadcast smell. That’s a good thing because no one would tune in and the actors would be looking for real-life morgue jobs like homicide cops, coroners and forensic pathologists.

I did two of those real-life morgue jobs for a long time. I’m a retired murder cop and field coroner who spent a lot of hours in that windowless place. Now, I’m a crime writer and thought I’d share a bit of what really goes on in the morgue with my crime-writing colleagues.

The morgue is strictly off-limits for anyone not having a specific reason to be there. That’s for a few reasons. One is the place can hold sensitive court evidence. Two is that it’s a somewhat disagreeable place due to the odor, temperature and the continual chance of contracting a contagious disease. The third reason is dignity. Even though the majority of the morgue occupants are no longer alive, they’re still human entities and not some sort of a morbid exhibit.

The morgue is a place of business. It’s a medical environment where the deceased are stored, processed and released to their final disposition. The morgue operates 24/7/365 as death pays no attention to the clock or the calendar. But, the morgue is busiest between 8:00 am and 4:30 pm Monday to Friday—holidays exempted. Morgue workers need time off like anyone else.

A city morgue, like I worked at in Vancouver, British Columbia, is an active environment. It has a dedicated shipping and receiving area with a loading dock much like a typical warehouse. Bodies arrive by black-paneled coroner vans or on sheet-covered gurneys brought down from the wards. They’re booked into a ledger, assigned a crypt and, yes, marked with a personalized toe tag.

Vancouver General Hospital’s morgue is like Costco for the dead. Stainless steel refrigeration crypts, stacked three-high in two rows of nine, have shelving for fifty-four. The freezer unit stores eight and isolation, for the stinkers, can take six sealed aluminum caskets or “tanks” as we called them. These tanks are also used for homicide cases, locked to preserve forensic evidence.

A grindy overhead hoist shifts cadavers from wheeled gurneys that squeak about fluorescent-lit rooms, touring them to and from roll-out metal drawers. Refrigeration temperatures are ideally set at 38-degrees Fahrenheit (4-degrees Celsius) while the ambient range in the autopsy suites is held at a comfortable 65 / 18. The storage rooms, laboratory and administration areas are normal office temperature, and they’re set apart from the main morgue region. Support staff, for the most part, have no sense of being so near to the dead.

Operational personnel in the morgue are highly-trained professionals. The workhorse of the morgue is the autopsy technician or attendant called the “Diener”. It’s a term originating from German that translates to “Servant of the Necromancer”. Dieners have the primary corpse handling and general dissection responsibility. They do most of the cutting.

Hospital pathologists are primarily disease specialists. They spend the majority of their day in the laboratory peering into microscopes and dictating reports. It’s a rare general pathologist who stays with an autopsy procedure from incision to sew-up. Usually, hospital pathologists come down to the morgue once the diener has removed the organs and has them ready for cross-section.

A hospital pathologist takes a good look for what might be the anatomical cause of a sudden or unexplained death. The main culprits are usually myocardial infarctions, or “jammers” as they called in the heart attack word. Aneurisms are another leading cause of dropping dead, and they’re often found in the brain.

Hospital pathologists sometimes do partial autopsies when they want to confirm an antemortem diagnosis. That might be a certain tumor or the extended effects of a runaway respiratory disease like Covid19. Sometimes, there’s no clear cause of death such as in a heart arrhythmia or a case of toxic shock.

Forensic pathologists are an entirely different animal. These are meticulous medical examiners with a tedious touch. It takes years of specialized training and understudy to become a board-certified forensic pathologist qualified to give expert evidence in criminal cases.

Forensic autopsies are peak-of-the-apex procedures inside the morgue. In a setting like Vancouver General Hospital (VGH), there are six autopsy stations in one open room. At any given time, the slabs are occupied and there more in the pipe. Not so with a forensic procedure.

There are two segregated and dedicated suites for forensic autopsies at VGH. Protection of the corpse, which is the best evidence in homicide cases, is paramount. So is maintaining continuity of possession, or the chain of evidence, that ends up in court. In a forensic autopsy, there’s utmost care to ensure the body is not compromised by contaminating it with foreign matter like DNA or losing critical components like bullets or blades.

In a homicide case, the body is taken from the crime scene in a sterilized shroud and locked in a tank. There’s an officer or coroner appointed to maintain continuity from the time the cadaver is bagged until the corpse is laid out on the slab. This is a critical element in forensic cases and one that is treated as gospel.

A forensic pathologist stays with the autopsy from the time the body is unlocked from its tank till the time the pathologist feels there is no more evidentiary value to glean. This is usually a full-day event but sometimes the body is put back in the tank, held overnight, and the process goes on the next day. This completely depends on the case nature such as multiple gunshot or knife wounds.

There are police officers at every forensic autopsy. Those are the crime scene examiners who photograph the procedure and pertinent physical properties. Detectives receive evidentiary exhibits like foreign objects such as fired bullets or organic particulates. There might be semen samples or other questionable biological matter. Then, there are usual suspects for toxicology examination like blood, urine, bile, stomach contents and vitreous fluid.

Radiography is done in almost all forensic autopsy cases. A portable X-ray machine scans the body as it lies on the table. In some situations, MRI / CT technology is helpful.

But, nothing beats the eye and experience of a seasoned forensic pathologist. They observe the slightest details that even a general pathologist would miss. However, don’t dismiss what a good diener can spot. It’s a treat to watch a forensic pathologist and a diener work when they’re in synch.

At day’s end, folks in the morgue are much like anyone else. They have a market to serve and they do it well. They’re also prone to talk shop in a social setting. There’s nothing like having drinks with a diener who’s into black humor.

 

What if six members—three generations—of your family were slain in a monstrous mass murder?

FROM THE SHADOWS is part of Garry’s “Based on True Crime” series. Available on Amazon and Kobo.

 

 

 

 

I couldn’t write a piece about what really goes on in the morgue without a few war stories. In my time as a cop and a coroner, I’ve been around hundreds of cadaver clients. Maybe more like thousands, but I never kept track. There were a few, though, that I’ll never forget.

One was “Mister Red Pepper Paste Man”. My friend Elvira Esikanian, a seasoned forensic pathologist of Bosnian descent who cut her teeth by exhuming mass graves, is a gem. She also has a wicked eye for detail.

I brought this old guy into the morgue after finding him dead in his apartment. Neighbors reported him screaming like someone was skinning a live cat. They rushed in and found him collapsed on the floor. No idea what killed him, but no sign of foul play.

Elvira opened his stomach and it was positively crawling. She knew what it was—botulism. Elvira told me to go back to the scene and look to see what he’d been eating. I found it. It was a jar of red pepper paste that was years past its expiry date, and the inside was a mass of organic activity.

Then, there was Kenny Fenton. He was found dead after being dumped beside a rural road and left to rot for a week in hot weather. I brought him into the morgue as intact as possible but it wasn’t easy. Kenny went into a stinker tank before Dr. Charlesworth could take him on.

As a routine, Kenny had a radiography session before his dissection. It showed a bullet in his gut. Not a run-of-the-mill bullet, of course. It was a .22 short with no rifling engraved on its sides.

Turns out, Kenny was accidentally shot in the neck by a Derringer dueling pistol. The bullet cut his carotid, hit his spinal cord, bounced back to his esophagus and he swallowed the dammed thing before bleeding out and dying fast. The crew he was with thought it was better to dump Kenny than report it.

And I can’t wrap up without a bit of spring foolishness that went on in the morgue. It involved my buddy—Dave the Diener.

Dave had about thirty years in the crypt before he met me. In fact, Dave had something to do with me getting hired by the coroner’s office because he thought I might be a good fit. Dave may, or may not, have been right.

It was the First of April and a Friday morning. Dave liked Fridays because he usually left early once his cutting was done. I don’t think there’s anything wrong with that, and I’ve done it myself.

But this Friday was different—probably had something to do with the date. I snuck into the morgue real early and prepared Dave’s first case. I needed some weight so he wouldn’t suspect anything off the bat. I put a bunch of concrete patio blocks on the crypt’s drawer base. Then, I placed my cadaver inside a shroud and laid it on top. I even attached a toe tag and made the right entries in the ledger.

I wasn’t there but sure heard from the other staff who were in on it. Dave rolled-out his first subject-for-the-day and unzipped the shroud. Smiling at Dave was the puckering face of a blow-up sex doll.

That’s the kind of stuff that really goes on in the morgue.

Garry Rodgers has lived the life he writes about. Garry is a retired homicide detective and forensic coroner who also served as a sniper on British SAS-trained Emergency Response Teams. Today, he’s an investigative crime writer and successful author with a popular blog at DyingWords.net as well as the HuffPost.

Garry Rodgers lives on Vancouver Island in British Columbia at Canada’s west coast where he spends his off-time around the Pacific saltwater. Connect with Garry on Twitter and Facebook and sign up for his bi-monthly blog.

 

 

 

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ELVIS PRESLEY — WHAT REALLY KILLED THE KING OF ROCK ‘N ROLL

By SUE COLETTA

I invited my dear friend Garry Rodgers — retired homicide detective with a second career as a forensic coroner — to share a fascinating post about the real cause of Elvis Presley’s death. Prepare to be wowed. Welcome to TKZ, Garry!

Elvis Presley suddenly dropped in the bathroom of his Graceland mansion on the afternoon of August 16, 1977. Elvis was rushed to Baptist Memorial Hospital in Memphis, Tennessee, where he was pronounced dead, then shipped to the morgue and autopsied the same afternoon. Three days later, the Memphis County coroner issued Elvis Presley’s death certificate stating the cause as hypertensive cardiovascular disease with atherosclerotic heart disease — a heart attack subsequent to high blood pressure and blocked coronary arteries.

It was a rush to judgment. Toxicology results soon identified ten pharmaceutical drugs in Elvis’s system. Codeine was at ten times the therapeutic level and the combination of other prescription drugs suggested a poly-pharmacy overdose. This revelation started immediate accusations of a cover-up and conspiracy theories quickly hinted at sinister criminal acts.

Four decades later, modern medicine and forensic science looked at the Presley case facts. The review indicated something entirely different from a heart attack or drug overdose really killed the King of Rock ‘n Roll. It said Elvis Presley accidentally died after long-term complications from earlier traumatic brain injuries (TBIs). TBIs are known as silent, stalking, and patient killers.

Looking back, it’s likely old accidental head injuries triggered events leading to Elvis Presley’s death.

From my experience investigating unexpected and unexplained sudden deaths, the accidental conclusion makes sense when you consider the totality of evidence in Elvis’ death. Setting aside media reports of gross negligence, arm-chair speculation of cover-up and fan accusations the King was murdered, there’s a simple and straightforward conclusion based on facts. But before examining the facts and knowing hindsight is 20/20, let’s first look at how coroners conduct sudden and unexplained death investigations.

Coroners are the judges of death. Their responsibilities include establishing five main facts surrounding a death. Coroners do not assign blame or fault. In the Presley case, the five facts determined at the immediate time were:

  1. Identity of Deceased — Elvis Aaron Presley
  2. Time of Death — Approximately 2:00 p.m. on Tuesday, August 16, 1977
  3. Place of Death — 3754 Elvis Presley Boulevard, Memphis, Tennessee
  4. Cause of Death — Heart attack
  5. Means of Death — Chronic heart disease

There’s a distinct difference between Cause of Death and Means of Death. Cause is the actual event. Means is the method in which death happened. Example: cause being a ruptured aorta with means being a motor vehicle crash, or cause being massive cerebral interruption with means being a gunshot wound to the head.

Once the facts are known, it’s the coroner’s duty to classify the Manner of Death. There are five universal manner of death classifications:

  1. Natural
  2. Homicide
  3. Suicide
  4. Accidental
  5. Undetermined

Elvis Presley’s death was ruled a natural event, thought at the time being an acute cardiac event from existing cardiovascular disease. If the coroner determined Elvis died from a drug overdose, the ruling would have been accidental. No one ever claimed it was suicide or homicide.

One principle of death investigation is to look for antecedent evidence—preexisting conditions which contributed to the death mechanism or was responsible for causing or continuing a chain of events that led to the death.

Another principle of death investigation is examining the cornerstone triangle of Scene—Body—History. This compiles the totality of evidence or case facts. Given that, let’s look at the evidence and case facts in Elvis Presley’s death.

Scene

Elvis was found on his bathroom floor, face down in front of the toilet. It was apparent he’d instantly collapsed from a sitting position and there was no sign of a distress struggle or attempt to summon help. When the paramedics arrived, Elvis was cold, blue, and had no vital signs. Rigor mortis had not set in, so he’d probably expired within the hour. He was transported by ambulance to Baptist Memorial Hospital where a vain attempt at resuscitation occurred because “he was Elvis”.

ER doctors declared Elvis dead at 3:16 p.m. He was then moved to the morgue where an autopsy was promptly performed. There was no suggestion of suicide or foul play, so there wasn’t a police investigation. The scene wasn’t photographed, nor preserved, and there was no accounting for what medications or other drugs might have been present at Graceland. There’s no official record of the coroner attending the scene as this was considered an in-hospital death and a routine occurrence.

Body

Elvis was in terrible health. His weight estimated at 350 pounds—gaining 50 lbs. in the last few months of his life. He was virtually non-functional at the end, being mostly bed-ridden and requiring permanent nursing care. Elvis suffered from an enlarged heart which was twice the size of normal and showed advanced evidence of cardiovascular disease in his coronary vessels, aorta, and cerebral arteries—certainly more advanced than a normal 42-year-old would be. His lungs showed signs of emphysema, although he’d never smoked, and his bowel was twice the length of normal, with a partially-impacted stool estimated to be four months old.

Elvis also suffered from hypogammaglobinemia, which is an immune disorder, as well as showed evidence of an autoimmune inflammatory disorder.

Toxicology tested positive for ten separate prescription medications but showed negative for illicit drugs and alcohol. The only alarming pharmaceutical indicator, on its own, was codeine at ten times the prescribed manner but still not in lethal range.

This is a quote from Elvis’s toxicology report:

“Diazepam, methaqualone, phenobarbital, ethchlorvynol, and ethinamate are below or within their respective ranges. Codeine was present at a level approximately 10 times those concentrations found therapeutically. In view of the polypharmacy aspects, this case must be looked at in terms of the cumulative pharmacological effect of the drugs identified by the report.”

History

Elvis was born on January 8, 1935 in Tupelo, Mississippi and had a twin brother who died at birth. As a youth, Elvis was active and healthy which continued during his time in the U.S. military and all through his early performing stage when he was a bundle of energy. He began experimenting with amphetamines, probably to enhance his performances, but shied away from alcohol as it gave him violent tendencies.

In 1967, Elvis came under the primary care of Dr. George Nichopoulos who was well-known to celebrities. Then, Elvis was 32 years old and weighed 163 pounds. His only known medical ailment was slight high blood pressure, presumably due to his high-fat diet.

Also in 1967, Elvis’s health took a sudden turn with progressive pain, insomnia, hypertension, lethargy, irrational behavior and immense weigh gain. Over his remaining years, Elvis was seen by a number of different doctors and was hospitalized a number of times, all the while resorting to self-medication with a wide assortment of drugs from dozens of sources.

Doctor Nick, as Nichopoulos was called, stayed as Elvis’s personal physician till the end. He was present at the death scene as well as during the autopsy. Doctor Nick concurred with the coroner’s immediate conclusion that the cause of death was a natural cardiac event resulting from an arrhythmia, or sudden interruption of heartbeat, and agreed that Elvis’s death was not due to a drug overdose.

When the toxicology report was released, it came with a qualifier:

“The position of Elvis Presley’s body was such that he was about to sit down on the commode when the seizure occurred. He pitched forward onto the carpet, his rear in the air, and was dead by the time he hit the floor. If it had been a drug overdose, [Elvis Presley] would have slipped into an increasing state of slumber. He would have pulled up his pajama bottoms and crawled to the door to seek help. It takes hours to die from drugs.”

Because the tox report appeared to contradict the autopsy report’s stated cardiac cause of death, a prominent toxicologist was asked to review the findings. His opinion was:

Coupled with this toxicological data are the pathological findings and the reported history that the deceased had been mobile and functional within 8 hours prior to death. Together, all this information points to a conclusion that, whatever tolerance the deceased may have acquired to the many drugs found in his system, the strong probability is that these drugs were the major contribution to his demise.”

The Tennessee Board of Health then investigated Elvis’s death, which resulted in proceedings against Doctor Nick.

Evidence showed that during the seven and a half months preceding Elvis’s death—from January 1, 1977, to August 16, 1977—Doctor Nick wrote prescriptions for Elvis for at least 8,805 pills, tablets, vials, and injectables. Going back to January 1975, the count was 19,012.

These numbers might defy belief, but they came from an experienced team of investigators who visited 153 pharmacies and spent 1,090 hours going through 6,570,175 prescriptions and then, with the aid of two secretaries, spent another 1,120 hours organizing the evidence.

The drugs included uppers, downers, and powerful painkillers such as Dilaudid, Quaalude, Percodan, Demerol and Cocaine Hydrochloride in quantities more appropriate for those terminally ill with cancer.

Doctor Nick admitted to this. His defense was because Elvis was so wired on pain killers, he prescribed these medications to keep Elvis away from dangerous street drugs, thereby controlling Elvis’s addiction—addiction being a disease.

One of the defense witnesses, Dr. Forest Torrent, a prominent California physician and a pioneer in the use of opiates in pain treatment, explained how the effects of this level of codeine would have contributed to Elvis’s death.

Central to misconduct allegations was the issue of high codeine levels in Elvis at the time of death—codeine being the prime toxicological suspect as the pharmaceutical contributor. It was established that Elvis obtained codeine pills from a dentist the day before his death and Doctor Nick had no knowledge of it.

The jury bought it and absolved Doctor Nick of negligence in directly causing Elvis Presley’s fatal event.

Continuing Investigation

Dr. Torrent was convinced there were other contributing factors leading to Elvis’s death. In preparation for Doctor Nick’s trial, Dr. Torrent had access to all of Elvis Presley’s medical records, including the autopsy and toxicology reports. Incidentally, these two reports are now the property of the Presley estate and are sealed from public view until 2027, fifty years after Elvis’s death.

Dr. Torrent was intrigued by the sudden physiological and psychological changes in Elvis starting in 1967. He discovered that while in Los Angeles filming the movie Clambake, Elvis tripped over an electrical cord, fell, and cracked his head on the edge of a porcelain bathtub. Elvis was knocked unconscious and had to be hospitalized. Dr. Torrent found three other incidents where Elvis suffered head blows, and he suspected Elvis suffered from what’s now known as Traumatic Brain Injury—TBI—and that’s what caused progressive ailments leading to his death.

Dr. Torrent released a paper entitled Elvis Presley: Head Trauma, Autoimmunity, Pain, and Early Death. It’s a fascinating read—recently published in the credible medical journal Practical Pain Management.

Dr. Torrent builds a theory that Elvis’s bathtub head injury was so severe it jarred brain tissue loose, which leaked into his overall blood circulation. Later additional head injuries exacerbated the problem. This is now known to be a leading cause of autoimmune disorder, which causes a breakdown of other organs. This progression was unknown in 1967 and Elvis went untreated. Side effects of TBIs include chronic pain, irrational behavior, and severe bodily changes such as obesity and enlarged organs like hearts and bowels.

Today, TBI is a recognized health issue in professional contact sports as well as incidental to motor vehicle accidents and workplace falls or other head injury events.

Dr. Torrent’s hypothesis holds that with a change in mental state and suffering chronic pain, Elvis Presley entered a ten year spiral towards death. He became hopelessly addicted to pain killers, practiced a terribly unhealthy diet and lethargic lifestyle, and resorted to the typical addict’s habit of sneaking a fix wherever he could. This led to early coronary vascular disease and, combined with his escalating weight and pill consumption, Elvis was a heart attack ready to burst.

Note that I used the term “antecedent,” like all coroners do when assessing a cause of death. Given Dr. Torrent’s observations—and all the facts compiled from forty years—if I were the coroner completing Elvis Presley’s death certificate today, I’d write it like this:

  1. Identity of Deceased — Elvis Aaron Presley.
  2. Time of Death — Approximately 2:00 p.m. on Tuesday, August 16th, 1977.
  3. Place of Death — 3754 Elvis Presley Boulevard, Memphis, Tennessee.
  4. Cause of Death — Cardiac arrhythmia, antecedent to hypertensive cardiovascular disease with atherosclerotic heart disease, antecedent to poly-pharmacy, antecedent to autoimmune inflammatory disorder, antecedent to traumatic brain injury/injuries.
  5. Means of Death — Cumulative head trauma.

Therefore, I’d have to classify Elvis’s death as an accident.

There’s no one to blame—certainly not Elvis. He was a severely injured and sick man. There’s no specific negligence on anyone’s part and definitely no cover-up or conspiracy of a criminal act.

If Dr. Forrest Torrent is right, there simply wasn’t a proper understanding back then to clearly determine what really killed the King of Rock ‘n Roll.

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Garry Rodgers now works as an investigative crime writer with a number of publications to his credit.

 

In The Attic is based on a true double homicide he investigated involving a psychopathic ax-murderer. Garry also hosts a popular blog at DyingWords.net.

 

Note from Sue: I read IN THE ATTIC in August of 2016, and I doubt the story will ever leave me. It’s just one of those books that I’ll never forget. Visceral, raw, emotional, and true!

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