Forensic Pathologists React to "Psych"

• Forensic Pathologists React to Body of Proof Podcast Episode
• Forensic Pathology Committee

Lisa Tomcko:

Welcome to the latest edition of the College of American Pathologists CAP Cast. I'm Lisa Tomcko, content specialist with the CAP. In this episode, I'm joined by three members of the CAP's Forensic Pathology Committee, Dr. Aurelius, Dr. Grandhi, and Dr. Tart. This is the second in a series of episodes where pathologists react to how forensic scientists and autopsy professionals are portrayed in TV and film. But before we get into the questions, I'd like to invite our panelists to introduce themselves. Dr. Aurelius, would you like to start us off?

Dr. Michelle Aurelius:

Sure. I'm Dr. Michelle Aurelius. I'm the Chief Medical Examiner in North Carolina. I should probably tell you how long I've been practicing, but it's a long time. So I've been a forensic pathologist for over 15 years. It's a fantastic, invigorating and amazing field, and I'm looking forward to chatting with my colleagues about the show.

Lisa Tomcko:

Great. We're happy to have you here. Dr. Grandhi, would you like to go next?

Dr. Natasha Grandhi:

Sure. My name is Natasha Grande. I'm currently an Associate Medical Examiner with the Georgia Bureau of Investigations. I've been here about eight years in a joint coroner and medical examiner system, and I also serve as the assistant program director for our forensic pathology fellowship training program. I'm happy to be back.

Lisa Tomcko:

Thanks for joining us again. I know you and Dr. Aurelius are our veteran panelists from our first episode. So a big thank you to both of you for coming back. And finally, Dr. Tart, our newest panelist. Can you tell us a bit about yourself?

Dr. Anna Tart:

Sure. My name is Dr. Anna Tart. I am a Deputy Medical Examiner in Western Michigan. I am fairly new to forensic pathology. I finished my fellowship almost exactly one year to the day ago, and so I've been practicing for just under a year.

Lisa Tomcko:

Well, congratulations. Happy to have you here. For the second installment in our forensic podcast series, we watch an episode of the TV show Psych called Autopsy Turvy. Got a fun little pun name there, and that's season six, episode 14 of the show. Psych is a detective comedy/drama that ran for eight seasons on the USA Network starting in 2006. And due to the nature of the show, it being a comedy, we know they are playing up some things for laughs. They're not taking themselves too seriously, so we'll kind of keep that in mind while reviewing. But I am of course, I'm really interested in hearing all of your takes on it.

So let's do some scene setting, for this episode of Psych. Woody, the police coroner has performed an autopsy and determined it to be an accidental death. The cause being the person was hit by a bus. However, the funeral mortician purports to have discovered a missing earlobe that appears to have been sliced off intentionally and she raises the possibility of murder. She's then brought on by the police chief to help Woody do another autopsy while the Psych detectives investigate the case. Let's start with that basic premise if we could, how realistic or likely would this have been to be missed in an initial coroner autopsy? And since we know this is kind of a red herring, it was probably added after the fact, would that be something that could be gotten away with?

Dr. Natasha Grandhi:

I guess I'll start. So in a complex trauma case like a car accident case, there's typically quite a few injuries that can be observed. The significance of any one injury is kind of dependent on the circumstances for each accident. The absence of an earlobe, I think it is very, very specific. The fact that they can say that it's specifically sliced off with intent, I think is definitely taking a little bit of liberty with the circumstances there. I do think that because of the comedic nature of the show and the ultimate premise of this episode, there may have been something that clued in a pathologist to the fact that it was done later. But I think that for something as small as a laceration on the ear to have been overlooked for the significance in a complex car accident, specifically, I believe it was a bus, I would not really be surprised if that was just kind of lumped into a constellation of findings in the head.

I mean, a lot of things that we do come with investigative information for the context, and so without that information, it's really hard for us to put any amount of significance onto one specific finding, and we really do work closely with whoever the investigative division may be to get that information. We try to focus on everything that we see, but I would say that it's not so much a miss as possibly, there's just a whole lot going on there and the significance of it was not appropriately conveyed at the time. And one thing that I will say is good is that ultimately, the coroner was open to being challenged and having a second look at that and with another individual. So we realize that errors can happen, things can be overlooked, and those situations, circumstances can change. And so we're willing to revisit things. We are not saying anything is 100% set in stone. We are reasonable with how we approach cases.

Dr. Michelle Aurelius:

And Dr. Grandhi makes a lot of really good and important points. The first, just dovetailing on what she said already is this grace mortician comes in as like, "Oh yeah, the ear lobe sliced off with a box cutter." That seems like ridiculously specific on top of everything else, and we'll likely discuss it more, but having the qualifications to determine whether it's a sharp force injury or a crush injury from something like a bus, is certainly an area for a forensic pathologist and not for a mortician.

And taking a look just to have Dr. Woody's back for just a moment, although I will dis him a little bit later, I promise, when we looked at the decedent who seemed to be laying there for somewhere between 12 to 24 hours while they chatted around him, he did not seem to have significant injury. So Dr. Grandhi's completely correct in that we would expect a person versus bus to have significant injuries and there to be descriptions related to describing those maybe in a generalized fashion, but this person looked ridiculously pristine and if an ear lobe is missing, a forensic pathologist is going to notice.

Lisa Tomcko:

Definitely. I think I was for sure questioning the state of the body a bit when we did see it, and we'll perhaps talk more about that, but just to dig into the characters a bit more, especially the ones pertaining to the autopsy that we see performed. The Woody character in Psych is known as Woody the coroner, so he is the police coroner. Can we talk a little bit about how accurate or not, that title seems to be for his role on the show, what we see him undertake, his responsibilities and then the training that they reference and maybe just I guess the difference between coroners and medical examiners?

Dr. Natasha Grandhi:

I just have to make a quick comment that I absolutely love that we all just went to forensic school. If I could cut down my entire training into forensic school, my goodness, I would've been much younger when I started, which I think maybe I would've had more energy and it would've been very entertaining.

Dr. Anna Tart:

I cringed and grinned at the same time when I heard forensic school, if only. So as a medical examiner or a forensic pathologist, more specifically, we go to medical school, typically it's four years, and then we do our pathology residency, which depending on the track opted into, is three to four years. And then after that, an additional year of forensic pathology as a fellowship, before we can officially become forensic pathologists. That qualifies us to assist in medical-legal, death investigations by performing autopsies, giving expert testimony.

And I mean that's really the crux of our job is determining cause and manner of death. As far as coroners go, at least in the jurisdictions that I've worked, typically they are elected officials in which they may or may not need specific credentials. I know specifically in Arkansas, the qualifications for coroner are 18 and elected, which means no felonies. And so there are different states that have different regulations, but typically it will be a forensic pathologist who will be performing these autopsies and making those determinations as opposed to a coroner or a mortician or any other title that someone may have.

Lisa Tomcko:

Thank you for setting the scene for us in terms of some of the training and credentials involved. And just to clarify for our listeners, it is kind passed off as Woody and the mortician character that come on have some history and it's that they knew each other from, "Forensic school," and that is kind of a very loose term for whatever training they've had. It's not really clear, so thanks for delineating that for us. Dr. Tart and Dr. Aurelius, is there anything you wanted to add in addition?

Dr. Michelle Aurelius:

So I think their school sounds like lots of fun, and if you would've told me a long time ago, "You can go to forensic school," I might have actually considered it. So it is kind of interesting and clearly they had a lot of drama and action going on in their forensic school in terms of the dating perspective. But we do partner with morticians and funeral directors. We do work closely with them. If there are particular cases that they're concerned about, that perhaps were not reported to the medical examiner or coroner system initially, and a decedent or a patient comes to them, they may encounter something and they do have a statutory in most of our state's requirement to report it to the coroner or to the medical examiner system. So we do see them as partners, but we have very different training.

So to become a mortician, it's dependent just like a medical examiner or coroner, depends what state you're working in, but oftentimes, they'll at least have an associate's degree in mortuary sciences or something similar. Here in North Carolina, you also have to undergo an apprenticeship. So there's additional kind of hands-on training. And then again, here in North Carolina there's a requirement for certification. But there are other degrees. You can have bachelor's degrees and also onsite work experience, but it is not the same as going for a pre-medical science degree. Those are different pathways.

Lisa Tomcko:

Yes. I think even as a layperson viewer, that seemed a little interesting. I will say first to find out that Woody was not technically a medical examiner or a forensic pathologist based on what his role seemed to be, but then also that the Grace character is a mortician. Just to get into that a bit more, she is brought on by the police chief to assist Woody when it seems like he's maybe missed this crucial detail and it's on the basis that she has current credentials, I guess, to do autopsy. Do we want to talk about that at all?

Dr. Michelle Aurelius:

So I will kick it off here. In terms of degrees in mortuary science, clearly they are to support families and choices that the families want to make with final disposition. That does not relate to performing an autopsy examination. That does not relate to having a medical doctorate degree and enough training as similar to a cardiothoracic surgeon, that is not the same. That again doesn't mean we don't partner with them and work with them regarding grieving families and final disposition that families choose to have for their loved ones, but it is not an appropriate qualification to be able to assess the work of a forensic pathologist.

I'm just assuming Dr. Woody is a forensic pathologist because in my heart I would like him to be so, even though he does have some strange degree, I'd like to think he got that in parallel with his undergrad, perhaps general chemistry degree or something else. But she is not qualified. She should not be in the autopsy suite and she should not be in the autopsy suite with her purse and food. I'll stop there.

Dr. Natasha Grandhi:

Yeah, I don't think there's anything less appetizing in terms of sight, sounds, smells, than in autopsy suite for... Yeah, it's just not a sanitary environment and there are some strong scents that you will encounter in there. Food is just not welcome, should not be encouraged. There's a lot of biohazard stuff in there.

Lisa Tomcko:

We're of course referring to a little bit later when we seem to be in the autopsy suite of what I'm guessing is the police station and there is a scene that's kind of an almost romantic date type situation with strawberries and creme fresh, I want to say, happening on the table. So yeah, I don't know if we would jump in that a bit-

Dr. Natasha Grandhi:

You're not into the date night over a decedent, that doesn't really interest you? Yeah, it's playing up that comedy side of it I think in really playing up the tension that they had there, but they had some liberties that they used.

Dr. Michelle Aurelius:

I could not stop watching his tie, every time he leaned forward. We're not in there autopsy wise in white lab coats just with a pair of gloves. We're definitely dressed for defense against biohazard, so that's infectious diseases like HIV, hepatitis, Covid, all sorts of things. And the idea of leaning forward, wearing a tie, having that tie end up in the examination table and space to me was mentally traumatizing. And then when Mortician Grace came in first, she had her hands propped... Again, personally, I just can't be distracted from that, her hands directly on the autopsy table without gloves on. So it was mentally pretty challenging. And I know for us, we wear enough personal protective equipment, we look like we're walking on the moon, so making some kind of romantic overture when you're wearing a papper, which is essentially like a see-through trash can on top of your head, is really not where you're feeling the mood. But as mentioned, this is a quirky comedy, lots of fun, but totally ridiculous.

Dr. Anna Tart:

On a final note of the attire that was worn is the fact that yes, there was so little personal protective wear, and yet he was still wearing loops, which are those the little microscopes on the glasses. And I know that I'm new, but I have never once worn loops. The only people I've really seen wear them are vascular surgeons and plastic surgeons. And so it was quite the dichotomy to see a business attire and purses and strawberries and loops in the autopsy suite.

Dr. Michelle Aurelius:

And who turns their decedent or their patient into a conference table. It just seemed like, "Oh, we're going to talk about the situation and we're going to do it here with a decedent in front of us. Let's all gather round." That doesn't happen. Although we may collaborate with the team we're working it with to perform the examination, because it's typically not just a forensic pathologist in a room, you have an autopsy technician, you may have someone helping you with radiographs or doing those x-rays. Another person, a photographer, a forensic photographer taking photos for you, so you are working together to take care of a decedent. You're not gathering around them for a coffee break or strawberries and whipped cream.

Lisa Tomcko:

Thank you. Calling all of that out, it did seem like there were a lot of people in the room at certain points, but just to get back to this, again, I think police station autopsy suite a little bit more generally. Apart from some of these liberties being taken, did it seem somewhat realistic or were there any first impressions in that way?

Dr. Natasha Grandhi:

I think compared to some other depictions of the autopsy suite, this one was actually relatively sparse, which is sadly the most accurate just because it didn't have all the fancy frills of the microscope in the room. The immediate lab testing that can be done right there, fancy cameras, this was pretty bare bones of the table. At one point, he even walks, actually I think it's at the strawberries and cream time. He has a bowl that looks like it's literally from the scale that would be used to weigh organs and he is just kind of mucking around in there. They have just forceps that they're using with a ladle when they're going through the stomach contents, which I mean, it is kind of unfortunate, but a ladle is kind of a standard thing that we have in at least our autopsy suite to try and remove fluids from certain cavities.

So while that may have seemed like it was a little strange, it's actually about on par with the tools that we do have. They didn't have anything overly fancy that they showed, which I liked. They definitely did need more PPE, as everybody was saying, I don't think there was a single mask used at all, whether it was by the people performing the dissection or anybody that was chatting at the table side. So there were some absences and I don't think they took photos at any point either. So it was probably one of the most sparse autopsy suites I've seen.

Dr. Michelle Aurelius:

And maybe I'm a little bit into functionality, but I like when there's more space around the table so you can move your patient gurneys, so it didn't seem super functional. And then on top of it, when you're looking where the decedent storage is, refrigerated storage, it's hard to open that and pull a tray out if it's going to actually hit your autopsy table. So I always look for the holes of these things. But I do agree that compared to many of the other things that we've seen, it seemed really accurate. They even had a scale in there, woo-hoo, I mean that's important. Some, not all autopsy facilities will do plain films like where you put them up on the light board. Nowadays, many of us have digital photos for radiographs, so you just pull up the image on your system, but it really wasn't too bad, other than the whole food, tie, personal protective equipment, aka, PPE and lack thereof.

Lisa Tomcko:

Sounds like at least maybe the props department was kind of getting it right. And Dr. Grandhi, I think you referenced, they do of the actual autopsy work that we see them do, they reference the stomach being the place to start and then they are doing that examination of the stomach contents. How accurate was that, I guess, both that statement and then what they're showing us of that examination?

Dr. Natasha Grandhi:

So I don't know that I would ever start with the stomach unless there is an overt, I guess gastrointestinal bleed maybe is where I would start looking at it. But I mean to get to the stomach, you have to see some other organs. So whether or not you are starting with it once all of the organs have been removed, it's highly unlikely that that's going to be the first spot you go to, when you're doing an exam and expecting it to be the most informative. We do actually look at the gastric content, so they did get that right. We will collect them, we'll measure them, we'll describe what we see. I know everybody always says you'll see corn. Well, that's unfortunately true, but you'll also see a few other things as well. I don't know that I can say it was sweet potato casserole or sweet potato pie, whatever they had.

But there are things that you can identify within the gastric content sometimes. Really what we're trying to look for are pills or pill fragments or any foreign objects, things that you wouldn't expect a person to be eating just because those are outside of the norm. The food within the stomach can digest at varying speeds based on many different factors. So it's a little difficult to give a precise time of death. And I don't believe that was one thing they did here. I think they just looked at the waffles and the sweet potato casserole and the collard greens. So we do get a little descriptive, but I'm not going to be giving you a recipe for what they ate based on their gastric contents.

Dr. Michelle Aurelius:

I was kind of impressed. They're like, "Potatoes with sugar." I mean, how are you going to know sugars in there? I hope you're not tasting it. That's really disgusting. But that seemed extremely particular. But yes, we make general observations about what is within the stomach contents. I was a little alarmed that the waffles and perhaps the syrup looked pretty darn like it wasn't digested at all. And we're human beings, I think we can say vomit on the show, but for those who are not forensic pathologists, and when you think about the consistency of vomit, there is some degradation or breakdown of food fairly soon after it hits your stomach, so it's not going to be clearly obvious in many of the cases.

Dr. Anna Tart:

And one last little part, I mean as it was stated, you have to take all of these organs out. During an autopsy procedure, there is a very specific cutting technique that is used. We open the chest cavity and the abdominal cavity in a way in which if someone chooses to have an open casket funeral, they may. So everything is covered over by clothing. We remove the ribs, the anterior ribs, the heart, the lungs, and so all of this has to be taken out first. And so to say, "Oh, I'm just going to cut the abdomen and go straight for the stomach," is a little bit farfetched, and quite frankly, I won't say impossible, but would be more difficult than it would be worth.

Dr. Michelle Aurelius:

I will say it, ridiculous. It's ridiculous. Not going to happen. Weird.

Lisa Tomcko:

And on staying on the note of what they're examining, they do get tipped off by findings under the nail bed I think, which they were able to identify as paint. And then later they're looking for a syringe injection site, I believe in a fingertip, which they do. I believe they're successful in locating. I just wanted to get your thoughts on how realistic those bits were.

Dr. Michelle Aurelius:

So we do examine every surface of our patients, every surface of the body. We look behind ears, we will look between toes, and we do look for any abnormalities. There are many of our cases where we may see chronic or acute injection sites, but it sort of depends on what type of or the size of the needle that is used and if it fits with the kind of natural folds in the skin or not. But I certainly have detected and located injection sites, even those on the top of the foot. Between the toes themselves, we do look between the toes, but that might be a little more challenging to find. So there's no question that we look at every single surface of the body and that we do in many cases, find needle puncture marks

Dr. Natasha Grandhi:

For the fingernails, we do in certain cases collect the fingernails, but we aren't doing the directed testing for anything that is found. We're basically people that collect all the evidence and then refer to any reports that are completed. But we're not trained to do things like actually do the GCMS of the full toxicology panel. We're not trained to look under the microscope and compare different types of hair beyond what we may need to know in general for an exam. That is too specialized, so we would just sit and collect either nail scrapings, nail clippings, items of that nature, and then send them for appropriate testing.

Dr. Michelle Aurelius:

I'm sorry, you're saying you can't look at stuff, gunk from under people's fingernails and immediately identify calcium carbonate, titanium oxide and pigment elements that can be seen in acrylic paints?

Dr. Natasha Grandhi:

I'm so far-

Dr. Michelle Aurelius:

I can't either.

Dr. Natasha Grandhi:

They may need to revoke my certification.

Dr. Michelle Aurelius:

I'll be right there with you.

Lisa Tomcko:

And just to circle back a bit, I did want to talk about the parameters in which autopsy professionals, forensic pathologists or medical examiners, coroners in this case, would have to work under, in cases where there is possibility of homicide. There's a reference to Woody having already lost them 40 hours of lead time in this case, I'm assuming that's the time he spent doing the initial autopsy or for the body to come in, the autopsy to take place and that he is saying later that he'll work late. So just a general question about how much are forensic pathologists or other autopsy professionals kind of on call in these sort of high stakes cases?

Dr. Anna Tart:

Yeah, I can at least start off on that one. So we have investigators, sometimes it's a coroner, sometimes it's someone who's certified in death investigations. They might be in another medical profession like nursing, EMS or they could just be certified, but they're on call essentially 24/7. We have enough investigators or coroners to be able to go to a scene and they might interview law enforcement, they may talk to family members who are nearby and try to understand some of the circumstances of the death. They take a lot of photographs. We'll document anything that could give the forensic pathologist information about the death, the circumstances, injuries, patterns, anything like that, to start collecting all of that information.

As far as any office that I've worked at, I have yet to have any one of my colleagues or myself be called in to perform an autopsy as soon as a body arrived. As soon as the decedent arrives, there can be some time in between. So typically my day will start somewhere between 7 and 8:00 AM, reviewing cases on my own as well as with other pathologists and our autopsy technicians, to go over the plan for the day, and then we'll typically start the actual autopsy procedure shortly after that. And so if a decedent comes in around 3:00 PM, then sure, there might be maybe 18 hours or so in between when the decedent arrives at the facility and when their autopsy procedure starts. Again, that's been everywhere that I have been, so I've never been called in to do a midnight autopsy. I'm not saying that it can't happen, but even in high stakes, typically this is not something that these extra few hours are going to make or break a case.

Dr. Michelle Aurelius:

And as Dr. Tart is mentioning, it's during regular business hours typically, although many of us do work holidays and weekends and perform examinations on those days, you want to make sure that you have the best team with you. 3 o'clock in the morning doing an autopsy examination, it means that you're going to have a forensic pathologist physician who's too tired. You're bringing in an autopsy technician who's not on the top of their game, a forensic photographer, et cetera. You want the best team, professional team, well rested and ready to take care of that patient. And when you have access to radiology, so taking x-rays and team members who are there to take care of a decedent, it is not best practice to do an autopsy examination at 2 o'clock in the morning and our patients are deceased. They can wait until we have mobilized the professional team that they need to afford the best analysis.

So on a personal note, that makes your personal life that much better. So again, even though I have similar training in terms of years as a cardiothoracic surgeon, I'm not popping in and doing exams for 40 hours at 3 o'clock in the morning. And let's just say an autopsy that takes 40 hours, better be wickedly interesting and well beyond what this case is described as. And do you have the chance to take most of your call is typically taken from home, so you have an opportunity to provide support for your death investigators or your medical examiner or coroner system from home, because there isn't the level of urgency when we have a patient whose life we're trying to save. That doesn't mean that we're not focused on doing the most high quality, surgical type professional examinations, but we can do that when we have our professional team there with us during the day.

Dr. Natasha Grandhi:

And I think that the only time it's extremely rare where an autopsy has been rushed is really to more commonly benefit the family and respect the decedent's own personal values and personal wishes. So things would be religious accommodations. There are certain restrictions that we have to be mindful of where there is a time clock. And that's the only time where I can think of where I've actually had to come in after completing work for a day. And that was mainly just because something wasn't correctly communicated to us and we still wanted to do best by that person. And so we came in.

But it's extremely rare, and I pretty much agree with everything else. You can do stuff during normal business hours. You need everybody fresh and ready to go when they're doing these very complex and meaningful examinations, they impact more than just the decedent. Their families, especially as you had initially asked regarding homicides, you don't know who may be impacted by whatever you find at the autopsy. You don't want to be tired and sloppy and misinformed law enforcement on what you find and have the wrong person taken into custody, that's impacting more people than need to be affected. So it really is important to be fully aware of what you're doing and rested and present.

Dr. Anna Tart:

And much of what we collect at autopsy for toxicology, for DNA analysis, for testing under the fingernails, whatever it is that we're collecting, that analysis will not be completed immediately either. So the actual procedure of an autopsy is really one of the shortest in duration, procedures that is done. And so again, this whole idea of we don't have answers in 40 hours that we've lost, well, it isn't just the autopsy that's taken 40 hours.

Lisa Tomcko:

So it seems like they're playing up some of this rush, rush aspect, perhaps, for dramatic purposes on the show. And if the possibility of homicide arises after an initial autopsy is performed, would that second autopsy be performed by the same team? I mean they bring on an additional person here. We can question her credentials certainly, but just wondering about that.

Dr. Michelle Aurelius:

I can certainly give a perspective as it relates to how things are done here at my office. And they can be done different ways in different offices. So here, we would encourage the forensic pathologist who performs the initial examination to work with that evolving information because that's what it is. There is evolving information. You don't show up and have every single piece of information by the time you pick up your scalpel, to do your surgical type Y incision on your decedent, the information is constantly evolving. And as a forensic pathologist and those in medical-legal death investigation, we are prepared for that and we are prepared for people to perhaps even confess. And that can happen hours, days later, then your examination has occurred and to go back and to reassess and have the opportunity to do that.

But typically in situations, especially those of us like myself who work in large offices, we partner with other forensic pathologists, we work together, we have morning report or morning rounds just like you see on Grey's Anatomy or whatever the latest medical show is and we talk about each of our patients together. We strategize together, we make sure that we're complimenting each other in terms of approaches. And we also do that once the cases are wrapped up so that we can work together and make sure that we have the best approach and the best assessment for each case.

I thought it was really interesting that I think Dr. Woody said in the beginning, "I don't make mistakes." That's not the point. The point is that as a forensic pathologist, your opinions can be challenged and maybe they should be. And there's also the point that information evolves and that means that the forensic pathologist can take a step back and absorb and take in that additional information and alter their opinion, to a better understanding since that information wasn't available, Here Dr. Woody, the earlobe was not cut off when he examined his patient. So it was not, there is nothing that he missed. Certainly there were other aspects that came up historically that would lead to taking a closer look at the circumstances of the death, et cetera. And that was based on the information, not from an inadequate autopsy examination.

Dr. Anna Tart:

I mean, just two quick things hopefully. One is if we had documentary photos at the time of autopsy, we can see whether or not that earlobe was really cut off at the time. And so just kind of circling back to the fact that there were no photos being taken. But also we're physicians, forensic pathologists are physicians, and much like any other, I'll say commonly thought of physician, family practice or internal medicine, we go based on signs and symptoms, essentially, to make a diagnosis and render a medical opinion. And so just like if someone goes to their family physician and gives a list of symptoms and the family physician makes a diagnosis, but then another symptom or another sign presents itself, they can alter their diagnosis based on new information and better information just like we can. And so we do the same thing.

We look at what's presenting itself at the time of examination, we render an opinion. And I mean if we've gathered a lot of information at that time, then the more likely it is to be accurate. And even when new information comes in, it only supports our original diagnosis. But if we don't have all of that information or if new or unexpected information comes in, then yes, it's very important to take that into consideration and to evolve in a way that makes sense. And it is somewhat on us to be able to explain that, to be able to say, "Here were the facts as they were presented to me at the time. Here is this new information and therefore my essentially scientific theory is now this new working diagnosis."

Lisa Tomcko:

That's interesting. So it seems like we're maybe lacking some of those forensic photos that would've backed Woody perhaps. But while he is at least somewhat open to being challenged and having a second opinion being brought in, his statement about not making mistakes, this may be the right outlook it seems like. And then is there any actual tension between forensic pathologists or medical examiners, coroners and then morticians?

Dr. Michelle Aurelius:

So people are people, that means that some people get along and some people don't. But we view our funeral directors and morticians and those who work in the funeral industry as our partners, that we're working together to take care of families to help answer questions. Although our roles are completely different. For example, you do not want me to embalm anyone, that is not my area of expertise nor my area of qualification, and a mortician's job and responsibilities and trainings have nothing to do with performing an autopsy examination. Know that we do work very closely together to ensure families have the support that they need and the questions answered. So can I briefly talk about two of my favorite quotes?

Lisa Tomcko:

Please.

Dr. Michelle Aurelius:

Okay. So it has nothing to do with forensic pathology, which is why we are not here. But kind of being the kind of person who has the diet of a 10-year-old boy, if I'm left at my own choices, one of my favorite quotes was, "Fruit and dry fruit are not snacks." So I really liked that one and kind of liked the joking nature of it. But the other quotes-

Lisa Tomcko:

I laughed to that too.

Dr. Michelle Aurelius:

I know, wasn't that great?

Lisa Tomcko:

I have to agree.

Dr. Michelle Aurelius:

Fruits and vegetables, no, that's not dessert, that's not snacks. But perhaps that says more about my own personal health than I should admit. But the other one that I really liked was the conversation between Mortician Grace and Dr. Woody where one said, "I love this job." And the other one said, "You know, I do too." And that's the truth. Like this type of television show, we have the opportunity to put the pieces of the puzzle together to try to figure out how and why someone died. And that can mean something different in a multitude of different situations. I know most people think about us as it relates to cases like this one, there are homicides or a murder or something nefarious happens. And yes, we are there to answer those questions, but we're also there to find diagnoses in relatively young children that have never been diagnosed before, so that families have answers and closure.

We're here to tell the stories of perhaps that 33-year-old father of four, who's running around the track and collapses and dies suddenly, and we're able to diagnose them with that acute myocardial infarction and atherosclerosis, a lot of fancy words, for a heart attack, so that, that widow who is left behind can tell her children and the other biological first degree relatives, can be warned that they need to work with their physician to help mitigate the potential for death. So our patients have stories to tell, and it is our jobs as forensic pathologists to tell those stories, so that they can ultimately save lives.

Lisa Tomcko:

Beautifully said. Thank you, Dr. Aurelius. And final question for you all, just kind of a fun one. If we could share overall ratings for the show, maybe from an entertainment, enjoyment perspective and kind of a separate one for perhaps accuracy or realisticness.

Dr. Natasha Grandhi:

Okay, I can start. So I actually used to watch Psych just because it was a good lighthearted show, that was great for the background while I was studying. So for entertainment purposes, I thought it was about an eight. For the realism of actual autopsy representation, I would give it a two, maybe. It really missed the mark quite a bit, but because the show was so lighthearted and funny and it was really playing up on a lot of the tropes that you typically see, I can forgive some of that.

And one of the quotes towards the end was, "Got to keep it light guys." We deal with heavy topics. And so one of the coping mechanisms that's used by a lot of individuals is humor. And we really do find joy in our job, but we will laugh about certain things and just talk to each other and remind each other that we still enjoy what we have. We can find a lot of entertaining educational points from just about every single case. And you do have to have some comedy in the experience as well. So for the reality portion though, I'm going to go with a two, far from what we do.

Lisa Tomcko:

I think is safe to say some liberties were taken.

Dr. Anna Tart:

I would give entertainment value a solid seven. I thought it was, I wanted to watch it. I was excited when I saw Psych. I haven't watched it all the way through, but I've certainly seen other episodes and so knew that it was going to be generally enjoyable. And I was going to say a three for accuracy. I thought the actual autopsy suite was the physical location, autopsy suite was probably the most accurate. But as far as depictions of a pathologist's capabilities and general duties, I would rank it pretty low, so overall, a three.

Dr. Michelle Aurelius:

I thought it was fun, quirky, engaging, and honestly, I'm probably going to add this to my watch list. I am actually at an 8 out of 10 for entertainment. In terms of accuracy, most of the time when I watch these types of shows, it's like nails on a chalkboard like, "Oh my gosh, I can't believe they're doing it." And my entire body will get tense because I'll be extremely frustrated. But because it's in the context of being very lighthearted and not taking itself seriously, I gave the accuracy for the room itself. The room itself, so just talking about the room itself, as an eight. In terms of the forensic pathologist, I'd probably give maybe a negative three because the whole tie on the dead person and the inappropriate comments that would probably lead to a termination, et cetera. So negative three forensic pathologists, but I'm loving that autopsy suite. Just need more space and less converting decedent into a conference table. That's all.

Lisa Tomcko:

Definitely. Well, I'm glad. It seems like we at least all enjoyed it.

Dr. Michelle Aurelius:

And do you mind if I do a quick plug?

Lisa Tomcko:

Oh, sure. Please do.

Dr. Michelle Aurelius:

So if you're looking for more information about being a medical-legal death investigator or a forensic pathologist, reach out through the College of American Pathologists to our forensic topic page and get to know your forensic pathologist or your coroner or the person who is providing that service where you're at and learn more. We'd like to have you join us as a part of a team.

Lisa Tomcko:

Well, I want to thank you all for joining me today. This was a fascinating discussion and a fun one. And I also want to thank all of us listening to this CAP Cast. Stay tuned for future episodes of Forensic Pathologist React, and for more information about the College of American Pathologists, visit cap.org.

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