J. Keith Pinckard, MD, who started out wanting to be a research scientist, made an interesting discovery during his residency.
“I loved autopsy pathology,” Dr. Pinckard said. “It almost felt like cheating; rather than making clinical diagnoses based on a dataset of information, an autopsy gives you the answer key. You are literally seeing everything, and can correlate the pathological and clinical findings.”
He soon discovered forensic pathology, “which goes even further into the unknown. Hospital autopsies are often autopsies of confirmation; forensic autopsies tend to be autopsies of discovery. So I was hooked.”
Texas Medicine recently caught up with Dr. Pinckard, who has been the chief medical examiner at the Travis County Medical Examiner’s Office since 2015.
Can you describe a typical workday?
There isn’t really a typical day. Of course, there are autopsies, but it goes much further than that. The autopsy examination itself is really just the tip of the iceberg. The entirety of the death investigation is much greater than the time it takes over the body in the morgue. We spend much more time reviewing photographs, microscopic slides, laboratory testing, and investigative information than we do on the autopsy. We integrate all of this case information to finalize the death investigation. Some days, we might testify in court or go to a death scene. We also teach medical students, pathology residents, and forensic pathology fellows. And, of course, I spend a lot of time on administrative duties and running the office.
How long does the typical exam take? Is there a standard set of things you look for, or does it change case by case?
There really isn’t a typical exam, either. It depends greatly on the nature of the case. An apparent natural death with uncomplicated autopsy findings may only take an hour or two. A complex case with extensive injuries may take most of the day, or in some cases, extend to another day. There are certain things we look for in every case; for example, we examine every organ system. Depending on either the nature of the case or what we find during the examination, we may decide to do more advanced, targeted dissections or special laboratory studies.
Shows like CSI, Law and Order, and others, sometimes go into medical exam rooms. How accurate are those scenes? Can you think of a show or scene that was wildly inaccurate?
Most of them. And I get it—the episode only lasts an hour, so they have to speed things up. The show doesn’t span the course of many weeks to follow a case from beginning to end. On many of those shows, the only thing that is accurate is that there is a body on the table.
And here’s the one I’ve never understood: an autopsy room is not dark, with dramatic accent lighting. We do need to be able to actually see what we are looking at, and our exam rooms are quite well-illuminated.
But I suppose that isn’t as mysterious as the medical examiner hiding in the dimly lit room.
Those shows actually pose a big challenge for us. It has been written about in the medical literature and has been called “the CSI effect.” Many people on juries believe that forensic pathology is actually as it is portrayed on television and on film, and they expect that we can actually do the sorts of completely unrealistic things that they see on those shows.
Or worse — they sometimes believe that we didn’t do a thorough job because we didn’t do something that they saw on television — even if it is completely unrealistic.
How desensitized are you to bodies and death? Is it just a job or does it sometimes still affect you?
People assume that we are desensitized to what we see, but I don’t think that “desensitized” is the right word. We are simply used to it. It is part of the job to deal with death and the unpleasant things that we see. But we aren’t desensitized, emotionally numb, or unsympathetic.
A large and very important part of our job is talking to family members, explaining how their loved one died and answering their questions. You have to be empathetic in order to do that. We have a job to do, but we don’t lose sight of why we are doing it. I think the field selects for people who have the ability to compartmentalize extremely well. It’s just a personality trait.
We do our jobs and see very unpleasant things, and we are able to go home and leave those unpleasant things at work.
Photo by Matt Wrightsteel
Tex Med. 2018;114(3):30