Still Lips Still Whisper

Meet Dr. Michael Graham, the city medical examiner. He hears dead people.

Jun 5, 2002 at 4:00 am
The silver plumber's pipe was the base of Michael Graham's bomb. Cool to the touch and freshly scrubbed, the pipe was recently plucked from a Wal-Mart rack.

With agile fingers, he screwed an end cap to the bottom of the pipe, then oh-so gingerly, he poured gun powder into the hollow tube. Graham meticulously swiped the open end with a rag; the smallest grain of gun powder caught in the threads could set the bomb off when he screwed on the second end cap.

A hole was drilled in the center of the cap and a fuse thrust inside the gap. If lit, the pipe would turn into a grenade, sending chunks of metal sailing through the air and into whatever -- or whoever -- happened to get in the way.

And the whole thing only set him back eight bucks.

On a Missouri military base he'd blow it up, examine the bits and pieces, and study the explosion. Just one more lesson learned about death.

Death is Graham's business. And he's spent years learning how to coax answers out of dead bodies. In return, they've taught him about the many freakish, random, careless or evil ways to steal warmth, breath, life.

The education is vital.

Vital not only to Graham, but also to the people he works with in the St. Louis Office of the Medical Examiner. Bodies have cold, still lips, but they still whisper about their last moments of life in ways only the people in the medical examiner's office can hear. Graham and his charges are the strangers with white latex gloves who remove the clothes of the dead and surgically caress cold flesh, trying to coax information from rigid limbs.

The stories they hear about life, death and the spaces in between are sobering.

Murdered people left to rot by their attackers; children stabbed or beaten by the parents; women bound with duct tape and shot brutally in the head; and elderly people overwhelmed by the unforgiving St. Louis summer. The medical examiner's office transcribes the tales dictated to them by the dead, then hands the knowledge over to grieving family members, law enforcement and, sometimes, juries.

Graham's pipe bomb experiment helped him unravel the mystery of one teenage boy's death. With the chilled body stretched out on a stainless steel bed, he cut the teenager open, probed inside with surgical tools, and pulled out a bent, corrugated scrap of metal.

A pipe bomb cap.

The boy's mother also died in the blast, killed because the bomb was inside a wooden box. Graham knew that just from looking at a hunk of wood embedded in the mother's neck -- it had bored into her flesh, leaving a gaping hole and severing her carotid artery.

"Of all the acts you see, one of the least humane is bombing because the number of victims is so random, there's very little care for human life," Graham says as he shows an auditorium half full of surgeons the autopsy photos during a bomb ballistics lecture.

Graham's voice is even, but never flat, as he talks about bombs, bomb makers and bomb victims. His clothes aren't flashy -- he favors light blue shirts, navy blue pleated pants and deck shoes. Substitute the blue shirt for a cardigan, and it isn't a stretch to picture Graham as a darker version of Mr. Rogers. Yet he isn't telling stories about the Neighborhood of Make-Believe.

This is real.

So real, that he occasionally makes a gentle joke to lift the somber pall that's descended over his audience:

A man who'd planned to fish with dynamite was killed in a truck outside of a gas station. A cell phone and the end caps had been placed in the console with the dynamite. The phone rang and blew the roof off the truck.

"I guess it was the catfish calling," Graham says before going on to the next victim.

But the mood of the younger surgeons in the group doesn't lift. They aren't battle hardened, so it is easy to pick the squeamish and the tenderhearted out of the crowd.

They're the ones who draw a deep breath and use their hands to cover their mouths as they stare at the photo of the mother killed by the pipe-bomb shrapnel. She's splayed on her back across her kitchen floor, shirt and eyes wide open.

They're the ones who whisper "Oh my God," when they see a photo of two charred bodies, their skin looking like the black flaky exterior of a marshmallow that's been thrust in a campfire, ignited, then pulled out of the flames and allowed to burn on the stick.

Pastries are left half-eaten on paper plates and coffee grows cold in Styrofoam cups as Graham explains that the bodies are of a grandfather and grandson found in the burned-up rubble of a basement. The grandmother was upstairs cooking dinner, the two were in the basement. She heard a loud explosion and screaming. A fire spread down below, engulfing the screams.

The slide show clicks and shows an internal organ.

"This is Granddad," Graham says matter of factly.

A piece of shrapnel had punctured one of Granddad's major organs. It killed him.

Then Graham shows a close-up of the grandson, maybe in his early teens.

"This is the other victim, he's got one shrapnel injury to the face, it starts here," Graham motions with a laser pointer to the upper lip, "scoots right along the left orbit and out."

The left eye had been torn out. Not a fatal wound.

The slide show clicks. Another photo of the grandson.

"A lot of smoke in the airway, indicating that he was alive and breathing," Graham says in a clinical tone. "So this is the grandson who was screaming. Granddad didn't have any smoke in the airway, he was dead right away."

The two were constructing homemade fireworks for the holidays, "bottle rockets, Roman candles and stuff," Graham explains. Something set off the explosive powder, propelling a fireworks container into Granddad and also setting off the fire that killed the grandson.

Graham's knowledge isn't limited to bombs.

In another lecture, this time to second-year medical students who haven't started seeing patients yet, Graham introduces the novices to broken babies.

"This child has a fatal hit from being whacked up against the wall," Graham says while the students look at the picture of a toddler with a large bruise at the base of his small skull.

The man responsible for the bruise claimed it was the first time he lost his temper with the child and "swung the kid."

Using a pointer, Graham directs the students to the child's jawline and lower cheek.

"But as you look at this kid, you can see he's got a bunch of big, brown bruises here, and here, and more back here, and there were others.

"This isn't a toddler who'd been playing around. This is clearly a chronically beaten child. So the story that this child had never been hit before just isn't true."

The slide projector clicks forward.

A child, maybe five or six years old judging from the lean look of his arms and legs, lays face down on an autopsy table, nude. The child's back is covered with several large bruises and welts of varying shapes and sizes.

Another child-abuse death.

"You just have too many marks of different patterns to be explained by a single instrument," Graham says. "Parallel marks here, peculiar marks there."

Click forward and a number of household items are laid carefully on a table.

"And there are some of the instruments. The kid was beaten with a belt, with wire, with a hairbrush and with a fan belt across the back."

Many of the medical students wince.

But Michael Graham doesn't.

He's a forensic pathologist and the chief medical examiner in the city of St. Louis. Soft-spoken but strong willed, he heads up a small staff that embraces death. They must in order to pass one-way messages from the dead back to the living.

The flies dance around the surgeon's light mounted on the ceiling, translucent wings shimmer under fluorescent bulbs. Their small, but well-nourished bodies bounce off the whitewashed brick, liberated from a thick, black, body bag.

Millipedes and flesh-eating beetles pop out of the decomposed cadaver where surgical instruments hold ligaments and muscles apart, only to dart into one of the many other cavities created by the hands of nature -- and the hands of humans. A few of the many-legged creatures slither onto the autopsy table, then scamper over to the perforated drain on the center of the bed.

A forensic pathologist holds a pair of forceps in his hands and deftly mines out a maggot. He picks up a plastic vial and drops the maggot inside. It will be sent to a toxicology lab and searched for clues -- for chemicals and toxins ingested by the living and purged by scavengers.

David Brown peers over the pathologist's shoulder and watches the autopsy that happened on a hot summer day ten years ago. At six feet five inches, it isn't hard for him to see. Because it is only his second day on the job as an autopsy technician, all he has to do is watch.

And wave.

Bugs are nature's cleaning service, and their work is too far along on a decomposed body to stop for a postmortem exam.

"You basically just do the autopsy and flick every once in a while," Brown explains as he brushes his long graceful fingers across his forearm.

But Brown wasn't sure he'd come back to the medical examiner's office after his first day on the job -- the day his supervisor unzipped a plastic body bag and introduced him to a dry floater.

This is the body you'll be working on tomorrow, he was told. It almost made him quit on the spot.

"I couldn't believe it," he says with a shy and embarrassed smile. "I didn't think a real person could look and smell like that."

"Floater" is the slang word for a decomposed body. Decayed bodies float in the water. A decomposed body pulled from the water has been dubbed a wet floater. One found on land is a dry floater.

Because Brown started in the summer, his odds of working on a decomposed body were very high. The odor's strength grows in the heat and the dead smack the living with a pungent smell, punishment for all the times they were ignored by passersby.

Brown says that he started mentally writing a resignation letter, minutes after enduring the stomach-churning smell and sight of his first bug-laced floater: "Thank you for the opportunity, but..."

It wasn't as if Brown was a stranger to the dead. He came to the medical examiner's office already comfortable around dead people, well-versed in the ritual of preparing them for wakes and burials.

He started out working in a funeral home, but it became an endless routine of embalming bodies, wakes, burials and long, slow rides in a hearse, then starting the whole process anew. He needed a challenge and the funeral home didn't satisfy his intellectual cravings. When a police officer told Brown about the medical examiner's office, Brown thought he was a perfect fit.

He contacted the office but there weren't any openings. Call back, they said. And so he did. Repeatedly. His fortitude was rewarded and he was given a shot, but he almost walked away after meeting that first floater.

"That lady didn't look real; she didn't look human," Brown says.

His training had left him wholly unprepared for working with the decayed remains. But mixed in with the disgust was a genuine curiosity.

One question kept pestering him at home after that first day, "Oh my God, I wonder what happened?"

But the only way he'd find out the answer was to go back to the body and ask. The next day, he returned to the floater's box.

The floater's box and the floater's autopsy room are separated from the main autopsy room and cooler. Decomposed bodies not only have an overpowering odor, they're a biohazard. The floater's box is a brick icebox that hovers around 15 degrees Fahrenheit, a feeble attempt to stop nature's mission.

The main cooler is kept at a balmy 36 to 39 degrees Fahrenheit, a temperature that helps slow decomposition, but doesn't freeze the body. Doing a postmortem on a frozen body is like cutting a frozen steak with a butter knife.

The floater's autopsy room is a private suite with only one table. In the main autopsy room, up to four postmortems can go on at the same time. But floaters demand undivided attention.

Brown watched as the floater was brought into the room and placed on the lone table. He donned scrubs, gloves, mask and surgical cap. It is an effort to keep the odor off of his own clothes and hair. Just like perfume that lingers after a lovers' tryst, the bitter stench hangs on as a morbid reminder of the inevitable.

Brown was both fascinated and repulsed by the autopsy, but he learned an important lesson: "If I can take this, I can take anything else."

After a decade of working in the medical examiner's office, preparing for an autopsy is like getting ready for bed at night. If the case is a homicide, he will get out evidence bags to prepare for a postmortem. If sexual assault is a possibility, Brown pulls out a rape kit.

The scalpel, bone saw, needle, sutures, syringes and DNA test pads are carefully laid out on a silver tray that sits on top of the bed. He may be asked to saw off a part of the skull for a head autopsy or take out the breastplate for a postmortem exam. He's an extra pair of eyes searching for a bullet that's been fired into a body.

He's always looking -- for clues and a deeper meaning to his workday routine.

"Maybe I make a small difference that no one knows, figuring out how Great Grandma died," he says.

Brown is a gentle man, but gaze deep into his face, look behind the wire glasses and past the sweet smile, and sadness colors his eyes. He isn't immune to the tragedy that sometimes surrounds him.

"I really get upset when there are kids and elderly people; I can't imagine someone killing an elderly person or child."

A sign hangs on the swinging door that separates the autopsy room from the long, narrow hallway where empty beds wait, ready for a visit from the recent dead. The sign predates Brown, but could have been written by him.

"Caution -- human beings here. Handle with care."

Brown not only talks to the dead, he feels the pain of the living left behind.

If a family member comes down to the medical examiner's office to identify a body, one that's already been examined by a doctor and photographed, Brown reaches back to his funeral training and pulls out a hairbrush. He unzips the body bag, smoothes matted and tangled hair, covers scars, wipes away dirt and dried blood left on the face, and shuts eyes.

His caring ways are directed at the living and the dead.

For the living: "It is bad enough that they have to come in here."

And for the dead: "I try to make them look as close to natural as I can."

A woman's dark red toenails poke out from beneath a milky plastic bag. Nearby is a large, long lump with masculine feet.

A half-filled body bag rests on a third gurney.

Across the dimly lit room, a silver cart is parked next to a laundry basket. On top are rows of tightly sealed freezer bags, each one containing an organ.

The cold air swirling about doesn't chill faces locked in a vacant stare. The sickly sweet scent of mortality doesn't wrinkle their waxy noses.

It doesn't seem to bother Baxter Leisure either.

He's standing in the middle of the main cooler -- the waiting room for the newly deceased -- describing 20-year-old renovations. The changes opened up the space to accommodate more bodies and made it more energy efficient, Leisure says with a heavy South Side accent.

He consciously limits today's lesson to the room's physical changes and doesn't talk about the people lying nearby. He knows who they are and what brought them here. That's one of the first things he finds out every morning, after taking off his jacket and grabbing a cup of coffee.

But he's perfected the art of pretending not to know. Not to know how many trip tickets have been left at the morgue desk by the funeral homes that provide livery service to the medical examiner's office. Not to know which ones are adults and which ones are kids. Not to know who's been shot, stabbed, beaten or died of a drug overdose.

Well, he does know -- but showing that you know means answering questions posed by the living: gore seekers and media types who aren't part of the medical examiner's office, law enforcement or immediate family members. And Leisure's not going to give specifics.

So he pretends. And sticks to giving visitors safe descriptions of the office and his routine.

"So if I have seven or eight livery tickets, I hope to God they aren't all autopsy cases," Leisure said earlier in his office, while talking about the abstract facts and figures he compiles.

He notes that autopsies aren't performed on every body that's brought into the medical examiner's office.

"If they are, then I ask what specifically we have and they may say three homicides, a motor vehicle, and a jumper."

That would be a pretty accurate breakdown of the types of cases that come into the office. The St. Louis City Office of the Medical Examiner handles most of the metropolitan area's homicides, 138 in 2000, compared with 36 in St. Louis County, eight in St. Charles, four in Jefferson County and one in Franklin County. And the city is second in the number of accidental deaths, 293 compared with St. Louis County's 322.

County and Illinois residents don't elude the grasp of the city Office of the Medical Examiner. What matters is where people die, not where they live. So a St. Charles resident killed in an accident on Interstate 70 in the city limits is sent downtown. Someone from Illinois who dies in one of the four hospitals inside the city limits might be brought down to see Michael Graham's staff. So too, a baby living in Jefferson County who dies in the Children's Hospital on Kingshighway Boulevard.

Leisure continues the tour of the main cooler.

It is a vast open space. The floor is painted hospital green. The walls are a few shades lighter. One wall has a window that faces into a small, uncomfortable room where families gather to identify their husband, wife, son, daughter, mother or father. A few feet back from the window, inside the cooler, a faded, blue-green curtain hangs from the ceiling. A body is wheeled in between the curtain and the window, blocking a visitor's view of other dead people.

Leisure points to a wall and describes what was once there: the drawers were stacked three feet high. Like everything else in the office, they were laid out in tidy rows. But they took up valuable space. The room can now host about a 100.

There's only been one time in Leisure's memory that the room was filled to capacity -- right after it reopened, in the summer of 1980.

That summer, a deadly heat wave hit St. Louis. At the same time, the grave diggers went on strike, which meant the morgue filled up and wasn't emptied.

"Imagine every inch of that room, including the ID window, with a gurney," Leisure says, "because that's how filled it was, filled to capacity. And coupled with that, the grave diggers were on strike, so the fact that these people were dying almost literally one after the other, we couldn't turn them over."

Leisure stops and smiles sheepishly when he realizes the pun.

"We couldn't get them out of here because the funeral directors were saying 'we have no place to go.'"

Leisure is the medical examiner's administrator and the office's highest-ranking city employee. He's a fixture. Been there for more than three decades. Leisure reports to Graham, but Graham isn't on the city's payroll. All three full-time forensic pathologists, including Graham, work for St. Louis University's medical school.

The city contracts with the university for their services because it saves money. The university also benefits because the doctors teach courses to medical students and train pathologists from both St. Louis University and Washington University. The doctors win because they straddle two worlds -- the practical and the academic -- and can pull the best from both.

Leisure is also the institutional memory, a bridge to the not-so-distant past when St. Louis had a coroner, not a medical examiner.

The coroner was a politician elected by St. Louis voters. Juries assembled and inquests were held in a now-disassembled courtroom in the building. Doctors would make their presentations and a verdict would be reached by everyday folks. "Coroner's Court" is inscribed in the cornerstone of the two-story medical examiner's building on Clark Avenue, next to the 14th Street entrance ramp onto westbound Interstate 40.

But relying on the coroner system made St. Louis seem unsophisticated -- hopelessly rooted in a medieval European tradition -- and it was also a hindrance to law enforcement efforts. So in 1974, the city voters decided to put the office out to pasture. The coroner's office was given three years to make the change, and on January 1, 1977, St. Louis got a medical examiner.

Leisure was hired in 1970 by St. Louis' last coroner, Helen Taylor.

He remembers his job interview for a deputy coroner position more than 30 years ago.

Taylor asked, "Baxter, have you ever seen a dead body?"

"No ma'am, I haven't," Leisure answered.

"What do you say we go downstairs and take a look?" he remembers her saying. Leisure says he followed her like "a little puppy" as they went down to the autopsy room and walked up to a body on one of the gurneys.

"And she just kind of pulls the sheet back and says, 'How does that look to you?'"

"I guess OK," Leisure answered.

"Does it bother you?"

"Well, no," he said.

"I expect you to come down here just about every day to look at these and understand and know what is going on with these cases," she said.

Even though Leisure isn't presiding over inquests and Taylor is dead, he faithfully keeps a promise he made three decades ago to a woman who is now a barely-remembered footnote.

History is an important part of Leisure's job. He's the guardian of the city's past.

In the basement, carefully organized banker's boxes going back as far as 1840 are arranged neatly on a shelf. There are books of the dead, some leather-bound and hand stitched. Neat, cursive handwriting entered more than 120 years ago on pages that are now yellowed list names, ages, occupations and addresses of each person who died.

The street names are familiar but some of the occupation titles are markedly archaic: servant, cigar maker, saloon keeper. An unborn baby is called a "foetus."

A card catalog going back to 1871 stands in another corner. Each drawer has two rows of index cards. The row on the left is the dead listed alphabetically. On the right side, the dead are arranged by cause of death.

On August 3, 1882, a seven-year-old boy who lived on Carondelet Boulevard was thrown from a horse-drawn wagon and died when his head hit a stone near Gravois and Jefferson avenues. On January 20, 1880, a 23-year-old man was shot in a saloon at Sixth and Market streets. In January and December 1886, there were two legal hangings performed by the St. Louis sheriff. Both men were listed as "colored."

On September 1, 1871, a man "under the influence of liquor" fell off the steamer, the Molly McPike, while it was on the Mississippi River between Olive and Pine streets. He drowned. A month later, a man fell overboard from the deck of a steamer, the Hensley, at the foot of Morgan Street. He was "in the state of intoxication."

In 1892, five men were killed when a steam boiler exploded at the Laclede Fire Brick Manufacturing Company. Another man died at the Anheuser Brewery on February 21, 1880, struck by a barrel of cement thrown down a chute.

The malaria segment of the 1890s drawer is thick with index-card entries. In the 1920s drawer, index cards are filed with women who died from criminal abortions performed by "unknown persons."

All of the coroner's records are public documents. But after the changeover to the medical examiner system in 1977, the records became private, treated like medical records. The banker's boxes in the basement are carefully divided between the public and the private.

Protecting patient privacy, even if the patient is dead, is a core principle in the office.

"A dead person has the right of privacy," says Graham in a resolute voice. "They are still people and I think that it is important that you never lose sight that you're dealing with people."

That means that autopsies are generally limited to medical students and people connected with law enforcement. The office frequently has community and student groups tour the building, but the walk-through is very limited. If the autopsy room is being used, they can't even see the metal tables and instruments.

"When people call you wanting to book tours, they're looking for the Freddy Krueger stuff," says Leisure. "They aren't looking for a boring lecture on the medical examiner and the coroner system. They want to see bodies and they want to see blood.

"And we just don't do it."

Leisure goes out of his way to shield the dead and way out of his way to help out homeless veterans. He helped organize a program for homeless veterans that pays for a military funeral service at Jefferson Barracks.

So when Leisure takes his morning stroll back to the morgue desk to find out who's checked in, he's also looking for veterans. When he finds ones without money, and often without family, he makes the funeral arrangements. And when the day arrives for the body to leave, Leisure puts on a suit and tie and heads over to Jefferson Barracks.

He's attended the funeral of every single penniless veteran who's ever been wheeled into the morgue.

The body waiting on the gurney for Dr. Phillip Burch was wearing a shirt stabbed full of holes and oozing blood. Black shoulder-length curls framed the face of a 16-year-old girl.

The girl's father, Zein Isa, pointed to a small cut on his finger and told the police that his rebellious teenager attacked him. There was a struggle and he killed her in self-defense.

But that's not what the body of Tina, as she was known to her friends, told Burch.

"I looked at the body and she had six trivial punctures inside of her left breast," Burch says. "And she had six very fatal injuries a lot closer around her solar plexus. A very tight area, I think within two and a half inches of each other.

"And I told the detectives, by looking at the body and listening to the story, she was not involved in a wild free-swinging fight.

"For whatever reason, she stood still while she was stabbed. Either she stood still of her own volition, or she was unconscious or someone was holding her," Burch says.

After this 1989 autopsy, Burch and the police discovered that Tina's death had been audiotaped by the FBI. The feds suspected that Zein Isa was a member of the Abu Nidal terrorist cell and his home had been bugged. The chilling tape recorded Tina Isa's death -- murdered by her parents Zein and Maria for dating an African-American boy and disgracing the family.

Zein was a small, sickly man, but his wife Maria was a big, strong woman. She pinned her daughter down on the floor of their South City apartment while Zein stabbed her.

"Mother, please help me," Tina pleads as her father starts cutting her flesh.

Her high-pitched screams rush out of her mouth as a knife blade is thrust into her chest.

The screams turn into moans.

Then silence.

But Tina's body told Burch much of the story before the tapes were ever played.

"This was very evil justice," Burch says, his eyes intense and unblinking.

As the deputy medical examiner and forensic pathologist on the case, Burch testified at their trials. Zein and Maria Isa were both convicted of first-degree murder. Zein Isa received the death penalty but died while in prison. Maria Isa received the death penalty, but the case was overturned. After a second trial, she received life without parole.

Burch has been with the office since 1985 and during the past 17 years, he's had intimate discussions with the bodies of people whose deaths have been fodder for front-page news.

A man, obsessed with a young woman who worked at the Tivoli Theater, broke into her apartment, tied her hands and feet together, wrapped duct tape around her head, then shot her. Burch carefully preserved the duct tape. Cutting it off in one piece, instead of unraveling the duct tape, he was able to preserve a single fingerprint, which matched her killer's hand.

Then there was the body of a man Burch X-rayed, finding a bullet deep inside the head. A little while later, the head was X-rayed again, but the bullet had moved.

"I couldn't figure out how the bullet moved," Burch says.

But when he cut off the top of the man's skull, he found the answer.

"The brain was gone and there were a mass of maggots in the skull."

The maggots had been pushing the bullet around.

Burch laments about the "casual way people are killed today," but he doesn't get emotionally involved with the people he examines. He doesn't form a close bond with the naked person stretched out before him on an autopsy table.

"Most of the people we see are people who die strangely," Burch says. "His or her life may be very warped.

"I don't relate to that kind of lifestyle and I don't relate to drug dealers," he says plainly, referring to the crime- and drug-related deaths.

He's also been around long enough to see a big change in forensic pathology, both in terms of science and attitudes.

On the science side, the biggest change has been advances in DNA testing. Once DNA became accepted by judges in the mid to late 1980s, the medical examiner has become an important part of the justice system.

And then there's the image.

Burch says that the medical examiner used to be portrayed in movies as "an overweight alcoholic has-been munching a donut over a body" -- a doctor who screwed up one too many times on live patients so now he's only allowed to work with dead ones.

But that's changed over time. While Burch was in medical school, the television show Quincy depicted the medical examiner as a crime-solving doctor with the answers.

"Now TV medical examiners are very intelligent, very attractive young women," Burch says with a laugh.

Dr. Jane Turner stands in the autopsy room, next to a morgue technician and the body of a woman who's been shot. Turner wears a blue scrub shirt and purple scrub pants; her gold choker is the only bit of flash in otherwise utilitarian garb. Her blonde bobbed hair is tucked behind her ears.

Turner deftly cuts a large "Y" into the woman's chest, making slits cleaved on either side of the breast, joining the cuts just below the breastbone, and extending it down the middle of the belly.

While she was a resident, Turner says, "I didn't care to do procedures on patients because I didn't like to inflict pain. But I don't have to worry about that here."

Turner peels back the skin and pulls out the breastbone. Her sparkling blue eyes slowly scan the exposed organs. She finds the bullet. And then something else catches her eye.

"In this particular case, she has some lesions in the heart that are unusual," Turner says. "So I'll put some sections through for microscopy."

Later, she'll study the woman's heart in her office. Looking at someone's tissue under a microscope is both an extremely intimate and distant exercise.

So is the autopsy.

"The autopsy is the ultimate physical exam," Turner tells medical students who cycle through the office for training.

As she performs the external exam, which involves carefully studying the body, she routinely asks: "What do you see?"

Trained eyes like Turner's can often decipher how someone both died and lived simply by looking closely at their skin.

"Some deaths have a certain appearance," she says.

An alcoholic has a "poor nutritional status, they might be thin, jaundiced yellow, they might have scars on the forehead and knees from falling. They often look older than they should for their age."

But not everyone she meets has led a hard life.

With some people, Turner says, "I get a feel that they are nice people. I can't put a finger on it, but maybe it is because of the expression on their face; an old person who smiled a lot and has crow's-feet. Even some young people, you can look at their body and tell they lived a healthy life."

At 38, Turner is still relatively new to her profession. She started in the office four and a half years ago, for a one-year fellowship. She spent most of her time in the city for training.

"I'd go out to the county once a month to cut brains with Dr. Case, she's also a neuropathologist," Turner says, referring to St. Louis County Medical Examiner Mary Case, who is also a medical school professor at St. Louis University.

The fellowship ended but she stayed on as an assistant medical examiner.

Her path to forensic pathology involves much more than just the St. Louis Office of the Medical Examiner. Turner's worked the grisly aftermath of the Oklahoma City bombing, when she was a resident at the University of Oklahoma Heath Sciences Center.

Turner isn't the only one who's had a brush with human disaster. Graham was in New York on September 11. He was in his hotel near the World Trade Center finishing up his breakfast before he was scheduled to testify in court on a case. Graham felt both planes hit. Unlike Turner, his role was limited to being just one of thousands evacuated from the area.

But Turner spent three weeks in the Oklahoma City Office of the Chief Medical Examiner, sorting through the human wreckage. At the time, her two sons were already born. Something spared her from working on any of the tiny bodies pulled from the day care center of the Alfred P. Murrah Federal Building.

"I don't know if it was intentional or not, but none of the children came through when I was there. There was one child who was in the morgue and a friend of mine did look at the child but that was very upsetting because both of us had children in day care."

Turner looks at a plaque shaped like the state of Oklahoma hanging on her office wall. Its inscription thanks her for "dedication and outstanding performance above and beyond the call of duty."

Then she says: "It was awesome, in a bad sense, a really bad sense."

Life and death march side-by-side in the medical examiner's office.

It is a place where grabbing a soda from a vending machine requires a jaunt past a body on a gurney. A small radio plays softly. The chief autopsy technician answers the phone at the front desk and patches through the calls.

Down a long hallway, a young patrolman stands to one side of a body stretched out on a gurney. The only part of the body visible from the lobby are the soles of the dead person's shoes. David Brown stands across from the patrolman, on the other side of the gurney. The two men exchange paperwork over the dead man.

A workman hangs up harvest gold curtains that flank the ID window. Once again, they've been torn down by a grieving family member.

On the second floor, away from the coolers and autopsy rooms, Turner's son sits on a couch in her office, sitting out a day of school because he didn't feel well.

Rose Psara, the chief investigator, gets ready to pick up her daughter from day care at lunchtime.

Down the hall, Burch talks about his fascination with the Civil War, then is interrupted by a phone call. Only Burch's end of the conversation is audible.

"One gunshot wound. Right temple, consistent with suicide."

Randy Hays, an investigator with the office for about 20 years, arrives to cover the four to midnight shift. Many of the employees have already left, so he'll be alone tonight, except for the small group of dead in the cooler.

Hays is settling in to his desk, ready to answer phone calls from homicide, his black bag primed and ready to head out to a crime scene. His computer is on.

As he sorts through phone messages, the chief investigator tells him about a body that will be coming in later that evening from a rural doctor. Hays needs to mark the body carefully because it is a possible meningitis case.

Around the corner, Graham sits in his office, large St. Louis Blues banners hanging from his bookshelves. Graham's a huge hockey fan, and the banners were a gift from his staff.

Outside his office door, Graham's secretary, Mary Kennedy, sits at her desk typing out death certificates.

Most of the time, the office quietly hums.

Four teenage girls, eighth graders from Ladue, sit in Graham's office. They've come downtown to ask him about his work as a medical examiner. The girls are in a gifted student program for kids interested in medicine. They've come to find out about forensic pathology

He patiently answers the same questions he gets asked over and over.

"What kinds of cases are the most disturbing?"

Graham has a well-worn answer: "children and the elderly. Both groups are defenseless."

Yet working with them, "doesn't bother me day to day."

When asked what is the most emotionally and mentally draining aspect of his job, listening to the dead, examining their bodies, probing their minds, don't make the list.

This does: "When my desk is stacked with files."