"Do you have a weak stomach?"
Put another way: Are you going to puke?
I'm certain this is what Dr. Rexene Worrell is really asking.
I can't give an honest answer. This is my first autopsy. I hold a general expectation of it but not of myself.
Right now, standing on flimsy legs in the forensic exam lab of the Clark County Coroner's Office, I feel like an empty vessel moving on auxiliary power.
Coroner Mike Murphy, my guide for this preliminary portion of the tour, is imparting useful information I am unable to process.
Pungent smells, foreign sights and power tools are commingling and creating sensory overload in my psyche. In front of me is a man with a hole in his head. Across the aisle, another man with a bigger hole in his.
Near the door lays a body in the early stages of decomposition, black and bloated with gas, scrotum the size of a cantaloupe. No such luck the penis, recumbent on the swollen testes. Life mocks, even in death.
Adjacent him is an 86-year-old black female—and Dr. Worrell, a forensic pathologist. Murphy hands me off to her and departs through the swinging door.
Worrell, who has seen it all, inquires about my mettle. It must be obvious. I'm wearing scrubs, gloves and a mask. The petite woman on the gurney is wearing nothing. She has been dead a day and is here on a maybe. Maybe she died of natural causes, maybe she didn't. External bruising has raised a red flag and necessitated an autopsy.
"I'm looking to make sure there's no evidence of internal injury, that she hasn't been strangled, hasn't been suffocated and has no broken ribs that we wouldn't see from the outside," Worrell says.
Blood thinners as much as abuse could be to blame, but she wants to make sure.
"What I'm really interested in is finding out is what the cause of death is."
There is only one way to do that, just like there's only one way to skin a chihuahua. I'm not sure I want to see, but I can't look away.
Before I know it, Danny Price, a forensic pathologist technician, is making a Y incision in the chest. Three quick cuts and voila! The chest plate is removed and the organs are exposed. I keep expecting the woman to open her eyes and smack Price in the face.
He removes the heart, lungs and a portion of the esophagus and hands them to Worrell.
"She has severe coronary artery disease, which we kind of expected at her age," she says, fileting the heart on her cutting board. "Her vessels are so hard I can't even cut 'em."
Worrell applies more elbow and gives a little grunt.
"Listen when I cut it. You can hear that it's crunchy, calcified."
She points to an occluded vessel, which could be a cause of death.
"And when you feel it ... here, set your stuff down and feel it."
What? Feel it?
I obediently place my notepad and pen on a counter.
"Feel right along here."
I extend a cautious hand. You would think it was a piranha.
"Feel how hard [it is]?"
Yes. Hard.
I retract my hand and bloody latex fingers.
"That's the coronary artery. As you age, particularly beyond 70, your vessels start to calcify."
And on it goes, Price removing and handing over the organs, Worrell dissecting and examining them. Lungs, esophagus, thyroid gland, pituitary gland, neck muscles, aorta, liver, gall bladder.
She is looking, both microscopically and with the naked eye, for structural defects and internal bruising and discoloration that could mean the woman was mistreated and died as a result. Everything is normal.
"Of real interest to me are her neck muscles," Worrell says, "because there's the question of whether or not she was abused or strangled."
They are pink, which means they haven't been hemorrhaging, which means she likely wasn't strangled.
Worrell drops each organ gently on a scale and weighs them in grams. They land with a wet smack. She enters the weights in washable black ink on a stainless steel vent.
"So now we need to determine what actually did cause her death. Her heart's bad enough [to have killed her]."
Large flaps of skin folded back from the torso during the chest excavation remain in place to reveal alternating strips of red and parchment-yellow marbling. Fat. More evidence contradicting a suspicious death.
"She's got a significant amount, so that tells me that her caregivers were feeding her," Worrell says. "We see some people in here that have a layer so thin, you can barely see it. Elderly that have been abused and neglected are not fed. She's got a nice fat pad, so I can tell she's been eating."
"Are you a vegetarian?" I ask.
Worrell, slicing through tissue, laughs.
"No. My daughter is. She's been involved with autopsies and helped me with things."
"We're going to lunch after this," Price cracks.
But first, the brain—the reason brain saws were invented. A circular blade at the end of a white handle follows the circumference of the skull cap, enabling the technician to remove it and expose the brain in its nest. The procedure is called a head post.
Price's brain saw and the other power tools cutting through bone and sinew form a choir in the examination lab. It sounds like a lumberjack convention.
He completes his task and hands over the brain.
He enjoys his work.
"Not everyone can do it," the 30-year-old says. "One out of 10 people maybe. Not even that. It's way different."
Worrell, meanwhile, is slicing the brain like a Christmas ham, evaluating if it has suffered an injury or a stroke.
"We'd see discoloration, we'd see softening, it'd be abnormal. There'd be a softened yellow-dark discoloration. OK, now take your hand and feel this."
I obey.
"It amazes people. Just go ahead and squeeze it and poke your thumb through it and see how soft the brain is."
I squeeze and poke. Hey, this is fun!
"It really has the texture of tofu," Worrell says.
And it looks normal.
"I think coronary artery disease is what killed her."
A natural death.
It is time to prepare the body for shipping to the mortuary. Enter John Lachbury, a 22-year-old intern from Cal State Stanislaus.
He has designs on a career in forensic anthropology, a specialized field focusing on identifying remains.
For the time being he is sewing up bodies and fetching things for the forensic examiners and technicians.
"It's really nothing," he says, stringing rope through skin. "It sounds kind of brutal, but it's like sewing cloth."
Lachbury has come a long way since his maiden autopsy.
"I literally went into shock the first time," he says. "I had to sit in the forensic office for 45 minutes and breathe. Then I could come back in, and I was OK."
"I remember your first day," says Worrell, chiming in. "I said, 'You better get another job.' 'Cause you were pale. You were like, 'Oh, my God, it's bad'."
"The big one for me was smell," Lachbury says.
Suddenly the exam room is quiet and still. Bodies have been returned to the cooler and doctors and technicians have departed. It is just past noon, and Price wasn't joking. Everyone has gone to lunch.
"The Macaroni Grille is really close and it's great," Worrell says.