Thomas R. Oldt, Special to The Ledger| The Ledger
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In this very uncertain time we find ourselves in, many people are fearful for their jobs. But there is one person in the judicial circuit encompassing Polk, Highlands and Hardee counties who isn't. Dr. Stephen J. Nelson occupies a secure place. As the county's medical examiner, he's “doctor for a day” to the dead.
It takes a special personality to find satisfaction in cutting up human remains for the purpose of determining cause of death, but that's exactly what Nelson, 62, has done for decades, working out of the county's public safety complex on SR 540 in Winter Haven.
How he ended up in Polk County, he says, is “a long and convoluted tale.” He grew up in Bradford, Pennsylvania, home to Zippo lighters and Kendall motor oil, got his master's degree in neuropathology and went to medical school at American University in the British West Indies.
He did stints in the medical examiners' offices in New York City, Broward County and Palm Beach County before the local position opened up. He was recommended by a search committee headed by then State Attorney Jerry Hill and appointed to his first term by Gov. Lawton Chiles and has been reappointed by every subsequent governor. He also serves as chairman of the state Medical Examiners Commission – the oversight board for his profession.
Q. Please describe your job.
A. It's spelled out in Chapter 406 of Florida statutes and Chapter 11(g) of the Florida administrative code. Those deal with what kinds of deaths we are involved with and what we do to certify those deaths. Of course, there's the stuff that makes the news – the murders, the suicides, the traffic accidents, the drug overdoses. The vast majority of what most medical examiners do, though, is for people who die, who fall through the cracks, who don't have a doctor, you become their doctor for a day. There's a lot of natural heart disease, a lot of chronic alcoholism that we're involved with as well because those people don't have a social support network.
Q. People may be inclined to assume that because the pandemic is likely to take out a lot of our fellow citizens that your job is about to get a lot busier. True?
A. Yes, the statute uses the phrase “disease constituting a threat to public health,” so this is a disease constituting a threat to public health and we are the only ones in Florida who certify these deaths.
Q. How are you prepared to handle a potential onslaught?
A. These cases would not be ones that we would be autopsying. When you are alive and you get a diagnosis like you see on TV – there's the drive-through where they stick a swab up your nose down your throat? – what they can do in life, we can do the very same thing in death. So it doesn't require that we autopsy somebody to say that they have the coronavirus. We can do the same kind of testing swabs when they're dead without doing an autopsy and exposing others in our office or elsewhere with the risk of contagion.
Q. So they wouldn't necessarily come to your facility?
A. If they died at home, yes they would. If they died of coronavirus in a health-care facility, had already been tested and found to be positive, no, we would not bring them in. We would not expose our transportation folks and other carriers that we use to the virus. However, we would do a medical records review.
Q. What attracted you to this line of work?
A. I knew I wanted to be a pathologist, a laboratory guy. I did training in anatomic pathology – examining things removed during surgery – and did a fellowship in neuropathology. I figured I'd be an academic neuropathologist someplace. But I had not done some of the prerequisites in order to be board certified and one of those areas was forensic pathology. So I did an elective with the medical examiner's office in New York City and was very badly bit by the bug. It was very low on the list until I saw what a need there was for neuropathology mixed with forensic pathology. There are not many folks in that field.
Q. Many people would consider this a very unusual bug to be bitten by.
A. Well, it's something that is different every single day. You have no idea what to expect when you get to the office. Even when you're expecting such-and-such, it may turn out to be completely different. Obviously, the government wants to know why people die, and there are a lot of safety changes that have come about as a result of medical examiner work.
Q. What kind of safety changes?
A. The uniform building code, for example, was changed regarding the bottom drain of your pool, which is a suction that must have a convex covering so that you cannot get stuck to that drain and drown.
Q. Aside from the fact that your patients never complain or sue you, what do you find most satisfying?
A. Well, they don't complain but their attorneys complain, their families may complain. Not everybody is happy when we say that they died of a drug overdose. Not everybody's happy when we say it's a suicide. Obviously, defense attorneys are not happy when we say it's a murder.
Q. Does your work require you to go to crime scenes?
A. It doesn't so much require it now that everyone in law enforcement has a cell phone. Now that practically everyone has my cell phone number, they can send photos, they can send video clips from the crime scene and we can look at them and advise them as to what's going on.
Q. Give an example of how that might work, some investigator texting you photos at 3 a.m.
A. The case that comes to mind is a person lying face down, surrounded by a large pool of what looks to the cops like blood. Is this the nastiest looking murder they've ever seen or is it what we call a “purge fluid” percolating out from somebody who has been dead for a while?
We had a case recently where a road patrol thought this person had been killed by ingesting a tire inflator type compound. And what it turned out to be was blowfly eggs all over the person's mouth and eyes that when you look at it from a distance, yeah, maybe it looks like Fix-a-flat. But up close it's fly eggs that have been laid on the dead body that have not yet matured into maggots.
Q. That's … charming.
A. Exactly! Good conversation right after dinner.
Q. Do you do all the autopsies yourself?
A. There are two of us in the office in Winter Haven. Personally, I do about 350 or so. Last year our office did about 750 autopsies.
Q. How long does a typical autopsy take?
A. Right about an hour. But from a crime scene we could potentially be there all day long.
Q. Is there a standard procedure?
A. Yes, and it hasn't changed since medieval times. “Autopsy” comes from the Greek “autos” meaning self and “optos” meaning to see. It's a standard incision that is a Y shape, starts with the crest of your shoulders, down to the midportion of your chest and then all the way down to your groin. Portions of your chest are opened, your rib cage is cut through and then the organs are taken out one by one, examined, weighed and then dissected. Everything is done in a very methodical fashion.
Q. It obviously must require a substantial capacity to separate your emotions from what laymen might consider very grisly work.
A. Yes, and also a good sense of humor. If you didn't, you'd probably cry all day long. You've got to divorce yourself from it and remember that you're there to do a job – and you want to get the answer right.
I had an appointment once to get my car serviced and went to the dealership and asked, “Where's so-and-so?” And they said, “Oh my gosh, he died and he's at the medical examiner's office. We're waiting to find out what happened to him.” I'm standing there dumbfounded. I'd just autopsied him but I never made the connection.
Q. Are there some cases you have trouble getting over?
A. There are those cases you remember year after year because you don't have a cause of death. There's one or two a year where you ask, “What on earth has gone on here?” And those are typically young people.
My wife can tell immediately if we've had kids in the office because my demeanor is just different when I get home. But having done this for so long, I can tell you that when my parents died it was a completely different thing. When death hits you personally, it's always completely different.
Q. What is your expectation for progress of the corona virus?
A. It's going to get far worse before it gets far better. Everybody needs to just stay home. Isolate yourself and your family and help flatten that curve.
Thomas Oldt can be reached at email@example.com.