Final Words: Reflections of a Forensic Pathologist


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Dark hair matted to the little girl’s head. Her lips were dried and cracked; her eyes sunken. The olive tone of her skin paled. At less than fifth percentile for height and weight, Amina lay gaunt on the morgue table.  

I sharpened my pencil, preparing to take notes. Feeling sluggish, I considered a cup of coffee, having not slept well the night before. Marty was the same age as this girl, four years old. In the wee hours, he had crawled into my bed and snuggled against me under the down blanket.

“Mommy?” he whispered. Taking my face in both his hands, he turned me to him. He felt warm like a space heater. His cheeks were wet from crying.

“What’s wrong, honey?” I said. The bedside clock read 2:02 a.m. 

“I had a bad dream,” he said, gulping breaths between words. 

“Shh, it’s not real,” I said, wrapping my arms around him. We talked about thoughts and visions until we drifted off to sleep. The alarm woke us at 6 o’clock. For Marty, nightmares were monsters under the bed, made real by two older brothers telling R. L. Stine stories after dinner. For me, they were embodied in a child’s corpse.

I skipped the coffee and did what I had promised Amina’s family: a quick yet thorough examination. They were Muslim and it was customary to bury the dead as soon as possible. The autopsy took under an hour. With a child this small, the dissection was easy. Without disease, the tissues cooperated with me––every organ in its proper place, no scarring, no tumors, no bleeding, no trauma. The only abnormalities were an empty stomach and collapsed bowels from 24 hours of vomiting and diarrhea. Pencil thin intestines rested in the abdomen; their contents purged and without the usual odor of guts. My insides twitched in sympathetic response. The internal findings confirmed what I had seen on the outside of the body: severe dehydration.

Earlier that day, I met with Munir, the father, and extended family in their small two-bedroom apartment. Amina’s mother, Nejra, sat on a worn sofa in the living room, head bent down, ready to collapse into herself, Munir by her side. Six other relatives were clustered on chairs hastily pulled into a semi-circle around the couch. 

Munir told me, through an interpreter, about the rapid illness. Amina had gotten sick more than a day before, in the middle of the night. She threw up the homemade broth she’d had for dinner. Throughout the morning and afternoon, she had unrelenting liquid bowel movements. Then the fever started and even sips of water made her gag.

In the evening, the parents and sick child made their way to the nearest emergency room, a mile from their home, via the bus. The hospital was unfamiliar territory, as was the city. Amina’s family was from the Balkans, recent refugees to Syracuse and part of the diaspora created by the civil war. There was no translator in the ER; no one understood what was going on with this little Bosniak girl. The nurse practitioner gave her an antibiotic for an ear infection and sent her home.

This family had survived ethnic cleansing; their village burned to the ground. They escaped famine and disease 4,000 miles away. Yet Amina died of an illness that modern medicine can cure. A simple intravenous line could have replaced the lost body fluids and essential salts. Without this salted liquid, the heart stopped.

“What did they do at the hospital?” I said. “Did they give her some saline into her veins? Check her blood pressure and pulse? Give her medicine to stop her vomiting?”

As the representative from the refugee center interpreted my words, Munir shook his head with each question. I confirmed his story later when reading every word of the one-page medical record.

Returning to their home from the hospital, Nejra took Amina into her arms and crooned to her. The child’s fidgeting slowed. They fell asleep entwined. The mother was grateful that her daughter had stopped needing the bathroom. 

In the morning, Amina’s face felt cool, and Nejra thought the fever had broken. But there was no breath, no heart beating in the thin chest. Nejra wailed, a sound primeval that woke Munir and the entire house of aunts, uncles, and nephews.

After the autopsy, I did two things for Amina. I filed a complaint of negligence to the disciplinary board of the hospital and the state. Carefully turning her body, I pointed her head toward Mecca.

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