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E. Blair Holladay, PhD, MASCP, SCT(ASCP)CM
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TV and movies have both glamorized and improperly portrayed the job of a medical examiner, misleading viewers. Nicole Jackson, MD, MPH, FASCP, Assistant Medical Examiner for King County in Seattle, Washington, jokes that onscreen, “no one is wearing appropriate personal protective equipment (PPE). And in some shows they are eating in there. You never bring food in; that would be disgusting!”
But the small and big screens do get something right—the atypical nature of a medical examiner’s workday, which is what attracted Dr. Jackson to the profession. Her day can be as mundane as any administrator on paper days—following up on studies that have been performed, reviewing toxicology reports, and other paperwork—but autopsy days are quite compelling. The variety keeps it interesting and allows her to use her multiple skills in anatomic, clinical, and forensic pathology, and public health.
She works about 11 to 13 autopsy days a month. These start around 7:30 a.m. and she can have between three and eight cases for the day, wrapping up in early afternoon for paperwork. Autopsies are often the most interesting part of her job, as she attempts to solve the mysteries of death.
“Every case is a puzzle. We’re figuring out what is going on in people’s bodies, but you’re taking more into consideration: the investigative report, your autopsy finding, your ancillary studies and the follow up report. It’s very rewarding,” Dr. Jackson says.
While many people are drawn to work as medical examiners because, “they watched true crime shows and found the detective nature of what we do fascinating,” she says, her route there was more circuitous. She initially went to medical school with the goal of becoming a surgeon, but didn’t find a good fit within the field. Still, she credits the surgery of a man with a cancerous polyp for spiking her curiosity in forensic pathology. “I just remember being so fascinated by this specimen and wanting to spend more time analyzing it.”
Forensic pathology matched her skill set and made her happy. “It’s a great tie-in to everything I’d already done and seen. You’re still working with the body and anatomy but working far more intimately with the body tissues. It’s very analytical,” Dr. Jackson says.
Patient care goes beyond the autopsy
Just as rewarding as analysis, however, is working with the families of the decedents, helping ease them through a difficult time. “You get to work with families on some of the worst days of their lives really,” she says. Her empathy is borne from many losses of her own, beginning with her own father. “My father died suddenly when I was about five, and I remember, you want to know what happened to your loved one.” She experienced three other recent losses very close together and can easily connect with families’ complex feelings.
Providing answers through her work not only helps families find closure and offers evidence in court cases, but it is her way of providing a little bit of justice to people who may not have had it in life. The physical evidence of an autopsy, Dr. Jackson says, “is protective either to the individual being accused or someone’s family.” Her work shines a light on “systems that fatally fail people,” be that people who are unhoused or victims of domestic violence and mental health conditions. “What we are doing in these reports is part of their care, if you will, and giving a justice element.”
Her tasks don’t end there, however. She is also called upon to review a non-medical examiner’s list several times per month. She looks through a list of all deaths that have occurred within her jurisdiction to see if any classified as natural should be investigated as homicides or accidents.
Lastly, she is called upon to testify in court cases, typically for homicides, which can take place as far out as several years after the autopsy was done.
Being a medical examiner is not only fulfilling, Dr. Jackson says, it has changed her. On the one hand, it has made her more afraid to drive. “I just see so many accidents and people going about their day and someone’s either drunk driving or had a psychotic split. I prefer to walk if I can.” On the other hand, she feels, “It caused me to be a more intentional and patient person, giving people space and realizing you have no idea what anyone is going through.”
Being new to her job during a pandemic has also been challenging. “Coming to the end of all your medical training during a pandemic, there was no time to pause, reflect or even celebrate, she explains. She was thrown right into a massive amount of work that, at times, felt “non-stop” to her. Since the pandemic has disproportionately affected people of color, as a Black woman, she has found it challenging and painful to see “so many people who look like you on the table,” she says.
When she is down, however, she finds inspiration and rejuvenation in mentoring others entering her field. “Mentoring has been really fulfilling. Helping them achieve whatever goal they have is very satisfying.”
She also takes pleasure in the research that is a crucial part of her job. “I find research to be very cathartic, especially if you’re dealing with stuff that can be very heavy. If you can turn it into something that’s a benefit for others to come, whether that’s preventing deaths in the future, or affecting change on a clinical practice or policy level, that’s rewarding.”
In her most difficult moments on the job, Dr. Jackson takes comfort in the very simplest of truths: “You’re still living. Every day above ground is a blessing,” she says.