Forensic Pathology is an incredibly fascinating field, and IFLScience wanted to delve into the profession a bit more and soothe the furious questions that have always bothered our brains. Who else should we ask than Dr Judy Melinek? 

Dr Melinek has a long and extensive career in forensics and is a forensic pathologist in New Zealand, is CEO of medico-legal consultancy (PathologyExpert, Inc.), and is co-author of both the memoir Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner and the medical examiner detective series Dr. Working Stiff.

Now, she is taking social media by storm with her informative content across multiple platforms. In fact, one of her TikToks has recently gone viral, explaining (in her expert opinion) what she thinks are the most preventable deaths.  

Your resume is very impressive and comprehensive. What was your career and education path to become a Forensic Pathologist, and when did you realize that was what you wanted to do?

My father was a doctor, and when I was a kid he imbued me with a fascination for the human body. I remember him explaining to me how neurons work by drawing synapses on a napkin in a fried chicken restaurant. Every science fair project was on the human body—my father even got me some preserved mouse brains from his lab for a project comparing human and mouse anatomy. I lost both a parent and a mentor at thirteen when he died by suicide. 

By the end of medical school I wanted to be a surgeon, but when I got into surgery training as a resident doctor, I found the working conditions intolerable. It took some months of miserable 80 to 130-hour work weeks for me to recognize how important sleep and uninterrupted time with my family was. 

In the memoir Working Stiff, co-authored with my husband, writer T.J. Mitchell, we write about what it was like to work 36-hour shifts with every other night a sleepless one on call. After collapsing from exhaustion twice on the job and witnessing how the hazing brutality of surgery training was causing harm to patients in our care, I decided to switch to pathology. 

My training in clinical (laboratory) pathology was not as exciting as surgery, but it wasn’t dangerously exhausting, either. As a pathologist you work in a lab, separated from your patients, and sometimes feel like you don’t make much of a difference in their lives—even though the diagnoses you make through the microscope are critical to their care. But it was when I did my forensic pathology rotation at the New York City Office of the Chief Medical Examiner that I found my true calling. In a sense, forensic pathology combined what I loved best about surgery and lab work—it's hands-on, it's diagnostic, and the work you start comes to completion. If you read about the first death scene investigation I attended [accessed here], you’ll see why I love my profession. 

I summarize my career and education path in this TikTok video responding to misinformation on social media, and also in this blog post, where I have advice for students of different educational levels who want to study forensics.  

You are very prominent on social media. What is it like talking about death on these platforms, and have you ever received any backlash?

I have a passion for forensic pathology and medicine, and I love to teach. Despite the popularity of my field in media and entertainment, we have a serious worldwide staffing shortage. Not enough science students are discovering forensic pathology. I went on TikTok to get straight to, as they say, the youths: I figured that if I could answer questions about forensics and mentor people remotely, I could do my bit to fix the pathologist labor crisis. My greatest inspiration comes when readers of our books—Working Stiff and the Jessie Teska mystery novels First Cut and Aftershock—come up to us at book signings and say, “I am studying forensic science because of you!” 

The internet is often the first place where people search for information about their health. Since the onset of the COVID-19 pandemic, the internet has also become a source of misinformation and disinformation: from “wellness” entrepreneurs trying to make a buck, to paid bots and trolls who spread anti-vaccine and anti-public-health talking points and conspiracy theories. Very few doctors or public health experts have the time or energy to be active on social media to counteract these messages, so I feel it is my responsibility to do so with as much energy as I can manage. I do enough autopsies, thanks very much. I care about the living, and don’t want to see them end up as forensic cases over avoidable reasons.

Have you got any more examples of preventable deaths, that you were not able to mention in your original video?

 Oh, I have dozens of them! 

My first video on the subject is on the five things I would not do.

My second is on Five things I would not do—pediatric edition. Trigger warning: I talk about losing children.

And my third is the one that went viral (despite the shaky cam).

Every day that I go into work I find a lesson to be learned from death. In some cases it’s mundane stuff we all know: don’t drink and drive, don’t use drugs, don’t smoke. Tobacco and alcohol kill a disproportionate number of the patients I autopsy, but those most common vectors of fatal disease and injury don't make the newspapers. 

It’s the weird, dumb, or extraordinary ways of dying that tend to get the most attention, getting the lay public to sit up and take note, especially on social media—sometimes out of amusement or even schadenfreude, but often, too, out of an instinct for self-preservation.

Are there any particular deaths that you see more of in the holiday season compared to any other time in the year?

Yes! I should do a holiday edition video, shouldn’t I?

Here it is - I recorded it today.

DON’T shovel snow in the cold, especially if you are a middle-aged man. Get a healthy teenager to do it. It's the season for giving, so pay them as generously as you can. It's worth it, keeping you away from that shovel grip: The cold air causes the blood vessels in your limbs to constrict in order to preserve heat; combined with the exertional strain of exercise, you have a setup for a heart attack. Forensic pathologists in cold climates see it every winter. A funeral is a bad way to get together for the holidays.

DON’T put up or take down holiday decorations while drunk or stoned – or even a little tipsy –and don't do it alone. Always do this in daylight and with a secure ladder, and get someone to spot you and stabilize it. You would be amazed how many people get injured from these types of falls. Gravity kills.

DON’T drink and drive, and don't drink any amount of alcohol if you are taking medications and are going to get behind the wheel (“mixed” driving). The holidays are a hard time to get a cab, and many people will drive after partying instead of waiting for the ride. Wait for the ride. Your blood alcohol level will go down, you'll give the driver some holiday cheer in the form of money, and you'll arrive home alive. Everybody wins!

DON’T use an indoor grill or fire in an enclosed space. Carbon monoxide poisoning kills people this time of year in shocking numbers. If you are using a fire to keep warm, you need to be in a properly ventilated space, and the fire needs to be monitored and put out before you go to sleep. Check the batteries in your CO monitors. Many people change them out on New Years, so they may be running low. Don't know what a CO monitor is? It's as important as a smoke alarm. Ask about them at a hardware store, and install as many are recommended for your living space.

DON’T ever plug an electric space heater into anything other than the wall socket. Do not use an extension cord or a multi-plug adapter of any kind. Loads of fatal house fires start this way. They're avoidable, and we see them every Christmas season. We don't like to.

 What are some key areas to look at when determining the cause of death?

First, I review the police report or death scene report to get a general idea about the decedent’s age, their pre-existing health problems, and the circumstances leading up to their death. That gives me a general idea about what I am going to be looking for, and what tests I might have to run. 

For example, if someone was documented as using drugs before they died, I am going to be focused on making sure I get enough biological specimens for a reliable toxicology screen, and I may also order special tests for drugs found at the scene. Then I go into the morgue (or the autopsy theatre, as they call it here in New Zealand) and do an external examination of the body, looking for signs of disease or injury. When I've completed and documented (in writing or dictated notes, and in photographs) the external part of the autopsy, I make surgical incisions in the body and remove all the organs one by one. I weigh them, then slice them up, looking once again for signs of disease or injury. I will send blood and other fluids or tissues to the lab to be tested for drugs or poisons, and I will take tissue samples from various organs and other body parts to be turned into histology slides so I can examine them under a microscope. Once I get the slides and laboratory findings back, I compile everything, review it all, and put it together in a report that summarizes my observations and my opinion on the cause of death.

Is it true that real rigor mortis only last about 2 days where after the body becomes floppy again? If so, does rigor mortis affect your work at all?

Rigor mortis is the stiffening of the body's muscles after death. Its onset and duration depend on the ambient temperature and can vary a lot. At a comfortable 18° C [64.4 ^oF] room temperature, it takes about 12-24 hours for rigor to reach its maximum. It will typically dissipate after two days—and, yes, the body will then become floppy again, but it will have also undergone many other decomposition changes, so it will not look or smell the same as when it was fresh. 

Rigor mortis can have a quicker onset and may dissipate faster at warmer temperatures or if the decedent had been exerting themselves right before they died. We use rigor mortis along with other observations like algor mortis (the cooling of the body) and lividity (blood pooling after death) to estimate the post-mortem interval. This helps families know when their loved one died, and sometimes it answers questions in criminal and legal cases. I have been involved as an expert in several court cases where the time of death was a factor in charging someone with a murder. In some cases, when it became clear that the accused had an alibi for the period of time that the science has established the death must have occurred, those defendants have been exonerated. This is a case I worked on where time of death made a difference in an exoneration.

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