Postmortem: How Medical Examiners Explain Suspicious Deaths by Stefan Timmermans

Robert Roose, MD

Each chapter is interesting and informative, full of historical anecdotes, careful accounts of autopsy procedure, and thorough explanations of forensic logic.

Postmortem: How Medical Examiners Explain Suspicious Deaths

Publisher: University of Chicago Press
Length: 360
Price: $30.00
Author: Stefan Timmermans
US publication date: 2006-06

It is possible that you are as weary as I am of the rash of glossy accounts of forensic science saturating popular media. If so, you will be pleased to learn that someone recently decided to turn the (autopsy) tables and put the authority of medical examiners under the microscope. Because while it is clear that the popularity of C.S.I. and Patricia Cornwell's fiction has uncovered a latent interest in forensics, there is a much deeper significance to the work of these experts never broached by these storylines. Not until Stefan Timmermans' well-researched book Postmortem can we truly start to understand the complex sociological questions that underlie the investigations and explanations of unnatural deaths.

Off-screen forensic pathology is just not that sensational. Trust me, I know; pronouncing someone dead and determining the cause of death is rarely suspenseful and never glamorous. It is, however, an extremely interesting cultural phenomenon -- which is why Timmermans, an academic sociologist, is the best man for the case. Just as medical examiners "bring society and body together to make sense of suspicious death" in the morgue, he spent three years observing autopsies, interviewing pathologists, and studying cases in order to probe deep into the processes of forensic decision-making.

Unlike its subject matter, Postmortem reveals its origins quickly. In the opening lines, Timmermans asserts that "death is not an individual but a social event" and that the social order of dying is disrupted when death is not expected or easily explained. Just like when Rico found the hotdog lodged deep in Edith Kirky's throat, these suspicious deaths, which account for nearly 20 percent of registered deaths, fall under the jurisdiction of the local coroner or medical examiner. And by integrating autopsy results, toxicology tests, medical files, and data gathered at the scene, these experts become the "authorities" who are responsible for the final classification of such deaths.

On the surface it seems like a straightforward, albeit technically difficult, task. However, as Timmermans shows us through six dense case studies, there is nothing simple about it -- and as is often the stereotype of academics, he favors broadening the discussion instead of focusing it. He asks grand questions: When do deaths become suspicious? How do death investigators satisfy audiences with conflicting expectations? What is professional authority? And he is honest about the lack of answers, instead providing a framework, somewhat hokily organized around hope, to think about them.

It is with this perspective, executed with an exhaustive attention to detail, that makes Postmortem such a successful book. Building off actual cases, he describes how "stenosis by atherosclerotic plaque" becomes death by heart attack in one man but not another, or how "the 51 percent rule" determines suicide. Each chapter is interesting and informative, full of historical anecdotes, careful accounts of autopsy procedure, and thorough explanations of forensic logic. Yet Timmermans' strength as a social analyst shines in his presentation of how forensic credibility is judged at "The Nanny Trial." Taking transcripts from the court records of the Louise Woodward shaken-baby trial, he puts the separate expert witnesses (along with their evidence and qualifications) back on the stand. But this time, with the acuity of a scientist who has previously published on professional power, he provides a running commentary of how the discussions of evidence reflect the principles of forensic expertise and will inform future practice standards. In this way, Postmortem is not a typical case; it never closes, but rather evolves with time.

Through it all, Postmortem deconstructs the authority granted to medical examiners and masterfully explains in what ways the character of their work influences "how we understand and give meaning to suspicious deaths." Ably mixing extensive research and problem posing, it is a text of great depth.

Unfortunately within the strength of Postmortem is also its struggle. The bulky technical passages will alienate some readers; the redundant theorizing will bore others. At times, Postmortem is too academic and theoretical for its own form, the glaring proof lying in 74 pages of footnotes and references affixed to his text.

As we know, in most cases, the occurrence of death is absolute. In some fashion a heart stops beating; blood stops flowing; breathing becomes erratic; and a brain stops functioning. However, as Timmermans exhaustively shows us, in the world of unnatural death, little else is so clear. With Postmortem, he seeks to get under your skin and into your head, and if you can stomach the depth of its rigor, you will be rewarded.

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