Forensic Ed (Reader Discretion Advised)

August 1, 2009

One of the best parts about working in a remote hospital is the opportunity to rub elbows with people who are doing work that would normally isolate them in some dank office downtown.

One of our physicians, Dr. M, is a young man with cerebral palsy. His spasticity prevents him from getting a license to do family practice in other states, even though it's pretty well controlled with a spinal shunt that infuses medication to help relax his muscles. He does not want to make the Arctic his permanent home, so he decided to become a forensic expert in child abuse. He'll start his 3-year residency next summer. In the meantime he'll continue to provide expert testimony on cases of adult assault and abuse of children here.

I thought I should take advantage of Dr. M's expertise while I could, since sexual abuse and domestic assault are so pervasive here. Alaska has six times more child abuse than the lower 48 and here in the Northwest Arctic Borough, the highest rate in the state. I was spoiled while working in Minnesota as St.Paul has the world-class Midwest Children's Resource Center, where I referred all suspected cases of childhood sexual abuse during my 20 years of practice there.

Although I feel the need to be more knowledgeable because I am working on the front line here, the basic practice rule stays the same: if the story sounds plausible, the nonspecialist like me needs to send the victim right on to the child abuse specialist because of the chance of contaminating the story by leading the victim. A clinician's innocent blunder can ruin a court case. As Dr. M explained to me, there are volumes written about how to extract the story and analyze the physical evidence in order to elicit the truth about what happened. Generalists don't make time to study those tomes. Except maybe the most curious or perverse practitioners. Seven percent of doctors are psychopaths, so who knows what they study in their spare time.

Dr. M was preparing expert testimony for a trial the following day and invited me to join him as he made a last pass through the evidence. This case involved an adult instead of a child, but I was eager to learn more about the physical manifestations of assault as it would help me hone my powers of observation during routine exams. Well-practiced medicine is after all a matter of astute sleuthing.

Dr. M read me the report he wrote based on the interview of a young woman who was strangled to the point of lost consciousness and then raped. The accused is up for rape and attempted murder charges. He proceeded to show me 180 pictures of her injuries as well as normal skin findings taken the night of her assault. He quizzed me as we went. I used my common sense but was sometimes clueless as to the signs he was showing me. The story is registered on the skin like the print on this page to those who can see.

Ninety-nine percent of rape here involves a woman who has lost all judgment and control from alcohol. I feel vindicated. Several of my female colleagues have told me it's unsafe to wander around town alone. So I can walk around town any time of day or night -- just as long as I'm sober.

We scan her arms. The paw prints on her arms are easy to decipher. The initial grab.

Two symmetrical bruises on the mid inner thigh? Cunnilingus. But which direction is he facing? Shouldn't his body be smothering her in case she wakes and resists? No, Dr. M says, the other way. He is stabilizing her legs with his thumbs to keep her from moving suddenly. Good hunch though, as women usually do come to during the rape.

When we get to the detailed photos of the vaginal area, I feel a comfortable sense of familiarity. During a pelvic exam there is a tendency to look comprehensively but briefly. Now I stare and study in a way that would be inappropriate with a live patient.

There is a vertical tear in the posterior fourchette, which is below the labia minora or inner lips. He tells me this is critical, classic evidence of forced entry. Like the cracked glass of the back door in a burglary.

He uses a colposcope, a microscope tailored to exploring human epithelial anatomy, to search the vagina for more evidence. Once, he tells me, he found a hair left by the perpetrator. This single piece of DNA-encripted evidence put the guy away for forty years.

We move up to the neck. There are bruises but not as impressive as I imagined they would be.

He had forced a kiss on her. She remembered that because it occurred before she had lost consciousness from strangulation. I made conjectures about the abrasions on her chin and lips and how his teeth or chin may have caused them. Dr. M appears at a loss at this point. He says, not too self-consciously, that he isn't much of an expert on kissing. I joke about my own knowledge and proclivities. What a strange moment, talking to this sweet, spastic, drooling man, who is 25 years my junior, about our respective experiences and acumen in the area of kissing.

Now we come to the most crucial piece of evidence. It is a centimeter-long superficial laceration along the jaw line. He asks me about its significance. I squint, cock my head and shrug. Jubilantly, as only Dr. M can be, with his infectious laugh that lasts just a beat too long due to his spasticity, he says, "Self-inflicted from her own fingernail, it proves that she was trying to pry his hands away from her neck as he was strangling her." They weren't playing a sexual game of asphyxiation as the defense will surely suggest.

We are just wrapping it up with a few pictures from inside her mouth when Dr. M points excitedly at something he missed before. There are petechiae (minute exploded blood vessels) on the inside cheek -- evidence of prolonged strangulation. This will help support the attempted murder plea because it suggests a greater degree of asphyxiation indicating an intent to do serious harm. This is important, he explains, because this is this perp's fourth victim in a town of 3500 people.

Although Dr. M assures me his job is "one hundred percent non-biased" as an expert witness, he wasn't exactly exuding neutrality at this moment, or throughout the examination. Instead I saw passion, and mission, and utmost seriousness. I can't help but think that all the childhood punishment he must have received for being a weird-looking spastic boy had to have made its mark on him. And what a functional if arduous way to get back at the dark side of human behavior.

Alaskan Animal Stories Amid a Little Night Music

July 30,2009

Dear Friends,

Last night after a hectic day spent in radiotraffic at Maniilaq Hospital in Kotzebue, I headed over to my friends' house for some R and R. Wendell Stalker and his wife Mary have a small beachfront home laden with animal skins, garlands of artificial flowers punctuated by pots of the real thing, pictures of family everywhere, and 5 or 6 guitars huddled along one wall of the living room. I detected as before the faint odor of dog, the scent of its rearend apocrine glands subtly wafting across the room.

Mary, who is usually the first to give me a big hug and big smile, hung back while Wendell, a gentle small Inupiat man in his fifties greeted me in his reserved way with a pat on the back and a mere meeting of chests. Wendell, pony-tailed, wears large glasses which allow one to track his very expressive eyes as he tells his stories in sotto voice. He met Mary five years ago in church where they began singing and playing guitar together. She's a down-sized Mama Cass, a California transplant who has spent her adult life in Alaska.

We started by talking about Wendell's music career. He and his four brothers taught themselves how to drum and play guitar. He played in an underground bar in Kotzebue in the 60's where he had a "chaperone" because he was underage afterhours in an alcohol saturated environment. After high school, Wendell took off for the Jobs Corps, a track many motivated Inupiat youth take to get work that pays. He started playing in a blues band and pretty soon he was making way more money than he was likely to make after graduating from the Corps with a technical skill. He and two other dropouts -- Native Americans from the West -- formed a band called The Local Blues Band -- and they got an agent and made some really great money playing all over the Northwest. He said, "Man, people in Missoula were only good for C and W until we came to town." No one up there knew how much they could like the blues. They made $15,000 on one gig -- gone getting high. Mary laughs then saying, "Yeah, we were all doing drugs, sex, and rock and roll back then." Wendell eventually played with Muddie Waters.

The Inupiat have a long tradition of partying for days on end after a successful hunt. It's like a prolonged carnivorous harvest celebration. Then they sleep for days. Wendell describes Thanksgiving homecomings in the 80's when all five brothers would stay up Thursday through Sunday playing music. "That's how many songs we knew back then." Now two of his brothers are dead and those are bygone days.

A break in the conversation, and Mary tells me that four days ago someone shot and killed Hunter, their 7-year-old dog she raised from just 4 weeks. She starts to tear up and says "I am so mad and I don't want to be mad." Somehow Hunter got out onto the road and when the neighbor children found him he was floating in the ocean face down. I looked blankly at her and asked why anyone would do that and she said, "it's fishing season." I just held her hand and said how sorry I was because a dog is as close to your heart as a child. And I knew too that her oldest son was killed in an auto accident in Fairbanks.

I said,"Well there's nothing like music to raise the spirits -- how bout you guys playing me some songs?" Then they dueted on "The Sweet By and By" and several Christian songs that seemed somehow familiar but I couldn't have named them. And it worked and before you know it they were telling me stories about living "at camp," which means the tundra, wild tundra of northwest Alaska.

Wendell reminisces about the years he and his brothers left their home in Kotzebue to help their aunt and uncle with chores on their homestead in Point Lay, a windy, forsaken settlement on the Arctic Ocean west of Barrow. They squatted in the abandoned sod homes, eventually building new places for themselves. It was a hard place to live for long as the wind never seemed to blow less than 35 miles per hour, 70 to 80 mph being the norm. Two of his brothers stayed on, married, and brought their wives to live there making it a tiny settlement without any amenities in the 80s.

"So," I asked Wendell, "tell me the truth about bears. How dangerous are they really?" The two of them then told me the story of their trip out to Wendell's family camp in a remote part of the tundra two years ago. They only had a tent and a fish-drying rack so this wasn't like a second vacation home. It was spring and a good time to hunt ugruk (bearded seal) from an immobile ice flow, shoot migratory ducks and geese, and fish.

They chose a fishing spot about a thousand yards from their camp where two streams meet forming a little peninsula. About three hours into an idyllic afternoon, Mary, Wendell, and their friend, Roy, spotted two grizzly bears moving aggressively toward them on the peninsula.

"They looked hungry," Mary said. Mary and Roy were very frightened. Wendell said he knew he could not let their fear enter him. He started yelling loudly in Inupiat telling the bears he would kill them if they ventured across the stream. He yelled at them for a very long time. He shot his duck rifle in the air to show them he meant it.

Wendell explains that he had to intimidate them with his body language, his vocal inflection, his eyes or they would surely cross the stream and attack the three of them. He described it as a very spirit-driven confrontation. Underlying it was a fierce cultivation of mutual respect between man and wild animal.

The problem was they had no weapon adequate to kill the bears. Now Mary talks about how stupid she was to have come unprepared. She left her Magmum 375 in the tent and her handgun had no ammo because she had removed it for safety reasons while on the bush airplane. She says this was the only time in all her years in Alaska when she wasn't prepared. "I let my husband down," she said, her disappointment in herself still palpable in the retelling of the story.

The bears turned around and ambled up the hill a ways. Then they turned back again and lay down facing Wendell, and watched and waited for 4 hours. He explains he couldn't retreat or they would have attacked. Mary by that time had rejoined Wendell with her Magnum 375. But they didn't want to kill the two bears except in self-defense. Killing them meant skinning and gutting them without proper equipment or the means to get them home. And a true Eskimo hunter never kills an animal only to leave it there to fester. This is considered deeply disrespectful to the animal's spirit.

Finally the bears went up and over the hill and soon the humans heard a great deal of squalking in the distance as the bears plundered the duck and geese nests, gobbling the eggs and the birds that remained to protect their young.

I asked Wendell how many times he had encountered bears in his life. He said about 15 times -- always with other male Inupiat hunters. I asked how those encounters were different. He said "The bears always ran away."

At the end of the evening I asked what happened to the brothers who stayed on in Point Lay. Wendell said one was eaten by a polar bear. I didn't have the courage to ask about the other.