Dr. Deirdre Amaro wanted to be a doctor, but as she successfully completed medical school and actually became a doctor, she learned something essential about herself: she hates suffering. And often, that’s what sick patients do. It’s even worse, she said, when the patient is a child.

“Suffering gets to me,” she said.

So Amaro changed his medical career path. Utah’s chief medical examiner, who took over in June, can still help people, but her patients are “no longer suffering.” And the help they provide remains focused on the living—family and other loved ones who want answers and a measure of peace after someone they care about dies. The office also prioritizes learning from deaths so future ones can be prevented.

Sometimes that degree of comfort is delayed, sometimes by many years. There are few things more satisfying than identifying someone whose remains have been a mystery, sometimes for decades, and reuniting their bodies with those who searched and wondered what happened.

Recently, as Amaro and some of her staff gave local reporters a tour of the Utah Medical Examiner’s Office in Taylorsville, she almost literally jumped for joy when she answered how satisfying she found it when her staff successfully identified someone who went missing. and had been Jane or John Doe for a time.

“It’s very exciting,” she said with a huge smile on her face.

Amaro is now also at the helm of an unusual medical practice – perhaps even unique in some ways.

Only 11 states, including Utah, have a statewide medical examiner instead of some version of an elected local coroner to lead death investigations. Sometimes that elected official has little or no investigative or medical experience. The Utah office has a dozen highly trained forensic pathologists and a number of qualified and certified medical examiners as well. The office is accredited by the National Association of Medical Legislators.

The Utah one was the first medical examiner’s office to lease a pair of on-site surgical suites to organizations that collect donor tissue and long bones, which can benefit up to 100 people. The Utah Lion’s Club and Donor Connection rent the apartments so that donated eyes, skin and long bones can be retrieved without having to first transport the donor bodies elsewhere, meaning that sometimes the tissue is no longer suitable for donation due to the time he had it passed. The result is a higher number of successful tissue donations.

Utah is one of the few death investigation offices that has an in-house epidemiology team. Suicide and drug overdoses are both significant areas of focus. The Utah office is also the only one that interviews family members in overdose cases. It often provides some grief support and outreach for families. Coroners regularly deal with family members and hope to help them understand what happened while unraveling the circumstances of the deaths in their jurisdiction.

Part of the bureau’s focus is on collecting data on such deaths to help prevent similar deaths in the future. It also looks at disease processes. When COVID-19 was new, for example, the office studied the virus’ effect on bodies to help unravel how it killed.

“We took a deep dive,” said chief medical investigator Dr. Cory Russo.

That the system is statewide allows for uniform and high-quality data collection, among other benefits, officials said.

Death investigation

The Utah medical examiner’s office oversees specific deaths: those that are sudden, unexpected or occur under suspicious circumstances. These deaths could include accidents, homicides, suicides, and deaths where it is not clear what happened. The death of children is their responsibility. Staff members interact with families, law enforcement, hospitals and care providers, among others. Not all investigations lead to a full review, including an autopsy.

Just over a third of Utah deaths fall under the bureau’s jurisdiction. It investigated 7,899 deaths in 2023. Coroners do not investigate or perform autopsies on Sundays, although they receive bodies around the clock. That means Monday can be very busy, with up to 24 autopsies. Most days average about 10 which without complications take about an hour each.

Native American remains are returned to the tribes because they have their own jurisdiction.

As Chief Medical Examiner, Russo leads a team that begins its work with a scene investigation to learn more about the life that ended and how it happened. Trained investigators photograph the scene and collect evidence that will help medical examiners reach their conclusions.

The aim is to answer two questions. The cause of death is the injury, illness, or disease that killed the person. The manner of death is different and limited to five categories: natural, accidental, homicide, suicide, or undetermined.

Family members and even friends are asked for information that helps complete the picture of the person’s life, to help the coroner understand and explain how they died.

After the body is carefully examined, an autopsy takes place, where the internal organs are examined and weighed. The goal is to find illnesses or injuries that may have caused or contributed to the death. Sometimes the screening includes toxicology, tissue samples, and even genetic testing. Toxicology results can take weeks and it could be months before all the work is done on an individual death and a report is completed. They also look through medical and law enforcement records to gather relevant information.

Pulling back the curtain

While leading Thursday’s tour, Brandon Callor, manager of mortuary operations, talked about the toll on staff and the need to find coping mechanisms to avoid what he called “collateral trauma.”

A press release from the office said staff “deal with the weight of their work in many ways: spending time with their pets, volunteering, exercising, being outdoors, enjoying music and art, bird watching , coaching youth sports and more”. It noted that their pets include “dogs, cats, turtles, snakes and a lobster.”

The tour, of course, included physical locations: The Sally Port is a large, garage-like area with fast-moving doors where bodies are brought in, then moved to the front desk to be weighed and measured and paperwork filled out. There are checks throughout the process to ensure that the chain of custody is firm and the identification established, if known, which is usually the case. Personal effects are collected and recorded, then placed in lockers so families get them back, although sometimes this is delayed if it is evidence in a case.

Mortuary clerks work 12-hour shifts, receiving and releasing bodies, Callor said.

Identifying who died is an important part of the job. Sometimes this is more complicated than it seems.

There are about 40 complete or partial remains awaiting identification, some dating back many years – at least half a century back. As DNA and other advances are made, some that have lingered will likely be identified. The office has helped solve three cold cases so far this year. Works with fingerprints, dental records and DNA. A grant bolstered cold case efforts by covering the cost of DNA testing.

There are 14 brightly colored two-dimensional decorative skulls on the door of the office where the coroners (medical examiners) work – a reminder that the staff retain a sense of humor and a healthy appreciation for life, even though their work includes the dead.

Eleven medical examiners are all board-certified physicians, many with different specialties, including neurological pathologists and one pediatric pathologist. A forensic pathology fellow completes his fellowship at the U. of U. Medical School. Investigators are also board certified.

“Our level of training and experience is second to none,” Amaro said.

Autopsy room

Standing in the hallway between the special procedures room – where extra precautions must be taken to protect the medical examiner’s staff in case of unknown disease or toxins or other factors that could be risky – and the room where the remains are kept until they are identified, which sometimes lasts decades, the faint, strangely sweet smell of decaying tissue is detectable. The special-procedure autopsy room has special ventilation and sterilization procedures, Callor said, but the odor lingers slightly.

The office can store 60 bodies awaiting autopsy at a time. But what about a mass casualty event? Is there an overflow plan?

There is, Russo said, and it’s about 200 pages thick. They believe—hope—that it will cover every eventuality, although that’s never certain until a plan is tested, which no one wants to have to do.

The office includes a low-dose x-ray machine because sometimes they find foreign objects like bullets that might not be readily visible that help explain how someone died.

In the white autopsy room, where stainless steel sinks and tables allow for multiple examinations at once, there are plants high up in the windows. It’s a spotlessly utilitarian space, but not bleak. The goal is to understand how someone got there, who needs examination, and to help those left behind find answers.

The room and the entire office is really “more about life than death,” Amaro, Callor and Russo agreed, with what was learned in some cases a tool to prevent later deaths and in others a tool to help grieving families find answers.

The trio laughed when public information officer Danielle Conlon asked if they still watch episodes of “CSI” on TV. “Or give you some bananas?”

The fact that what many people know about their work is from TV shows and movies that may not truly reflect what they see or do is one of the reasons they have opened doors that are normally closed to the media and public. As Callor noted, “We don’t see homicides every day” the way TV pathologists do. But they see them.

They hold back when asked if they have everything they need to do their job. “Is your budget adequate?” asks a reporter. They allowed that state-level jurisdiction means travel costs are sometimes high, but emphasized working with legislators. Their goals, they say, are similar, including reducing preventable deaths and understanding those that do occur.