Book Club: Working Stiff by Dr. Judy Melinek and T.J. Mitchell

I wanted to learn about human anatomy.

It’s a running joke in my family that we all sucked at biology in school, and dropped the subject like a hot potato as soon as we could. As I’ve become more and more interested in health and fitness, however, I found my embarrassing lack of knowledge about the human body to be a handicap.

I bought a college anatomy textbook, but found it too dense for a biology beginner. I tried watching Crash Course: Anatomy and Physiology, which was a lot more accessible, but was still a firehose of information that I struggled to fully digest. When I found myself staring blankly at the Michigan edX Anatomy course instructor writing “osseous tissue” on the screen, I decided I needed a different approach.

I needed something oriented around a story, I decided — I needed to find a story of anatomy. Maybe something about clandestine dissections of human bodies, or about how each bone and muscle was discovered and christened, or whatever. Just not a college textbook.

I went on Amazon and searched for narrative non-fiction books with a focus on anatomy. That is how I found Working Stiff by Dr. Judy Melinek and her husband T.J. Mitchell. Working Stiff is a memoir about Dr. Melinek’s two years at New York City’s Office of Chief Medical Examiner (OCME), where she learnt how to conduct autopsies and piece together the stories of the dead.

I’ve been fascinated by medical memoirs for years now, especially the “making-of-a-doctor” subgenre. Like any good genre story, there are certain tropes that appear in every making-of-a-doctor story: the bright-eyed new doctor, fresh out of medical school, sees their first patient; the new doctor who doesn’t know how to insert a cannula/suture an incision/other routine procedure and has to be taught by a nurse; the new doctor’s first code, first death, first “I’m sorry, we tried our best”; the crazy shifts that leave the new doctor falling asleep anywhere it is possible to fall asleep (on a gurney; in traffic); spousal troubles from the doctor’s gruelling workload; the shift where the young doctor is alone overnight and a patient comes in in awful shape; the case where the young doctor nearly misses a serious diagnosis; the case where the young doctor saves the day and gets a laconic utterance of praise from their attending physician; the doctor’s last month, last week, last day as a resident, before they morph into a beautiful, complete, board-certified physician or surgeon.

Well, Working Stiff is a very different kind of making-of medical memoir. The story starts with Dr. Melinek as an overworked first-year surgery resident who quits after she has to perform an appendectomy on a patient while she (Dr. Melinek, not the patient) is feverish with the flu. She switches to pathology, loves it, and her chief resident tells her to do her forensic pathology rotation in New York:

“If you really want to learn forensic pathology, do a rotation at the New York OCME,” my chief resident advised. “All kinds of great ways to die there, and the teaching is brilliant.”

That is how Dr. Melinek finds herself as a forensic pathology fellow at the NYC OCME after completing her pathology residency.

It is true that New Yorkers die in unexpected ways, although I don’t know if I would call them “great”. I'm not going to lie, though: some of the stories made me wish I were still living in that crazy city, always on the edge of adventure. Dr. Melinek tells of the time she was assigned to the “postal bin case”, when the NYPD hauled an postal bin containing a dead body to the morgue for the medical examiners to deal with. (Spoiler: homicide by heroin poisoning — yes, you read that right.) During a fight, a man is pushed into a 300 deg F steam tunnel and boils alive. (Boils dead? Boils dead alive?) A decomposed body is found on its knees with an electrical cord around its neck, and words scrawled in blood in the kitchen and on the bathroom door.

For the forensic pathologist, the focus is finding the “proximate cause of death”: the last mechanism that resulted in each person’s death. Their analysis is medical, not legal or criminal. We think of people as dying in car accidents or falls, but medical examiners think of them as dying of “acute intrathoracic aortic transection” (translation: broken aorta) or a “subdural hematoma” (translation: bleeding between the brain and the skull). I learnt some physiology that I’d never thought about. For example, medical examiners can reconstruct the order in which bullets hit a victim based on how much blood there is around each gunshot wound, because arterial pressure drops and less blood hemorrhages out of later wounds.

This is a making-of medical memoir that, by nature, turns most of the common medical tropes inside out. For doctors, as for most of us, a dead body is an ending, but for forensic pathologists, it is a starting point. Through each dead body, Dr. Melinek is able to reconstruct each person’s last moments, bringing their stories to life. Instead of the nervous meeting with the first patient, Dr. Melinek dissects her first cadaver and fails to figure out how he died; instead of a nearly-missed diagnosis, Dr. Melinek makes a mistake on a death certificate that could have sunk a homicide trial. She has victories, too: a woman with narcotics in her urine dies after a blood transfusion. Hospital doctors write the death off as narcotic-related, but Dr. Melinek’s investigation leads to the unusual (and correct) diagnosis of TRALI (transfusion-related acute lung injury), and gets a laconic utterance of praise from the chief medical examiner.

An essential component of the medical memoir is the origin story: what made the author decide to become a doctor? In this case, the story about quitting the surgery residency is mechanistic, almost like a plot device that leads to our heroine finding her calling in pathology. The real origin story that runs like an undercurrent throughout the book and gives Dr. Melinek's work purpose is the suicide of her father Menachem Melinek. The senior Melinek’s death, which happened when Judy Melinek was just 13, shapes how she thinks about her profession. Suicide is perhaps the most brutal type of death for those left behind, and Judy Melinek understands more acutely than most our need for answers from those who cannot give it.

“Taceant colloquia. Effugiat risus. Hic locus est ubi mors gaudet succurrere vitae.” I stared at the words… The security guard’s expression softened; it was clear that she had greeted a lot of stunned people walking into that building. She glanced back at the polished silver motto and said, “‘Let conversation cease. Let laughter flee. This is the place where Death delights to help the living.’”

A shadow that necessarily looms large over the story is 9/11. The book contains the level of precise detail one would expect from a forensic pathologist, including the dates of autopsies, and their proximity to September 11, 2001 is impossible to ignore. As I read, I wondered when I would get to the chapter on 9/11, and when it came near the end of the book, I was not disappointed. From the point of view of narrative structure, 9/11 is a natural climax. Nothing tops 9/11 in terms of drama, or in terms of magnifying the importance of the medical examiner’s office.

Even the 9/11 story turns a medical memoir trope on its head: it begins with one of Dr. Melinek’s friends, an oncologist who rushed to her hospital on the morning of September 11, and sat with her fellow doctors waiting for mass casualties to arrive. They didn’t.

In terms of medical complexity, 9/11 did not seem particularly interesting the way it was described in the book. There was no mystery about the cause of death. That's not to say the 9/11 story is shallow or insignificant – quite the opposite. The 9/11 chapter documents Dr. Melinek’s boots-on-the-ground perspective of a massive logistical effort to solve the mystery of how many people died in the World Trade Centre buildings, to give the bodies and bones names and to give families and friends closure. It's clear that Dr. Melinek enjoys the intellectual challenge of her work, but it is just as clear that the driving force of her work is emotional in nature. Medical examiners seek out the stories that dead bodies tell, in order to bring peace to the living.

I wanted to learn about human anatomy. Did I get what I wanted? I certainly didn’t get an anatomy textbook. I got, instead, one heck of a story about anatomy and physiology as dynamic disciplines, and a story was what I was looking for. I’ll be cherishing the experience of reading this book for a long time.