The body on the table was that of a 28-year-old man. Inside an autopsy bay, professionals from the Denver Office of the Medical Examiner were trying to figure out what killed him.
To the doctors and forensic pathologists who perform the valuable service of cataloging Denver’s dead, this was just another day at the office. On a recent Monday morning, there were at least four autopsies scheduled — part of a dramatic increase this year partly driven by a surge in fentanyl-related drug overdose deaths. As of early December, the office had performed more than 900 autopsies in 2021, dozens more than it did in all of 2020 and hundreds more than in 2019, each one carried out according to a precise order of operations.
Inside those autopsy bays, every body is a puzzle to be examined, interrogated, magnified. In there, it’s just science.
But, of course, each body is also a story, and here is part of that 28-year-old’s: Visiting his father one night, he took a little blue pill to relax and never woke up.
It would take weeks before the science could confirm whether the death was related to fentanyl, but two things were already certain that morning: The death would bring immense grief to someone left behind, and the police, very likely, wouldn’t consider it a crime.
Because there would be no criminal investigation and no prosecution, the families of the deceased wouldn’t have access to victims’ services through the police department or the district attorney’s office. They might not have someone to connect them to grief counseling or to talk them through how to find a funeral home.
The same thing happens with suicides, with accidents, with all manner of sudden deaths. Someone is suddenly just gone, and the people who love them are left adrift.
Coroner’s offices are, by necessity, tidy places. When an autopsy finishes, everything is quickly cleaned up. Floors are scrubbed spotless. Gowns are hung in neat rows. Tables and tools are rearranged in perfect symmetry.
But, in Denver, the medical examiners and investigators increasingly found themselves overwhelmed with a different kind of messiness that couldn’t be so easily put away. Family members of the deceased would call, again and again, to learn how their loved one died. They called to ask how to get a death certificate or arrange a burial or to hear a friendly voice during a moment of emotional pain.
“If they just want to talk about it, I’m there to listen,” said Steve Castro, the manager of operations at the medical examiner’s office. “But am I trained to do that? Not really.”
So, the Denver coroner’s office created a first-in-the-state family advocate program to provide support from trained victims’ advocates to the loved ones of the deceased. The office now hopes to expand the program — and that it will catch on in other jurisdictions.
“They have to keep their emotions out of it to do what they do,” Meghan Clark, the office’s family advocate coordinator, said of her colleagues. “That’s why we’re here.”
The need no one was trained for
In his seven years at the medical examiner’s office, Castro said there was one type of call that always bothered him.
Castro is in charge of the office’s media releases, which often provide public notice of the identity of a victim in a high-profile incident. Every time before he sends a release, Castro said he calls the victim’s family to let them know.
“I’d say, ‘Hey, we did an autopsy, here’s the cause and manner of death,’ kind of walk them through any of the death process on how to look for a mortuary and anything else,” he said. “And then I’d hang up. … And I always felt bad about that. That was my last conversation with them.”
Except, sometimes, it wasn’t.
Sometimes people would call back and ask him to repeat what he had told them earlier, and sometimes they’d do that more than once.
“A lot of times people have tunnel vision” when they’re first informed of a death, Castro said.
Other times, people seemed to call out of loneliness or isolation. This happened especially after the initial rush of attention surrounding a death faded away and the bereaved’s friends and family went back to their everyday lives.
Erin Worrell, the office’s chief of investigations, recalls one person who showed up at the office to show her pictures of his cat. Sometimes people call to vent about conflicts with family members during the estate-settlement process. Other times people might call for advice.
“I’ve seen a lot of times family members say things like, ‘How do I tell their kids?’” Worrell said.
It became clear that the office needed someone who could do more than provide a sympathetic ear. They needed someone skilled in helping families navigate grief.
Castro said he scraped together some vacancy savings to fund a family advocate position. In Clark, they found someone with experience working as a victim advocate at both a police department and district attorney’s office but who was ready for a new challenge. The program has since expanded to include several interns and volunteers who help Clark with the work.
“The reason why a family advocacy program is so vital,” Clark said, “is that it helps families address the initial What do I do?”
Calling to check in when nobody else has
Clark’s job, though, isn’t just about dealing with the immediate aftermath of a death.
One of the first calls she took when she started in the position this summer came from a woman whose mother was killed on Christmas Day in 1978. The woman had been in the house when the killing happened, just a little girl then. Now, she was hoping she could see her mother’s autopsy report.
“Just in talking with her, I knew she needed more than the autopsy report,” Clark said. “I knew that the autopsy report was not actually what she needed. She wanted to know what happened to her mom, because she was too little to remember.”
So Clark reached out to Denver police and to the district attorney’s office to track down the case files. She found a detective who had gone to the scene. Once all the documents are assembled, Clark hopes everyone can sit down together to go over what happened and answer the woman’s questions.
Clark also connected the woman with a grief-support group in her area, after hearing how as a child, the death had tossed her into a cycle of foster homes and trauma.
Not every case is so involved. Sometimes people call looking for copies of documents. Other times they request blood samples that the coroner’s office keeps in storage for a couple years after each autopsy, in order to run genetic tests. And sometimes Clark calls families just to see how they’re doing.
“I usually start by explaining who I am and immediately saying I’m a family advocate, so that they know I’m not another death investigator calling with more bad news,” Clark said. “And I just tell them the purpose for my call is to check in on you.”
The approach has proven tremendously effective at reaching people in need who are resistant to help from other sources.
Clark recalled a conversation one of the family advocate volunteers had with a mom whose son was killed by police. The police department was providing her little information as it completed its investigation, and she was struggling to care for her family while also suspicious of people calling from government agencies.
But when the volunteer explained why they were calling, Clark said the mother’s “fences went down and she just started crying. She said, ‘Nobody has asked how I’m doing. Nobody.’”
Because of the delicate emotional state of the people the program works with, the medical examiner’s office declined to connect The Colorado Sun with a family whom the advocate program has helped for an interview. But it did provide emailed notes of gratitude the office has received from some families.
“I appreciate how patient all of you were with me as I processed the circumstances,” one typical email reads. “The TV shows never show ME (medical examiner) staff helping family members deal with their loved ones’ deaths, and I didn’t realize how supportive you would be.”
Ending the cycles of grief
There is also a more strategic goal for the family advocate program, one that Castro and others at the medical examiner’s office hope can help reduce the office’s rising workload and the city’s recurrent traumas.
Often, Castro said, the office doesn’t deal with a family or a group of friends just once. One death can lead to another — a person who lost a loved one to suicide will months later die by suicide; a person who lost a family member to a drug overdose will later succumb to an overdose, as well.
“I’ve noticed them over and over and over,” Castro said of these chain-reaction deaths.
This is why the family advocate program places a special emphasis on child fatalities and deaths from suicide and overdoses. Every one of those cases that comes into the office gets flagged for Clark and her team to follow up on.
The grief from these deaths can be corrosive, leading to worse mental health for the bereaved. The family advocate interns have started a project to track how grief from one death can contribute to another. On a whiteboard in their office area, they chart whether people who recently died by suicide or overdose in Denver had themselves recently lost someone close to them.
By helping to address the grief that sustains the trauma, the medical examiner’s office hopes to stop the patterns that lead to recurrent suffering in the city.
“I think intervention is what gives people the space to break those cycles and making sure that it’s meaningful intervention, and that you’re getting them connected with the right kinds of resources,” Clark said. “And understanding that it’s going to take time, and you might have to be on that journey with them for a while. It’s not going to happen in one day. You might have to actually have lots of phone calls with them.”
Hopes for expansion
All of this makes for a daunting workload for Clark, but she’s already eager to add to it.
She has undertaken an effort to create a more welcoming place at the medical examiner’s office for families and advocates or investigators to meet. Previously, those meetings took place in a bland conference room devoid of warmth.
She has also assembled a handful of bins with stuffed animals, toys and games for when families arrive with children in tow. Clark believes firmly that the office needs a place where children can play quietly while investigators or advocates have conversations with family members too traumatic for young ears to hear.
And then there’s the therapy dogs. It’s not just the emotions of the bereaved that need tending to, Clark said. The office’s employees also need to look after their own wellbeing after dealing with so much reflected grief. So Clark has started bringing in therapy dogs for the office staff to cuddle and has developed other self-care programs.
There’s a lot to do, she knows. But that’s only because there’s so much good the office believes it can do.
“I don’t think there’s ever going to be such a thing as getting on top of all the work,” she said, “but I do hope that we can expand it. I have high hopes for it.”