Among the socially forbidden realities of death, the autopsy may get the coldest shoulder of all.
To many people, the very idea of an autopsy is morbid and taboo. And that's understandable.
We've all heard the lament when a loved one dies suddenly: "I don't want anyone cutting into her/him."
I've read enough, watched enough TV and have known coroners long enough to have an idea of what to expect at an autopsy.
But there were surprises. Perhaps chief among them was the fact that it wasn't what my imagination had suggested.
It is not a pleasant process — the postmortem examination of a human being; inside and out.
But it was not a particularly disturbing process, either.
I will be as gentle as I can be, but I also wish to warn you: Some aspects can be unsettling.
In the end, however, the answers are worth the pursuit.
The drive to deliver
At first, it was just the three of us in the black Ford Expedition: Me, Rock Island County Coroner Brian Gustafson and Times photographer John Schultz.
I freely acknowledge feeling uneasy when I looked over my left shoulder from the front passenger's seat and saw the stretcher right there — its frame pushed against the back of Brian's driver's seat.
"I can fit two of them in here, and I've done that," Brian said. "I took one of the cots out today and put a seat up to make room for you."
It was one of many times that Brian's professionalism, thoughtfulness and matter-of-fact delivery put me at ease. His all-business confidence in what he was doing settled my nerves.
We drove to a local funeral home, and Brian backed his beast of an SUV into a large garage that contained other stretchers and a funeral car.
The stretcher's collapsible legs made its removal nearly effortless, and Brian wheeled it toward a room from which a funeral home employee emerged. The two carefully moved an obviously occupied body bag from one stretcher to the other.
They briefly exchanged information about the deceased, then the stretcher was pushed just as seamlessly back into the SUV. John and his cameras sat next to the body for most of the two-hour round-trip drive, though we switched places briefly, so John could take some pictures of Brian behind the wheel.
“A lot of people don’t like to ride with a body in the car," Brian said. "It’s a bit of a tight fit with two bodies, but I've done it, and it saves taxpayers a ton of money."
Until he took office in 2008, Rock Island County taxpayers spent between $300 and $500 each time a funeral home was hired to deliver remains to out-of-town forensic pathologists.
In the 10 years he has been coroner, Brian has saved nearly $200,000 by delivering remains himself.
“Of course, I have no back left,” he said of the physical wear-and-tear.
When autopsy charges went up recently at one place, he found another. Today, most of the county's autopsies are performed in Oregon, Ill., which neighbors Dixon. When his regular doctor isn't available there, he has backup resources in Peoria and Bloomington.
As we headed east on Interstate 88, I felt a pang of anxiety. What if I couldn't handle it and had to leave? How will I write about what happens at an autopsy if I have to excuse myself and wait it out in the parking lot?
So, I slipped into a comfortably familiar role as inquirer and started asking questions about the people we'd meet in Ogle County.
Brian said we would be observing the work of board certified forensic pathologist Mark Peters. He spoke highly of "Doc," warning me that their familiar, breezy banter should not be misconstrued as insensitivity to their work. Doc performs hundreds of autopsies every year, and he's been doing it for many years. If solemn conversation was required of every procedure, they would go mad.
I witnessed no shortage of sensitivity.
Things have changed
In 2017, Brian delivered nearly every one of the 55 people who died in Rock Island County to out-of-town autopsies to determine their causes of death.
In 21 of the cases, drug overdoses were the cause. That's the highest number he's ever had. And, until a few years ago, the cause of death was regarded obvious in overdose cases.
"I used to never autopsy them," he said. "I'd do toxicology (drug/alcohol screen) and get my cause of death.
"In about 2010, the DEA (Drug Enforcement Agency) started going after the suppliers. They started going after the dealers that supplied them the dope. It was happening on the coasts earlier than that, but the policy made its way here.
"Defense attorneys can pound me if I do only toxicology. They could ask me on the (witness) stand whether it could have been a heart attack or stroke or pulmonary embolism. So, along with the toxicology proof, I have to rule out other causes."
When children die, Brian loses sleep. And he acknowledges having cried himself to sleep more than once, especially when the kids were the same age as his own children at home. But overdose deaths are hard, too. And that's because they are preventable.
“Overdoses are my nightmare, and it’s the weirdest pathology," he said. "Drug addicts hear that someone overdosed, and they want to run to that person’s dealer, because they think he’s got some really good stuff.
But those feelings of sadness over unnecessary deaths, and the profound sympathy he feels when a child is lost are the very things that assure Brian he is doing what he's supposed to be doing. If a day ever comes that he doesn't feel an ache in his gut, he'll get out of the business of caring for our dead.
"This is my calling," he said. "I really believe that. If it ever gets easy, I'd have to rethink it. It's supposed to be hard."
The autopsy begins
You will not read the cause of death in the autopsy I observed.
We are not identifying the decedent, and we've been careful to omit any potentially revealing details.
Brian asked for my word the identity would remain private, and I couldn't agree fast enough.
When we arrived at the morgue next door to the Ogle County Sheriff's Department, Brian removed the body from the car and wheeled it into a large room that looked very much like a surgical suite. Sinks and tables and scales are stainless steel, and the doctor's assistant was wearing scrubs.
The body was moved from Brian's cot to a stainless-steel table. I was not prepared for the rest to happen as quickly as it did.
As soon as the body was on the table, forensic technologist Gene Conus unzipped the body bag. The bag fell instantly to each side of the body, revealing a fully clothed person. I recognized rigor mortis, which is the stiffening of the joints and muscles after death.
Since the person appeared from a few feet away to be merely sleeping, I was relieved to see the obvious signs of death, because I knew what was coming next.
Things get harder
If you are squeamish about death or medical procedures, I would urge you to skip the next two sections of my column.
The decedent's clothing was removed with considerable efficiency. Then Dr. Peters and his "diener" (German word for autopsy tech), Conus, took a close look at the body. They were looking for anything unusual — any signs of trauma, injury or outward hints of disease.
Conus then used the power tools he brought with him to open the body, beginning in the area of both collar bones and extending below the abdomen into a "Y" shape.
I took comfort in something Brian had said in the car: "By the time I get the call to pick up a body, that soul is long gone. It's in heaven, hell or purgatory. That's how I was raised and what I'll believe until the day I die."
It may sound ridiculous, but I had to remind myself that no one was really in there. The body was an empty shell, and the person who once occupied it had gone away. What was taking place in front of me was something that is done to bring peace to the living — those who loved the former tenant and need to know how the body had failed.
With the skin and attached rib cage out of the way, the chest and cavity below it were open. To get a sample for toxicology, Conus used a needle to withdraw blood from the heart. He then removed the organ, weighed it and handed it over to Peters.
I moved to Peters' side.
He was giving the heart a long look, paying especially close attention to the ventricles. He was looking for blockages that could reveal a fatal cardiac event. He then dissected the heart, studying the muscle for signs of damage from a possible heart attack.
The other organs were removed, one by one. I was taken by the size of the liver, having imagined it more the size of a dessert plate than a dinner plate. A yellow liver would indicate disease, including alcoholism. The lungs were next, and Peters told me, in the event of carbon monoxide poisoning, the lungs turn a very bright red.
The stomach was removed and its contents poured into a measuring cup and inspected.
As Peters and Conus worked, they talked about mowing the grass and the rain that was expected that day. They were meticulous in their observation of the organs, weighing each one and talking over their findings.
I asked Conus where the word "diener" comes from.
"It's German for slave," he said, compelling a smirk from Peters.
Then the doctor said they'd have to go another step and have a look at the brain.
Over before we knew it
Conus used a large comb to carefully move the decedent's hair to one side. He took out a different power tool, and John and I exchanged a wide-eyed glance; each of us understanding the other's hesitation. Could we handle this part?
But it was over in an instant. A neatly cut portion of skull was raised, and the brain removed.
Peters studied it carefully as I marveled: It was not bloody or messy or gross. The brain was, in fact, quite neat and dense and fascinating. It resembled a large fungus; something you'd find growing on a downed tree in a damp woods.
"I'm looking for evidence of a stroke or tumor," the doctor said.
He then dissected the organ, using his index fingers to feel for abnormalities.
As he completed his inspections, each organ was placed in a bag, which lined a 5-gallon bucket. Called a viscera bag, it is used to transport the organs outside the body to the funeral home. There, the organs are dried and placed back into the cavity. That part is done during the embalming process.
Next thing we knew, Brian and Conus were zipping up the body bag, moving it back to the stretcher and rolling it out to the Expedition.
When we made a stop before our drive back to the Quad-Cities, Brian backed his vehicle into a parking space in the back of a parking lot and left it running. The ignition cuts out if anyone would try to steal it, and it's important the air conditioning is left running to keep the remains cool and the odor down.
"What did that take, maybe an hour?" Brian asked. "I'll let the family know what we learned today, and we'll take the body right back to the funeral home.
"The guys won't stick around at the morgue for long. Doc's going home to do paperwork, and Gene's going home to mow the lawn."
And that was that.
A family now would know why their loved one died. Maybe it would bring some peace. Maybe it would deliver more sorrow. I didn't want to know.
My mind was satisfied with what I had witnessed, which was the careful and respectful handling of a body that once contained a human being.
It was not a pleasant experience, nor was it particularly traumatic. More than anything, I was grateful that people like Brian and Gene and Doc are made the way they are — hard-wired to handle it. They do a job every day that most of us prefer to think nothing about, ever.
Their patients cannot thank them. But I do.