Over Your Dead Body (Last Rights)

We all imagine that when die, our dear and familiar bodies will be treated with respect -- even as our flesh suits are readied for the earth or the flames. But let's just say that if you or a loved one just happen to die somewhere in the U.S. but away from home -- on vacation, or on business or professional travel -- your dear and familiar body might not be treated with the solemn care and dignity it deserves.

No one knows When or How he or she will buy it -- but since we're in the realm of the Imagined Unimaginable now: I'm not talking about catastrophe, massacre, homicide or your spouse hiring a hit man; rather I'm talking about a fairly unknown yet real fact of death in the United States.

Let's say that you, who are about to die, have traveled to Washington state (to the Seattle/Tacoma area) from Los Angeles on a professional trip. Let's say that you (as a tennis enthusiast) decide to hit a few on a public court after landing and before dinner -- with a plan to get up early for work the following day. You play for almost an hour, but then something goes wrong -- you stagger, begin to shake and you ask for water. Your heart has gone into V-fib (or ventricular fibrillation) and after a few seconds you lose consciousness and fall hard to the surface of the court. Blood is cut off to your brain as your heart continues in spasm and your body begins to die, among strangers, lying on the court. Your court-mates and the tennis pros call the paramedics, who arrive in ten minutes, but that is too late. You are taken by ambulance to the local hospital, to the ER. One of the tennis pros calls your spouse or partner in LA, by pressing HOME on your cell phone.

And this is where the general category of Unimaginable shifts to the painfully particular and real. On October 9, 2000, my husband, the actor David Dukes dropped dead on a tennis court in a suburb of Tacoma (he was there shooting Rose Red a Stephen King movie-of-the-week) He had been with my daughter Annie and me over the weekend at our home in L.A., then flew back to location on Monday so that his new scenes could be shot on Tuesday.

But he missed his call the next day, he never made it to the set. David, who had no previous history of heart disease, who was strikingly handsome and appeared physically fit, who exercised regularly, played tennis everyday, who was a "young" fifty five years old -- collapsed on a tennis court at around 6:30 PM PST on October 9th, 2000.

He was taken to a nearby hospital by paramedics where ER physicians worked on him, fruitlessly, as it turned out. Annie and I, who had been given the name of the hospital by the tennis pro who pressed HOME on David's cell phone -- finally, after several minutes of confusion and resistance, got through directly to the ER. A nurse picked up the extension and asked my daughter and me, holding on the line, if we "wanted to know what was happening." We said yes. So our kitchen phone, on "speaker" so we both could hear, became a life-line -- we stood in the slanted gold early evening light -- the dinner dishes still on the table, and we locked eyes, listening as the medical team working on David called out his pulse rate, his heart rate (after the paddles were applied), his skin color and pupil "response." We listened, still looking into each other's eyes, as the numbers began to fall rapidly. After the (very young sounding) ER doctor who was in charge came on the line to tell us that "We lost him" (and my daughter and I began to suggest, in shock, that perhaps there was a mix-up in identity, this could not be our David?) -- the death-line began to hum.

A new voice came on the line, identifying itself as a representative of the "Pierce County Medical Examiner's Office" -- and I was asked a question by this voice -- The Question -- and I gave the wrong answer.

"Does your late husband have a local physician?" the voice asked. I could not get past the adjective "late" for a while -- and then answered, in a fog, "No." I was in shock, I did not consider that doctors were available on the Rose Red film set -- I said no. But here is my hard-won advice: whether your "late" spouse, partner, child or friend has a "local" physician or not -- under no circumstances answer "No" to this question.

A bit later, still in my black fog -- I asked this "death representative" exactly where the Pierce County Medical Examiner's office was -- and "he" or "she" (I could never tell what gender the death rep was -- as the voice was sexless, impersonal, without human sympathy and depthless as tin) stopped me as I began to talk about flying to Seattle that night to be with his body.

The response I received is what I most want to warn about: the "death rep" from the local coroner's office informed us that since my (late) husband had no local physician -- his body would be taken away by the Pierce County Medical Examiner's office. My daughter and I would not be allowed to "be with" David -- or to claim his body and accompany it back to L.A. I was told that the Medical Examiner (whom I much later learned was named John Howard -- I was given the wrong name for the "death chief" at that time) made it his policy not to allow family members or survivors into the chambers of the Pierce County Medical Examiner's office. I was told that he felt that families and survivors were in the way and became "agitated" and made noise, which apparently was intolerable to John Howard and the employees of his office. Thus my daughter and I had a right as old as civilization itself arbitrarily taken away from us -- the right of survivors to be with the dead, to sit by the body, to touch it and speak to it, to weep and speak words of grief -- and love.

It turns out that this type of arbitrary inhumane policy is not uncommon among "local" or "county" medical examiner's offices and they can prevail over your dead body. These neighborhood bureaucracies, these mini-DMV's of death -- are independent of any oversight or standardized procedural or quality-of-care boards -- you, the dead body, and those who love you body and soul, will have nothing to say to the policies and practices of these offices. Many "local" or county coroners (it later was pointed out to me) are not even physicians; they are "political" appointments.

Here my own experience becomes more personal (and yet more public) -- my website, www.carolmuskedukes.com offers (under "Remembering David Dukes") the continuing details of my dealings with Pierce County and Dr. John Howard -- but let me add a few more warnings here. The Pierce County coroner's office performed an autopsy on David the next day without my permission. I was told later by a lawyer that I had a legal right to "stay" the procedure and have the autopsy performed by a doctor of my own choice -- I was never informed of this right. (David's body was also badly embalmed by a local "referral" funeral home -- since his body was eventually going to be flown to L.A., to Forest Lawn, the law required embalming before he would be released to return home on a plane.)

The autopsy was also poorly done. When I finally (after weeks of oversight and confusion) received the autopsy results, I showed them to doctor-friends in LA who were taken aback by the report. I engaged a renowned and very compassionate pathologist from a distinguished university who managed to "reconstruct" the autopsy, despite the fact that the Pierce County doctors did not keep the requisite number of tissue samples, -- the pathologist was able to provide important medical information about David's heart, which we would never have had. The cause of David's death was listed as coronary artery disease, which was not entirely inaccurate, though this was a "broad" category. The heroic pathologist (who also said that these county medical examiner's offices should be taken over by teaching hospitals and reputable medical centers -- that they were scandalous) discovered, for example, that what the Pierce County office called "fibrosis" was actually proof of a previous "silent" heart attack which David had had -- it was unclear when.

The very night that David died, Pierce County administrative staff talked to the press about David, announcing that his death was a "heart attack" -- though they told me that they could not state the cause of his death until the autopsy results were final. They refused many of my calls, they "misfiled" the report on their computers -- and when I asked to speak to the medical examiner himself (a right of all family members of the deceased) I was told that he was unavailable. Later, John Howard claimed that I had never asked to speak to him.

The LA Times, the Seattle Times, the Seattle Post-Intelligencer, and the TV program, Extra, all reported on how David's "case" was handled. I was able to speak out about what had happened -- though I have waited a long time to write this "late" report.

It is YOUR dead body and your loved ones I'm thinking of now. Out of nowhere, I recently heard from an investigator from a medical examiner's office in Honolulu, who happened on my website and found the narrative I posted there years ago about the Pierce County office. She had "blown the whistle" on some of the practices I've described here, which she says are widespread and endemic and particularly rampant in her "home" office in Hawaii -- (just as Pierce County holds a further dark history -- preceding John Howard's term of office -- including litigation over the commercial sale of autopsy photographs). This medical investigator found herself suddenly placed on "administrative leave," despite her good efforts. She is now appealing her treatment and trying to get the word out -- and ran across my site.

Her "search word" was "John Howard". The same John Howard who told the press when I reported what had happened to David, that he would not have done anything differently in the matter of David's body -- and that I was "on a soapbox".

The same "John Howard" whose name this thwarted investigator keyed in -- because she believes that he will ultimately have influence over her case -- this same John Howard -- who is now head of the National Association of Medical Examiners.

Will you or someone you love lose the right to be treated humanely in death -- just because a "wrong answer" will inevitably lead to a Pierce County experience? None of us knows when we will "go" -- but until these "local" coroners' offices and the policies and practices they "live by" are "deep-sixed" and overseen by reputable hospitals -- none of us can rest easy in anticipation of what Henry James called, memorably, "the distinguished Thing."

Comments

[Kalona808]

Excellent article Carol. Mahalo for taking the time to share such a sensitive subject to many. from ur dpeth of ur heart.

I am so sorry for the expeirence u and ur daughter went through. U certainly deserved way better with more compassion and hinesty. Mr Howard has no clue to what compassion and honesty means. I have writen to him a few times only to recieve generic rude answers. As far as I can see this agency of Accreditation is more of buy it not earn it organization. A paid trip to Honolulu seems to be priceless.

We have had our complaint in with his organization since Nov 2008. Not a thing was done. In fact the Medical examiner here hasn't seen one day of consequences. But those of us who stood up have certainly lost our careers of many years. Worse then that is the loved ones that suffer for the rest of thier lives not having the real answers they deserve and not having some closure and peace with honest answers and compassion.. That is simple unforgivable and unacceptable.

[neem]

I am so sorry this happened. It seems that things are going out of control in this country. Ordinary people like me and most everyone else can count on absolutely nothing, when dealing with a government bureaucracy, or a private insurance company. I really feel like the United States is turning into a third-world country. I admire Obama tremendously, but there are so many difficult problems for him to fix! Ever since Hurricane Katrina, I can only wonder how many more institutions will disappoint us, and if America will be recognizable in 2010 or 2011.

[PatA]

This John Howard needs to go before a governing board and explain his actions in detail. No one should have to go through what you and your daughter did. This is absolutely sickening and if I were you, I'd find a way to get John Howard's name out in public as much as possible. (we are helping you as much as possible)

I am going to copy your article and send it to everyone in my email address book. I suggest that others do the same.

Central Texas

[sheilaofmiami]

Not all of the commentators get the point. The point is if you want control over your loved one's body after death, out of town, best to say there is a personal physician and then call a lawyer for support.

If you don't care about your loved one's body after, then you got nothing to worry about.

For some people it really matters!

[Cynthia Savage]

I'm sorry you had such a bad experience BUT it is the law in all 50 states that an unexplained death is dealt with by autopsy. Even if your husband had had a personal physician, I seriously doubt that he would agreed to sign the death certificate-a LEGAL document attesting to the nature of the matter of your husband's passing-without having an explanation as to why it happened. I am a practicing physician with over 20 years experience signing death certificates for my patients. If the county coroner had called me from the field and asked if I would sign a death certificate on a previously healthy patient attributing his death to a certain cause, I would have said "NO" and, thus, starting that patient down the path of having an autopsy-without spousal approval-to ascertain the matter of the cause of death. It wouldn't matter if the county coroner was a MD or not-he would have a pathologist in the area conduct the autopsy if he could not. Now if your husband had had a known problem, like advanced emphysema, heart disease or cancer, no one would have requested an autopsy-the cause of death would have been considered "natural". He did not, so an autopsy was legally mandated. The nature of why the laws are written are to protect people who die suddenly because of an unnatural cause. FYI, deaths occurring within 24 hours of hospital admission go to autopsy automatically, too.

[Ono4Hoopono]

Wow. This is really good to know. It shocks the conscience, but in a way I'm not surprised because I had a situation with my father that was similar enough but no where near as bad. For me, it was just really weird how quick it went from the bad news phone call to pretty near zero tolerance "come and get him now, or..." without time to even get my bearings, under the threat of lord knows what (I was afraid to ask), if I didn't find someone to take care of him in the pre-dawn hours 3000 miles away. So it came down to me and a relative and grief and the yellow pages trying to sort it out while calling them frequently to keep them updated so they wouldn't act without our knowledge.

With the people I dealt with it may just have been a learned pragmatism or their emotional armor, but for you it went way beyond that, and I'm sorry you had to go through it. You have done a real service here by bringing it to everyone's attention, as even with my experience I couldn't have imagined that what you are saying could happen without you writing about it. I thought every coroner was a doctor, and that there were certain rules of civility, and that every family had assumed rights that were inviolable.

I hope you get some healing from writing about this. Again, my heartfelt thanks.

[FlightLover]

I am so grateful for your article, and terribly sorry about you/your daughter's loss, and how you came to all of this knowledge. Speechless. I will share your story at every turn possible to help shed light on this dark, horrid and completely unexcusable 'thought' process of these people. You will help many and not even know it, Carol. God Bless you and your daughter.

[Cyberoptic]

How about the label, domestic family terrorist?

There is little more frustrating, or angering than to run into a senseless bureaucrat, or an officious one at a tragic time in one's life.

John Howard, if these facts bear out, should be replaced by someone, as President Obama puts it, with empathy.

[offred]

If a public official won't speak to the public to explain his decisions, procedures, policies, etc., he doesn't deserve a paycheck. Who does this John Howard think he is--Dick Cheney?

[Snowdonia]

What a travesty. The whole way your husbands' death was handled is a disgrace.
Those people should be ashamed of themselves. That medical investigator should
be given a medal for blowing the whistle on practicies like these, though I'm sure
if John Howard has his way she will be given the boot instead.