Jeffrey R. Steinbauer
The snowstorm had started on Friday, before I'd gone on call for my group. At first I'd thought the weekend would remain quiet, that the small town where I practiced might just slumber under a fresh blanket of snow. But by early Saturday morning, things had gotten busy at the hospital. Several emergency-room visits, phone calls and admissions from the nursing home changed the stillness I'd felt amid the snowfall. In no time, there was the familiar stress of trying to bring order to a day that was rapidly becoming chaotic.
Sometime that afternoon, I looked up from a chart to see the town sheriff standing at the nursing station. Although we were acquainted through weekly Rotary Club meetings, he now was barely recognizable--bundled in heavy winter clothing, his head covered by a parka hood. Flakes of snow lingered on his jacket and caked his boots. Beneath the hooded parka, his eyes were severe and his face ruddy; together they broadcast an unspoken weather report. He was not smiling.
"Doc, we need you to come with us," he said.
This was an unusual request, coming at an inconvenient time. There was much to be done--phone calls to answer, patients to admit and emergencies to attend to. Thoughts of how to avoid this new, unknown task shot through my mind. But my words came out differently: "What do you need me for?"
"We've found a corpse down by the river. The coroner is out of town, and you're covering for him."
Residency hadn't prepared me for this. The sheriff's earnest voice conveyed that this particular duty was unavoidable. Any chance of getting home to a warm dinner began to melt like the snow on his parka.
Leaving instructions with the nurses, I joined him in the patrol car, leaving behind the lights and bustling noises of the emergency room as we drove to the cold, calm, white outskirts of town. The sky was overcast, the temperature bitterly cold. Snow continued to fall silently, and the countryside gradually took on the appearance of a holiday greeting card. The whole scene, so reminiscent of my pleasant childhood days in the north, jarred against our grim mission.
The sheriff said little, but indicated that they'd found a dead woman near the river. Before she could be taken from the scene, I was legally required, as acting coroner, to investigate and rule on the cause of death.
A few miles out of town, the patrol car turned off the highway and crunched through snowy tracks left by other vehicles. We arrived at a clearing on the riverbank. Stepping from the car, I saw an old Chevrolet pickup truck, the kind favored by local farmers. People stood nearby, looking vaguely familiar in their heavy garb; I recognized the deputy and two people from the local funeral home. Another patrol car and a hearse idled quietly, white fumes rising from their tailpipes.
Feeling out of place and unsure of myself, I walked alone to the truck and opened the door. Inside, behind the wheel, sat a woman perhaps thirty-five years old. She was cold and dead. Her skin had taken on a blue-gray tone that matched the truck interior. The sheriff had said she was the wife of a local farmer known to me only by name. On the floor of the truck cab stood a small charcoal grill, holding some partially burned charcoal.
Although I'd never been trained in forensic medicine, the routine behaviors of a physician took over. I made note of her position, looked for signs of a struggle, noted that the truck windows were rolled up and that the charcoal hadn't burned completely, and proceeded to examine the body. History and physical. I tried to remember from pathology classes the stages of rigor mortis and noted the extent to which it had set in. I didn't undress her, but made a mental note to check her degree of lividity back at the funeral home.
With the truck windows tightly closed, I thought, she'd probably died from asphyxiation as the burning charcoal replaced the cab's oxygen with carbon monoxide. But as I grew more convinced of the cause of death, warm clinical certainty surrendered to cold unknowns. Had she purposely started the charcoal and kept the windows closed to kill herself? Had she come to the river for some quiet time away from a hectic household and mistakenly used the charcoal for warmth?
How had she felt, coming to this place? Had she intended to go home?
I studied her face. It was cold and peaceful in death; there was no anguish, no pain. The cold seeped into my body as it had into hers, my thoughts and feelings now as frozen as the landscape.
After the examination, I released the body to the men from the funeral home, and they put it into the hearse. The landscape looked grayer and the air felt colder as I paused by the riverbank, wondering. Was it suicide or an accident? I would never be sure, but I knew that I would officially call it an accident. As I stood there alone, no holiday greetings came to mind. It was a cold, harsh world where living breath froze in the gentle silence of snowfall.
I felt caught in a world between life and death, caught in the snowscape. She had passed this way a short time before, but she had gone on by a different path. I turned and walked back to the waiting figures. Back to light and warmth. Back to the life of the town.
About the author:
Family physician Jeffrey Steinbauer MD is a professor at Baylor College of Medicine and medical director of a private practice at the Baylor Clinic. "I come from a family of artists: my father is a professor of music, my son is a documentary filmmaker, and my daughter is a creative writer for an educational software company. I've always had artistic interests and worked my way through school as a jazz musician. After I began family practice, those artistic interests shifted to writing about the interesting people and experiences I encountered in medicine. Thinking in terms of the patient's story helps me to see more than guidelines, test values and a problem list when I'm working with patients."