What the Dead Know

Barbara Butcher's memoir traces her path from alcoholism and near-suicide to a 22-year career as a medicolegal investigator (MLI) at New York City's Office of the Chief Medical Examiner (OCME), and through the severe depression that followed her forced departure from the job that defined her.

The book opens with a case that encapsulates both the danger and the investigative insight of Butcher's work. Working the night shift with her arm in a cast, she responded to a hanging in a pitch-dark Washington Heights apartment. The scene appeared to be a straightforward suicide: a heavy, middle-aged man hung semi-suspended from a pipe, with petechial hemorrhages (tiny pinpoint hemorrhages caused by compressed neck veins), a swollen tongue, and no signs of struggle. Unable to cut the man down because of her cast, Butcher left and radioed the morgue team. Back at her desk, she noticed an orange extension cord plugged into a wall socket trailing from behind the body. The electricity had never been off; the man had unscrewed every light bulb to create the illusion of a dead circuit. Anyone cutting him down near the live cord would have been electrocuted. Her broken arm, the very misfortune she had been cursing, saved her life.

From this case, Butcher reaches back to the years before the OCME. She had been living in a shabby studio, drinking heavily, and working off the books in a button store. She traces her struggles to early adolescence, when depression and suicidal impulses first set in. Despite receiving a college scholarship, she never filed the paperwork. A turning point came when her boss at a Long Island nursing home, Celia Strow, told her about the physician assistant profession. After a failed, hungover interview at Stony Brook University, Butcher was admitted to Long Island University the following year, earned her PA degree, and rediscovered the pleasure of learning. She thrived as a physician assistant in the South Bronx, earned a master's in public health at Columbia University, and built a promising career as a hospital administrator. Then her addiction resurfaced. She lost her partner, her job, and her apartment. Her 24-year-old brother, John Luke, died of a drug overdose. In despair, she rehearsed suicide with an unloaded revolver, dry-firing it at her head before passing out from vodka.

After more than a year of continued decline, Butcher hit bottom. One evening in July 1991, after blacking out, she woke injured on the floor and called her friend Kate, who directed her to Alcoholics Anonymous. It was her last night of drinking. She threw herself into the program, learning tools she would carry throughout her life, including the concept of "God shots," providential moments when unexpected misfortunes redirect a life for the better. Her sponsor directed her to the Employment Program for Recovering Alcoholics (EPRA), where vocational tests indicated she should be either a poultry veterinarian or a coroner. She chose coroner. For a homework assignment, she arranged an interview with Dr. Charles Hirsch, New York City's chief medical examiner, who described the work as noble. His director of investigations, Richard, surprised Butcher by offering her a position on the spot. Terrified but determined, she accepted, drawing on the AA principle of acting as if she were sober, confident, and unafraid.

Butcher began at the OCME in September 1992, training through autopsies, lectures, and fieldwork with experienced colleagues. Hirsch taught her foundational principles: never lie to families because people can handle the truth but not uncertainty, and always do the right thing. Her first solo case, a man found dead in a Morningside Heights alley, allowed her to synthesize her training. Using contrecoup injury patterns (damage at both the point of impact and the opposite side of the skull, indicating a fall rather than a blow), a belt split through the leather from impact compression, and the body's distance from the building, she determined the man had jumped from a sixth-floor window. Fingerprint identification the next day confirmed he had a psychiatric history and prior suicide attempts.

Cases grew more complex. Her first double homicide involved two men killed in contrasting styles in a West End Avenue apartment, leading detectives to identify two perpetrators, George Cobo and Tony Lee Simpson, who were also linked to a double homicide on Park Avenue. Butcher's work also took her into hidden corners of the city: Bowery flophouses where men rented plywood cubicles for six dollars a night, squatter buildings, underground tunnels, and apartments sealed in tinfoil by residents convinced they were blocking death rays.

One case scarred her more than most. In September 1997, she responded to the George Washington Houses in East Harlem, where firefighters had extinguished what they thought was a trash fire. She found the charred body of a young woman in a stairwell bulkhead. The victim, Johalis Castro, a 19-year-old computer science student, had been raped, suffocated, then set on fire while still alive. Police connected the murder to other attacks on young women and girls over eight years, all linked by DNA to one perpetrator. Butcher expresses outrage that the crimes received virtually no media attention. A wanted poster finally led to 25-year-old Arohn Kee. At his 2001 trial, Butcher testified as an expert witness, applying courtroom lessons Hirsch had taught her after a previous humiliation on the stand: pause before answering, direct responses to the jury, and grow more courteous as the opposing attorney grows more aggressive. Kee was convicted and sentenced to three life terms plus 400 years.

By her ninth year, having investigated approximately 5,500 deaths including 680 homicides, Butcher was profoundly worn down. She scheduled a hysterectomy for July 2001 and negotiated extra recovery days, meaning she would return to work on Wednesday, September 12. On the morning of September 11, she watched the attacks from her home in New Jersey. Hirsch had rushed to the site with several colleagues; when the towers collapsed, he shielded investigator Diane's body with his own. All survived. The OCME mounted an unprecedented operation to identify 2,753 victims from 22,000 body parts. Butcher was promoted to deputy director of investigations.

Over the following years, she managed additional mass-casualty events, including the crash of American Airlines Flight 587 and the Staten Island Ferry disaster. In 2007, Hirsch promoted her to chief of staff. In late 2012, a crisis erupted in the OCME's DNA lab: a technician named Serrita Mitchell had been mishandling sexual assault evidence for years. Butcher was appointed interim lab director and spent a year reviewing 843 cases. After Hirsch retired in 2013 due to illness linked to 9/11 exposure, political adversaries on the New York State Forensic Science Commission maneuvered against Butcher. When Mayor Bill de Blasio took office, she received a call from City Hall telling her she had to go. After 22 years, her career ended without explanation.

Butcher spiraled into severe depression. She could not eat, could not work, and could not get out of bed. In April 2016, she spoke with Hirsch by phone; he died the next day from illnesses worsened by 9/11 exposure. She fantasized about being killed by a stray bullet rather than actively ending her own life, her years investigating suicides having given her an aversion to the act. At the urging of those close to her, she agreed to be hospitalized. She underwent electroconvulsive therapy (ECT), a procedure that uses brief electrical stimulation of the brain under anesthesia, three times a week for a month. She started an AA meeting on the psychiatric ward. After two months, she was released.

Her psychiatrist suggested she pursue dreams she had set aside when young. Butcher took acting classes, landed a role in a low-budget TV pilot, and walked a red carpet. Looking back, she identifies a pattern of God shots: alcoholism leading to her dream career, a broken arm saving her from electrocution, a delayed surgery keeping her away from the towers on September 11, and the loss of her job pushing her toward creative fulfillment and this memoir. She expresses gratitude for all of it: the good, the bad, and everything to come.