Photo: Jeff Nelson

James Caruso has an impeccable bedside manner. The 52-year-old former Navy doctor—he served for three decades—has an easy smile. He’s amiable and delivers quick quips about his favorite pro team, the Chicago Blackhawks, but is still professionally reserved. His eyes convey just the right amount of concern. In other words, he exudes the sort of calm all patients hope to receive from their physicians. It’s too bad none of his will ever get to appreciate it. They’re all dead.

In January, Caruso took over as Denver’s seventh chief medical examiner (ME). He’s a forensic pathology whiz not unlike the ones you see on popular TV series such as CSI and Rizzoli & Isles. He’s performed thousands of autopsies on American soldiers, civilians, and even astronauts from the 2003 Space Shuttle Columbia disaster. After retiring from military service last year, Caruso—who was living with his wife and two daughters in Tennessee—landed in Denver to run the city’s office and its $2.15 million annual budget. Now he oversees a staff of 22 investigators, techs, and doctors who work more than 2,000 cases each year of suspected homicides, suicides, and other unusual ways people have met their ends.

That also means his team performs up to 900 autopsies annually and completes a massive amount of paperwork. These reams of data line the hallways of the department’s two-floor office space on the Denver Health medical campus. Death certificates dating back to the 1920s are crammed into vertical filing shelves. A box with the words “2006 Autopsy Reports” handwritten in marker perches on top of a dusty index card file cabinet. Brightly colored maps of the metro area serve as functional artwork. Amid this controlled chaos is a massive six-foot-wide whiteboard that, on any given day, is filled with the names of people who’ve recently died in and around Denver.

Lately, Caruso has had a broader issue to address: His landlord—Denver Health—has other plans for the building that currently houses his staff and equipment, which means the medical examiner’s office has a few months to find a new home, all while keeping up with the relentless queue of the newly dead. “That doesn’t leave us with time to build anything from scratch, and medical examiner offices are not cheap,” Caruso says. “That puts us in quite a bind.”

Every morning at 7:30, a small group of civil servants gathers for the day’s staff meeting in the ME’s cramped quarters. Although the focus is on the whiteboard and the constantly changing list of names, what doesn’t fluctuate is the agenda. It’s always who died, and why.

A 24-hour rotation of investigators has been working the cases on the whiteboard, taking photos, gathering medical files, and talking to relatives. Some look like they’ve been plucked straight from a 1920s detective novel, with slicked-back hair and surly demeanors. Some are ex-cops or paramedics; others are former anthropologists or psychologists. Many look like typical working parents who just happen to spend their shifts being called out to examine a fatality. At the meeting, they’ll brief the pathologists on who’s chilling in the coolers downstairs. The doctors will divvy up the bodies and head to the autopsy suite, a macabre version of an operating room.

Piece by piece, the team gathers the information that becomes the basis for legal cases. Every piece of clothing, every photo of a blood smear, every note on the autopsy report can—and likely will—be used in a court of law. But unlike the crime labs you’ve seen on TV, there are no shiny glass doors. You won’t find massive computers that precisely plot a bullet’s path. There is no fingerprint scanner that catches the killer every time.

No, Denver’s ME office looks a little different. First, there is what just might be the largest scale in Denver, which weighs the bodies upon their arrival at the morgue. It is the great-great-great-grandfather of a digital scale. The green, Toledo-brand contraption, at least 30 years old, is nearly six feet tall and so heavy that it probably can’t be moved to a new building. Its operator, Karen Jazowski, the manager of autopsy support and a 20-year veteran of the office, has short blond hair and a hearty laugh that echoes throughout the hallways. “We’ve been tipping 500 [pounds] a little too often on the scale,” she says, “even for one of the healthiest cities in the nation.”

To hoist bodies from flat gurneys to coolers to autopsy tables as delicately as possible, Jazowski and her crew use a forklift. (There was a time when the staff had to lift the bodies themselves, something they jokingly referred to as the “Friday Afternoon Coroner Shuffle.”) Jazowski also runs the office’s secondhand X-ray machine, which dates to the 1990s. They have been able to scan and digitize the images and store them electronically—roughly akin to putting your old film camera shots on a floppy disk.

Ideally, the office would have a CT scanner to better record internal trauma such as difficult-to-see fractures in child abuse cases. That sort of information could help prosecutors try cases and the accused to better defend themselves. It’s the type of thing Caruso would add to his wish list for a new facility. “Jurors are all expecting 21st-century forensics,” he says. “If you don’t provide that, sometimes it can mean the difference between someone who is appropriately convicted or maybe inappropriately convicted. We don’t want anybody who didn’t do something to be incarcerated, and we don’t want someone who should be incarcerated to be let off based on something we failed to do.”

Despite being one of the largest counties in Colorado, Denver’s medical examiner’s office hasn’t been remodeled the way similar facilities have in Douglas County, where voters helped approve state-of-the-art improvements. The offices could have been part of the Denver Police Department’s new crime lab, which received bond monies in 2007, according to Denver District Attorney Mitch Morrissey. The ME at the time chose to maintain separate facilities so as to avoid potential conflicts of interest in criminal investigations, even if it left the ME in a more modest space. “It’s disappointing to see the new medical examiner come in and have to work with this building problem,” Morrissey says. “But it’s something Denver should consider with the next bond issue, and I would fully support it.”

The first thing you notice in the autopsy suite is the smell, a nauseating, goose bump–inducing scent that lingers in your sinuses hours after you’ve left the room. It’s the essence of antiseptic, trauma, and death. And if you’re surrounded by corpses all day, like so many unsavory aspects of the job, you get used to it. “There are things that are just appalling, what one human being can do to another,” Caruso says. “For instance, child homicides. Why would someone do this to a kid? You have to leave that prejudice at the door. You can feel angry, a little sensitive, but you have to be objective. You have to document and be thorough because that case is going to go to court.”

To limit mistakes, every autopsy begins the same way: with an external examination that pores over every inch of the body. A fleck of plastic buried in the leg might help tell Caruso if the person was standing when hit by a car. The decomposition of the skin provides clues about when a death occurred. He’ll make note of hair color and collect the vitreous humor, a fluid in the eye that can be used for toxicology tests. He’ll look for insect activity, such as maggots. “Most of us call that job security,” Caruso says, “because no one else will do that sort of thing.”

After the external examination, Caruso cuts a Y-incision into the deceased’s chest to saw open the ribs and extract the organs. Each one will be weighed, measured, and observed for abnormalities. Caruso likes to listen to music while he works, usually something from the ’70s or ’80s. And although the everyday work is tragic, he’s seen worse. Like the 17-year-old girl in Japan whose blood vessels fell apart in his hands because she had a connective tissue disorder. Or the Challenger astronauts’ remains that resembled nothing he’d ever seen before, or since. (He declines to provide details out of respect for the victims.) Or “the gentleman”—Caruso always refers to patients in polite terms—who came in last week with a needle buried in his arm.

Once Caruso determines the cause of a patient’s demise, he files an official death certificate and releases the body to the family. After he’s collected what information he can, Caruso and his team replace all the organs and stitch the body closed with twine. If he has a choice, the family won’t have to see their loved one like this. The too-bright halogen lights, the smell, and the sutures are all too brutal. If needed, the team will use an elevator to raise the body for identification behind a glass window on the first floor, but he’d rather the investigators find a gentler way to talk to the family first.

The job occasionally continues outside the office walls. “I’ve spent many years with families,” says Michelle Weiss-Samaras, a 30-year veteran of the office who now manages general operations. “Sometimes you feel like you actually helped them.” She’s stopped by people’s homes to provide comfort during her off hours, and she received calls for years from a widow she helped, on every anniversary of the husband’s death. These public servants help the families navigate the pain—and sometimes more. “Our big charge to the family is $12 for an autopsy report,” Weiss-Samaras says. “And if they tell me they don’t have the money, I’ll give it to them.”

Therein lies part of the problem: A $12 report fee is nowhere near enough to keep a medical examiner’s office flush, which means the entire department is a money drain. As much as their services might be valued, voters can be fickle on funding services they don’t use regularly. “The truth of it is that dead people don’t vote, and we’re not generating revenue,” Caruso jokes. In a more serious moment, he adds: “The least we can do is to help some justice come to the deceased.”

That sense of duty, which is palpable among the entire staff, is why it doesn’t really matter where the ME’s new home will be, or what type of bond issues Denver voters might soon see on the ballot to fund the move. Autopsies and death investigations must be performed, and Caruso will figure out how to deal with it all, including finding a new home. He and his staff will work through it, because they know they will always have to clear the whiteboard—again and again, as reliably as death.


Natasha Gardner is 5280 ’s senior editor/digital editor. Email her at and follow her on Twitter.