Front & Center: Medical examiner pursued career in forensic pathology by happenstance

Dr. Sally Aiken sees dead people.

No, not the macabre “Sixth Sense” variety.

As Spokane County medical examiner, Aiken performs about 300 autopsies a year on bodies from Spokane and 14 surrounding counties. A second forensic pathologist performs a similar number.

Besides determining the manner of death, Aiken and her staff investigate death scenes, provide legal testimony, meet with relatives of the deceased and prepare for mass casualties.

Aiken also is serving a one-year term as president of the National Association of Medical Examiners.

And later this spring, she and Dr. John Howard will oversee her department’s transition from cramped basement quarters on the North Side to a new, $12 million facility near the University District.

Aiken recently slowed down long enough to discuss why some months are busier than others, what she likes most (and least) about her job and an advantage of her profession over other medical specialties.

S-R: Television shows – from “CSI” iterations and “Crossing Jordan” to “Quincy M.E” – portray forensic pathology as a glamorous profession. Is it?

Aiken: I often tell people that it’s not as glamorous as you see on TV. During presentations, I sometimes show two slides – a photo of the cool “CSI” people, followed by one of me in scrubs, face mask and three pairs of gloves, looking like a total nerd.

S-R: When people discover what you do, what do they ask?

Aiken: Well, I don’t often tell people what I do because some feel about what I do the same way they feel about abortion. They have a strong opinion one way or the other. They’re either really, really interested – maybe even overly interested – or they think it’s gross and revolting.

S-R: Where did you grow up?

Aiken: In Sunnyside, Washington, home of the mighty, fighting Grizzlies.

S-R: What was your first job?

Aiken: When I was 13, I taught swimming lessons for a program that helped prepare prekindergarten migrant children for school. I think I was paid $80 for the summer. Once I turned 16 and could get a real job, I cleaned a lot of really dirty locker rooms at the local pool. I’ve also been a housekeeper.

S-R: What were your interests in high school?

Aiken: Swim team and debate club. I also liked science classes.

S-R: Did you envision a particular career?

Aiken: No, but I envisioned going to college.

S-R: Which did you attend?

Aiken: WSU, where I earned a degree in bacteriology and public health.

S-R: Then what?

Aiken: I went to medical school at the University of Washington.

S-R: What steered you toward a career in forensic pathology?

Aiken: It was pretty much happenstance. In those days, medical schools had hard-copy catalogs of residencies and fellowships. Forensics sounded interesting. It tied into my family background – my father had been a lawyer – and my interest in debate. But when I saw it required seven years of post-medical-school training, I started leaning toward geriatrics or pediatrics. Then my husband was transferred to Portland, and the only residency opening I could find was in pathology. I hated it at first. But then I got rotated to the medical examiner’s office, and that changed my mind. When my husband got transferred back to Seattle, the UW had an opening in their fellowship program and accepted me.

S-R: What was some advice during your medical training that stuck with you?

Aiken: One of my mentors said, “Even though we work for the public, don’t expect the public to thank you.” (laugh) That is so true. If people don’t like your opinion as to cause of death or the circumstances, you hear about it. Relatives particularly have difficulty accepting suicides, whether for religious reasons or “they loved me too much to do that.”

S-R: What brought you to Spokane?

Aiken: I started working as a forensic pathologist in Stockton, California, in 1992. But we wanted to get back to Washington to be close to parents, so I joined this office in 2000. I took over in 2001 when Dr. George Lindholm left.

S-R: Did skills learned in earlier jobs transfer to this one?

Aiken: Working as a lifeguard and cleaning locker rooms taught me things they don’t teach in school, so I’m always reluctant to hire people – even Ph.D.s – who don’t have any work experience.

S-R: How has the profession evolved during the almost three decades you’ve been involved?

Aiken: Both training and investigation techniques have improved, in part thanks to the efforts of the National Association of Medical Examiners.

S-R: How many members are in the association?

Aiken: About 1,300. When I joined in ’89, there weren’t many women. Now it’s about half and half, which reflects changing medical school enrollment.

S-R: Has the technology you use also changed?

Aiken: Not much, except for imaging. Our new facility will have a whole-body scanner.

S-R: With the popularity of shows such as “CSI,” do writers ask you for advice?

Aiken: All the time – mostly through our national association.

S-R: Do you respond?

Aiken: If I can. But I pretty much work seven days a week most weeks, so I don’t have a lot of free time.

S-R: What do writers tend to get wrong?

Aiken: One thing they almost always get wrong is having a relative come into the morgue to identify someone. That’s dramatic, but we almost never do that because it’s the best way to misidentify somebody. People look different when they’re dead, or they may have injuries that preclude a visual identification. We prefer something scientific, like fingerprints, X-rays or dental records.

S-R: Have you ever considered writing a book about forensic pathology?

Aiken: I minored in creative writing, so I have thought about it. If I were to write a book, it would probably be about cases I’ve worked on.

S-R: Do certain unusual cases stick in your mind?

Aiken: Definitely.

S-R: Can you mention one?

Aiken: Probably not. Our work is confidential, so I’d have to make sure any information I shared had already been presented in court.

S-R: You manage a dozen people. Was there anything in your medical training about being a boss?

Aiken: Only observing two other bosses during my fellowship, and having some discussions about that. But I think knowing so much about medical investigations makes me a better boss than, say, a coroner with administrative experience but no forensic background.

SR: Is there a busiest time of year in your office?

Aiken: Summers tend to be busier because more people are outside boating or riding motorcycles. But we’ve been really busy since the end of December.

S-R: What do you like most about your job?

Aiken: It’s interesting, and we see people at their most vulnerable. It’s also nice that we don’t have a predictable schedule.

S-R: What do you like least?

Aiken: Same thing – unpredictability. People call and ask, “What’s your caseload today?” I never know, because it depends on who died in the last 12 to 24 hours in our 15-county service area.

S-R: What would happen if there were a major disaster?

Aiken: It would be a tough go. But we’ve done a lot of planning for mass fatalities with our new facility. For instance, we have ports where we could bring in refrigerated trucks.

S-R: What’s the career outlook for this field?

Aiken: There’s a huge shortage of forensic pathologists. One thing that discourages people is the long training after medical school. Another is the low pay, compared with other specialties. And some people don’t like the prospect of adversarial court hearings.

S-R: Any upsides?

Aiken: Unlike some medical specialties, if you make mistakes, at least you’re not going to kill anyone. But I fully recognize the serious consequences of my work to grieving families, the community, the accused, justice and to public health. Like most of medicine, forensic pathology is a high-stakes profession.

Writer Michael Guilfoil can be contacted at mguilfoil@comcast.net.