This is the place where the New York City Office of Chief Medical Examiner (OCME) runs its investigations into the roughly 8,500 sudden, unexpected, sometimes criminally violent deaths that occur each year in the city. The building, built in 1960, houses autopsy rooms, testing laboratories, and administrative offices, as well as Manhattan’s massive central morgue. The facility is just one part of the nation’s largest forensic science operation, which employs more than 750 professionals—including pathologists, field investigators, and scientists—across locations in all five of the city’s boroughs.

Founded in 1918, OCME is also one of the oldest and most historically innovative agencies of its kind. It developed the nation’s first toxicology and serology labs more than a century ago, and today its public DNA crime lab ranks as the biggest in the world.

Chief Medical Examiner Jason Graham 06MR helms the enterprise. Graham, who has worked at OCME for nearly 17 years, was appointed to the position by New York City Mayor Eric Adams in April 2022. Fellow Emory grad and First Deputy Chief Medical Examiner Michele Slone 91B, also is a long-timer, serving OCME first as an intern then a forensic pathology fellow before joining the full-time staff in 2003. The duo immediately bonded over their Emory connection, but what’s more important is their shared passion for forensic science and their roles as speakers for the dead.

Under their leadership, OCME operates as an independent science and medical agency separate from the New York City Police Department (NYPD). “We sit at the crossroads between public health and public safety,” Graham says. “And since we are not part of law enforcement, our focus is to investigate deaths unobstructed and to provide impartial answers and support to grieving families.”

When a person dies in an uncertain, untimely way within its jurisdiction, OCME conducts a full investigation of the death scene, secures the decedent’s body, brings the body back to its facilities to perform needed tests, and in most cases conducts an autopsy to determine the cause and manner of death. “In total, we conduct nearly 6,000 autopsies a year,” Slone says.

That’s an average of more than 16 autopsies a day.

To handle that volume, OCME fields 30-plus medical examiners who all possess full medical degrees and board-certification as forensic pathologists. “Of the roughly one million doctors working in the U.S. today, some 20,000 are pathologists—most working in hospitals and other health care settings—and only 500 are forensic pathologists,” says Graham.

“Pathologists are sometimes called the doctor’s doctor,” Slone adds. “They analyze tissue and fluids for disease, look at biopsies under the microscope, and work in labs.”

That makes forensic pathology a small sub-specialty of a specialty. “We are indeed a rare breed,” she says. “It takes a special, unflinching but empathetic type of person to want to work in a field shrouded by death.”

FORENSIC FORAYS

Forensic science’s central goal is twofold. First, medical examiners work to determine the cause of death—be it car crash, heart attack, drug overdose, or knife wound. “The cause is often obvious and can be confirmed via an autopsy,” Graham notes.

Second, they look to identify the manner of death; that is, whether it resulted from an accident, illness, or other natural causes, or potentially a homicide or suicide. This is a far more difficult task that frequently requires more evidence such as lab testing or police reports.

In apparent criminal cases, OCME’s field agents—widely known in the industry as medicolegal investigators— collaborate closely with law enforcement officers to help gain greater context.

“They work side-by-side with the NYPD and other agencies to examine the scene closely and collect as much investigative information as possible,” Slone says. “While an autopsy can easily tell you that someone died by gunshot, we need more info to determine if it’s a homicide or suicide. We are independent from law enforcement, but we do consider their findings to help make our impartial determination on the manner of death.”

Contrary to popular perception, most of the cases that medical examiners handle do not involve lurid, sensational crimes like those depicted in TV dramas like CSI, Law and Order, and Bones.

“There’s a thread of truth to those shows, but by far the majority of the deaths we investigate are caused by disease and drug overdoses,” Graham says. “Fatal overdoses are unfortunately unrelenting in our work—we saw nearly 2,700 overdose deaths in 2021 and expect the number for 2022 to be even higher. Next in line are sudden cardiac deaths, strokes, and other natural causes. Violent, criminal deaths make up a relatively small portion of our caseload.”

When an investigation does become a criminal matter, medical examiners are often called to testify in court and provide fact-based, scientific evidence. “Our findings can be pivotal in convicting the guilty or exonerating the innocent,” Graham says. “And we take our independent role in the service of justice seriously.”

Both Graham and Slone see forensic pathology as a noble calling. “We are public servants, working not just for the government, but also the people,” Graham says. “It’s a privileged position, and we work hard to build trust with families and the criminal justice system.”

Building that trust is crucial.

“Our job goes far beyond the science itself,” says Slone. “There’s a skill and empathy we’ve developed being so familiar with death. We comfort grieving families who are going through one of the worst times of their lives. We try to give them the answers they’re seeking and help them to move forward with living.”

For Slone, this is the most important aspect of the work. “In truth, it’s what inspired me to become a medical examiner,” she says. “We are uniquely equipped to assist families when they are at their most vulnerable. I am proud to work in a place where all the staff put the families first.”

PROTECTING THE LIVING

Although medical examiners speak for the dead in many ways, that's not their sole purpose. “We also exist to protect the living, whether it is to raise awareness about preventable overdoses and natural diseases or to help remove violent criminals from the streets,” he says.

Graham remembers vividly a homicide case from more than a decade ago that drives home this point. A mother of three was abducted from her job as a cleaner at a building in Manhattan’s financial district. She was found dead—bound, gagged and hidden in an air conditioning duct system in the building.

“Anyone who had access to the building was a potential suspect, Graham says. “There was great fear among everyone who worked at that building, especially other women, that the perpetrator was at large and could strike again.”

Through OCME’s death scene investigation, and then Graham’s autopsy, he was able to identify and clearly describe the horrific way that this woman had died—asphyxia from her bindings. “And during the process of examining her body and collecting evidence, it was our meticulous efforts that spurred us to look closely at her hands which were bound in extraordinarily tenacious tape,” he says. “There, in the layers of tape and underneath her fingernails, we found DNA evidence that was not hers.”

Thanks to the extraordinary capabilities of its DNA lab, OCME was able to process the evidence quickly and identify her killer. The NYPD was informed, and the murderer was immediately arrested and taken off the street.

“I testified in the trial of the individual who abducted, bound, and killed her,” Graham says. “He was sentenced to life in prison and won’t ever do this to anyone else. In speaking for the dead—this ordinary young woman who left for work and never came home to her children—we were also protecting the living. We were able to bring closure to that family and ensure justice was served.”

But sometimes OCME’s protection of the living comes in quieter ways.

In January 2003, the agency created a first-of-its-kind molecular genetics lab that can help identify unexpected causes of natural death that are genetic and hereditary.

“When our lab finds a genetic cause of death, it means that a surviving family member may also have it and could be at risk for sudden death,” Slone says. “We have an in-house genetic counselor that explains the results to the family and connects them to potentially lifesaving preventative services. At first, these results are very overwhelming for family members, especially after losing a loved one.”

She remembers a recent case where a man in his 30s, with no known medical problems, died without warning. The autopsy showed that he had an enlarged heart and evidence of some heart disease. “We decided to do some molecular genetic testing because he was so young, and we found a genetic defect. It was a defect his first-degree blood relatives would have a 50-percent change of having, too,” she says. “Tragically, we found out that he had a brother who died almost a decade ago under very similar circumstances. But at that time, we didn't have the capabilities to test for this specific genetic-causing molecular change.”

OCME’s genetic counselor shared the information with the family, and his surviving brothers turned out to have the same genetic change. “Everyone in the family, including the decedent’s 10-year-old daughter, has since undergone cardiac evaluations and testing to determine their chance of developing this heart condition,” Slone says. “Luckily there are treatments available that can help them prevent similarly dire outcomes.”

At its inception the lab tested only six cardiac genes that were associated with sudden death. But since then, OCME expanded its molecular genetic testing capabilities and today tests for 304 different genes associated with cardiovascular disease, epilepsy, and blood disorders.

“We are truly lucky here in New York City to have these kinds of resources that other forensic science centers around the country and the world do not have,” Graham says. He hopes that by continuing to blaze new trails in forensic pathology and public service — and showing what’s possible in the field—OCME can continue to teach, share, and inspire.

DESIGN BY ELIZABETH HAUTAU KARP