Hektoen International

A Journal of Medical Humanities

On the way to school

Mary Jumbelic
Syracuse, New York, United States


Art like that by a young boy
Illustration by Joshua Jumbles. Published with permission.

A thin line of blood oozed from a shallow cut in the skin, like the first stroke of an artist’s brush on a blank canvas. The second and third incisions intersected the first to form a large Y-shape. Sanguinous fluid beaded up along their lengths. As the scalpel penetrated deeper, yellow globules of fat extruded, normally hidden beneath the white dermis of the skin. It took less than a minute to remove the bones of the front of the chest as the knife slid smoothly through the pliable cartilage next to the sternum.

Except for this one case, the morgue was quiet that day. I had arrived earlier than usual hoping to catch up with the endless governmental paperwork. My second cup of coffee had long gone cold, abandoned in my office as I hurried to the autopsy suite when the call came in for this pediatric motor vehicle accident.

I stood garbed in a white coverall, hair bonnet, N95 mask, and splash shield. My purple Crocs, dedicated morgue shoes, peaked out beneath my maroon scrubs. The personal protective gear was standard but felt overdone as I stared at the corpse of a six-year-old boy.

The boy had been the front seat passenger in a car driven by his mother. They were on the way to school, just the two of them. Another car rear-ended them at a stoplight. Had the mom paused too long at a green light? Had she stopped suddenly on an amber? Was the other driver distracted or had the sun just caught his eye? I would have to wait for the police report.

The mother had whiplash from her head jerking forward and back at the collision. After the shock of the impact, she had turned to her son and saw his head slumped forward. That is when her screaming began.

Joe, an Emergency Medical Technician (EMT) had been on the scene right away. He was getting a breakfast sandwich at the corner bodega when he heard the familiar squeal and crunch of the cars. Already heading toward the scene, the woman’s screams made him hurry faster. The boy’s face was blue and respirations wheezy. The chest muscles pulled tight to the rib cage as the child tried to inhale. Pressing fingers at the neck, Joe felt for the pulse of the carotid artery, which was weak and slowing. As Joe undid the seatbelt and slid the child out of the car, he noted that the airbags had not deployed. The rescue team arrived quickly assisting Joe and then transported the boy to the hospital with advanced life support continuing. This was documented in the medical records.

His mother waited for an answer from me. She sat sedated with a cervical collar in place in the Family Room, a dimly lit space with soft-cushioned couches. A forensic investigator sat with her in a quiet vigil that would end only when the autopsy was completed. She had refused to go home until she knew what had happened to her son. A small rack on an end table contained brochures about the stages of grieving with contact numbers for groups claiming to help with the process.

The boy looked so small on the autopsy table, vulnerable in his size and nakedness. I thought of my three boys. Images of them in the bathtub splashing and laughing contrasted with his still and silent form.

I methodically removed each internal organ, examining in turn the heart, lungs, liver, spleen, and kidneys. Working through from most to least likely injured, the dissection started with the aorta. When the body’s forward motion is abruptly stopped in a collision, this large vessel can rip right off the heart. There is rapid exsanguination if the tear is complete but at times some gauzy layers remain with a final break occurring later. The person can be conscious initially only to suffer collapse on the way to the hospital.

Ribs can fracture which leads to outside air rushing in and collapsing the lungs. The remaining hard organs of the abdomen can lacerate and bleed. None of these injuries appeared in this little boy.

His insides were a text-book lesson in normal anatomy. The lungs glistened pink without the ubiquitous black dots of urban living or smoking. The heart and viscera gleamed without years of unhealthy eating coating their surfaces. No injuries or broken bones or blood poured into spaces where it should not be. My hands carefully palpated the inner lining of the body and the spine, feeling for minuscule trauma. X-rays hung on the light-box next to the autopsy table. I scrutinized them once more and still could find no abnormality.

The stomach lay on my dissecting board with clamps on both ends. Using bandage scissors that hold one lip of the tissue while cutting, I opened the stomach and poured its contents into a measuring cup. Peach colored fluid with chunks of scrambled eggs spilled out, a total of ten ounces. The distinct aroma of orange juice wafted up. A pang of guilt hit me that I did not make my boys breakfast this morning. They had waited for the school bus with their pop-tarts wrapped in paper towels. Maybe I would pick them up early and make them breakfast for dinner.

In the morgue, I withdrew body fluids for toxicology—blood, bile, and urine, more than 300 mL and clear. He had not had a chance to go to the bathroom before rushing to the car.

I watched closely as my assistant removed the top of the cranium. There was a soft sound like opening a vacuum-packed plastic bag as he does this. In car crashes, the typical fatal injury is in the head. The forces generated cause the thin lining of the brain to tear. A multiplicity of blood vessels spidering through this tissue rupture and bleed. The skull is a confined space so when liquid accumulates, pressure pushes the brain. Having nowhere to go but down toward the spinal cord, the swelling damages the area that controls the heart and breathing. Enough pressure causes circulation and respiration to cease.

I looked into the skull of the child, the inside, pristine and without hemorrhage. The tan curves of the brain reminded me of a coral reef.

The neck block remained for me to examine. Slicing along the edge of the tongue, I checked the red-brown muscle for small bruises. These might show up if someone has a seizure and bites down hard. I saw none. I opened the tubes of the throat starting with the esophagus; the pearly white lining appeared perfect. Anxiety rose inside me with the possibility there would not be an answer for the weeping woman down the hall.

The airway was last, covered by a little flap of cartilage called the epiglottis. This valve is responsible for the coordination of breathing and swallowing. When it is working properly, eating and talking occur without conscious awareness of two side by side pipes. When it is not, a stray food particle can enter the larynx resulting in hacking coughs. Below the epiglottis are the vocal cords, membranes moving like bellows to create speech. If something larger is inhaled instead of swallowed, talk ceases and the Heimlich maneuver is needed.

Then I saw it—a pink glob wedged in the upper trachea. It was the size of a grape and peeled easily away from the mucosa. The magnifying glass revealed ridges on its surface, indentations from teeth. I leaned closer. The odor of bubblegum surrounded me.

An answer—intense in its simplicity.

“Pat,” I called to my assistant, “can you photograph this?”

He looked at the object of interest, the wad of pink chewing gum that I had placed on a blue photo board. He stopped sewing the child’s scalp closed and gaped. Years in the morgue did not lessen his surprise.

“I’m going to talk to the mother,” I said. I had uncovered the mystery of why she sat alive less than fifty feet away and her son lay dead within my reach. Your son choked on a piece of gum. It sounded ludicrous.

I removed my autopsy garb, took a deep breath, and headed to the Family Room. I imagined the morning of his death—his mom hurriedly organizing the car with a lunchbox, coffee, and list of daily chores. A morning like dozens of others; a morning like many of mine. Her son sat quietly enjoying a Big-League Chew or bubblegum cigar, a treat before school. Perhaps it had been from a gift bag at a friend’s weekend birthday party. Maybe the boy had found it in a crevice in the seat or glove compartment. Ten minutes later, the jolt of the accident caused the gum to go down the wrong pipe and block his airway.

“The truth will set you free,” John 8:31-32. It was my job to deliver the truth. Yet wouldn’t my words make this immeasurable loss worse? They certainly could not make it better.



MARY JUMBELIC, MD, is an author from Central New York, and former chief medical examiner of Onondaga County. Performing thousands of autopsies in her career, she elaborates a strong voice for the deceased. She explores through creative non-fiction the imprint the dead have made on her humanity. Published with Rutgers University Press, Vine Leaves, Ground Fresh Thursday, Jelly Bucket, and Grapple Alley, among others, her pieces have also ranked in the top ten in national writing contests. She teaches at the Downtown Writer’s Center in Syracuse and is assistant editor at Stone Canoe. Her blog, Final Words, is available at www.maryjumbelic.com.


Highlighted in Frontispiece Volume 13, Special Issue– Fall 2021

Fall 2021  |  Sections  |  Personal Narratives

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.