Nearly 1,000 people were killed last year in Cook County, which includes Chicago. Ninety percent of those deaths involved a gun. The victims ended up at the Cook County Medical Examiner’s Office — the agency tasked with determining the cause of each and every death. These homicides, in addition to drug overdoses and deaths related to COVID-19, placed an unprecedented strain on the office, which brought in additional staff to handle the uptick in cases. 

Dr. David Waters is a forensic pathologist in training. He began a yearlong fellowship at the Medical Examiner’s Office last July, just as homicides peaked in the city. As a fellow, Waters works on the most difficult autopsy cases, including gunshot victims. The Trace spoke with Waters about his experiences in his job, and how he and his colleagues process the trauma they confront every day. 

This interview has been edited for brevity and clarity.

L.C.: Walk me through a typical day at the office. 

D.W.: I usually get in early to see which [autopsy] cases I have been assigned that day. I take this time to review all the relevant information we have about each case. This often includes police reports, medical records, and the initial report about the death that is taken by our investigators. The time it takes to perform all of my assigned exams depends on the types of cases I am handling. Once all of the pathologists finish autopsies for the day, we hold a consensus meeting where each doctor presents their cases and conclusions they’ve reached and the others have a chance to weigh in, ask questions, and offer insights before the cause and manner of death are finalized. I spend the rest of the day starting the initial parts of my report for the day’s cases, sign death certificates, and speak with others regarding the case if needed. 

When you perform an autopsy, what are you looking for?

We start with the external examination where we examine the body much like a clinician would examine a living patient. We document any evidence of natural disease processes or any evidence of injury. For example, in a gunshot wound case, I would document the gunshot wounds and any possible injury that they may have caused. Next, we perform the internal examination which essentially does the same thing; documents any natural disease processes and any evidence of injury. We document the injuries, whether it be one or multiple. In doing so, we determine fatal injuries. In the case of a gunshot wound examination, I may also retrieve bullets/projectiles as they are a type of evidence.

As a fellow, you’re tasked with some of the office’s most difficult cases. Why is that?

It’s important for fellows to see a wide variety of cases, including things that don’t occur that often. The fellows get the most challenging cases for three reasons: Performing exams and learning how to handle a wide range of cases. We are always assigned a supervising medical examiner, meaning one of the other medical examiners is available to help us with any aspects of the case. Lastly, the fellows are generally assigned less cases to give them additional time to spend on more complicated cases.

How did you become interested in this type of work?

My mom worked as a medical technician in hospitals, so I was exposed to it at a young age. She hooked me up with a pathologist at her hospital, and I got to observe an autopsy when I was in high school. It was the coolest thing ever, and it confirmed what I wanted to do. A forensic pathologist is a speciality of pathology that focuses on the cause and manner of death within the legal system.

Before starting your fellowship with the Medical Examiner in July, had you worked in a place with similar levels of gun violence to Chicago?

I grew up in South Dakota, where crime in general is not super high. For my medical school and undergraduate training, I spent time in Nebraska. I did see some of that violence there, but not to the sheer volume that we see here. This is definitely the most that I’ve experienced. I knew what I was signing up for, but the volume has definitely taken me by surprise. 

You started this past summer, when homicides were at their peak. What was that experience like?

I had rotated here previously as a resident, but it was definitely different when I got here [in July]. The office was abuzz, for a lack of better word, because it was just very apparent that it was busy and we had a lot of cases. After only a couple of weeks, they had myself and a couple of other fellows perform autopsies on homicides. I remember when we started, the doctors talked about how usually in the summer it’s busier and sometime during the fall it slows down — that didn’t happen. 

You perform autopsies on some of the most difficult cases, including people who died from multiple gunshot wounds. Can you walk through what the process is like? 

Our job is to figure out the big questions: How many times were they shot? Do they have retained projectiles or bullets? We try to recover all of those if we can because they might be linked to a gun sometime in the future. If a person has been shot multiple times, it’s more complicated. After we look at them from the outside and figure out what’s what, we also look at them on the inside. The most bullets I’ve ever had to recover is 17. It takes a really long time to retain all of those bullets, and every single one of those could be evidence. 

How long does an autopsy take? 

It depends on the case. If I have a person that’s shot in the head, then the entrance and exit wounds are clear. In the case where I had to recover 17 projectiles, it can take hours. In some cases, we have to hold the body and go back to it the next day.

That must be hard to process. It seems unimaginable and sad. 

I think there’s a base level of sadness whenever you see what someone has done to another person. I kind of feel that way about all my homicides, regardless of the manner they occurred. I think it’s definitely a tough part of our job to have to process these things. There’s definitely cases where afterwards, I want to go to my office and think a little bit. It can be tough. I have a good support system so I don’t get overwhelmed. Obviously with what we do — regardless of whether it’s a homicide, I’m seeing death every day. 

Last year we saw a historic level of death from COVID-19, drug overdoses, and gun homicides. You’re one of the few people that has a sort of bird’s-eye view of the situation. How do you cope with what you’re witnessing?

Every day, we see our list of [autopsy] cases, and we’ll see over a hundred of cases in the same day. I think it’s taken aback many of the other doctors that have been here for years — not just myself. We talk about it sometimes. It’s astonishing the numbers that we’re seeing, and it does take a toll. Every once in a while you’ll see a list of public death certificates that day, and it’s just like ‘Wow, look at how long this list is, look at this loss of life,’ and you just need to take a minute.

Do you ever read articles or watch news stories about the people you perform autopsies on? 

Some of the doctors try to avoid the media because you don’t want to be biased about anything before you go into an examination. There are just some things you can’t entirely avoid. A lot of times, though, after I perform an examination, someone will send me this article or I’ll see something in the news, and it’s like ‘Oh, that’s the person I performed the exam on.’ A lot of times we don’t know everything or have a full police report.

At the time of autopsy, it’s working for the sake of the truth. When I go into an exam, I don’t care if the person was an assailant or a victim — I care about finding out what happened to that person. 

So often when we talk about people who respond to crime, we think of police officers, firefighters, and city officials. Where do forensic pathologists fall in?

People kind of forget about us because we’re not first responders, we’re last responders. For the people that we perform examinations on, we’re the last doctor that they’re ever going to have. People forget about us, since the people we treat have passed away, but the work that we do is still very important. 

Your proximity to death is so much closer than most people will get — or want to get — during their lifetime. What keeps you coming back?

I think just being a proponent of the truth is very rewarding. It’s the long-term rewards that keep me coming back, like performing an examination that helped convict another person. I truly enjoy doing what I do. I enjoy speaking with families, even though it’s difficult conversations. It’s nice when you can provide answers and comfort.