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t m c » p u l s e | o c t o b e r 2 0 1 7 6 'A Rather Peaceful Place' Inside the Galveston County Medical Examiner's Oce T he green folder on Dr. Erin Barnhart's desk continues to gnaw at her. The Galveston County Chief Medical Examiner is trying to deter- mine why, exactly, a seemingly healthy man in his 30s came to be found dead in his bed. All she knows is that, before he died, he reportedly had been feeling sick for a few days. She flips through the pages inside the folder, ticking off the facts that deepen the mystery. The autopsy came back normal, and the toxicol- ogy report showed no signs of drugs. Organ samples looked fine too, and Barnhart—down to the last few tests she can perform—isn't optimistic that she'll come back with a definitive answer. He might have had undiagnosed diabetes, she speculates out loud, but admits that's not looking likely. She's dreading what she'll likely have to enter into the record—"cause of death: undeter- mined"—and the uncomfortable conver- sations with his family that will follow. "Those are some of the most frus- trating, unsatisfying cases," Barnhart said. "You wonder 'Have I missed some- thing? Is there something wrong with the story?' You can drive yourself crazy with cases like that." For someone like Barnhart, who is motivated by the search for the truth and the challenge of peeling back layers of a case, the experience can be maddening. Fortunately, she has an impressive success rate: Fewer than 1 percent of her office's cases wind up with an unknown cause of death. The rest of the time, thorough examination yields clues that ultimately lead to a conclusion. Her office performs about 1,200 autopsies annually. "Just the way human bodies go together, they come apart in much the same way," Barnhart explained. "They go together like puzzle pieces and come apart like puzzle pieces. You look at each of the pieces, and see which ones are dysfunctional or injured, and there's a nice symmetry and organization to it." For Barnhart, a Fort Worth native who took the job in Galveston in 2015, the position was something of a homecoming. She attended medi- cal school at The University of Texas Health Science Center at Houston and did her anatomic and clinical pathol- ogy residency, as well as her surgical pathology fellowship, at The University of Texas Medical Branch at Galveston (UTMB). She completed her training in forensic pathology at the Miami-Dade Medical Examiner's Office in Miami. Before returning to Galveston to lead the medical examiner's office, she spent four years as the deputy chief medical examiner for the Mississippi State Medical Examiner's Office. In her role as chief medical examiner in Galveston, she's also an assistant professor at UTMB. Barnhart didn't expect to become a medical examiner when she was in medical school. But it was always in the back of her mind, ever since she saw autopsies performed while working at a hospital in college—and didn't recoil. "Without sounding too morbid, there's a certain beauty to it," Barnhart explained. She marvels at the wonders of the body, and her privileged position to observe and explore it. "Think of how few people in the world know what it feels like to squeeze a piece of brain in your hand." Barnhart's office is charged with determining the cause of death in more than a dozen specific instances, includ- ing when a human body is found under uncertain circumstances; when a homicide may have taken place; when someone dies in the absence of a credible witness; or when chil- dren die, in some cases. Her office is responsible for examining deaths in Galveston, Fort Bend, Brazoria and Matagorda counties. Though television dramas suggest that medical examiners spend most of their time working with police to solve homicides, those cases represent a relatively small portion of Barnhart's work. The most common are natural and accidental deaths. And there are other, television- inspired misconceptions about her job she wants to refute, too. "Those 'CSI' shows are the bane of my existence," Barnhart said with a laugh. "I refuse to watch any of them." For starters, she doesn't like the stereotype that the medical examiner is "the troll in the basement," a morbid or antisocial type who doesn't work well B y R y a n H o l e y w e l l Erin Barnhart, M.D., in the morgue of the Galveston County Medical Examiner's office.