I wasn't one of those kids who was dissecting roadkill at the age of 6. It was a late decision to go to medical school. —Dr. Todd Grey
SALT LAKE CITY — More than 26 years since he handled his first autopsy in Utah, Dr. Todd Grey still fields the occasional phone call from a family member wanting to talk – again – about what happened to their lost loved one.
Some of these calls date almost as far back as his move to the state in 1986. And, as Utah's chief medical examiner for the past 25 years, Grey says he is more than happy to answer their questions, to try to make sense of the often senseless.
"This is what we think happened. This is what we think it means," Grey says, recounting the conversations. "I talk to families and relatives and no one's happy, but they're certainly desperate to try and understand what's going on and if we can give them some sense of understanding, then that's an important part of the job."
He is a regular fixture in courtrooms, where he takes the stand and identifies himself — "Todd Cameron Grey, G-R-E-Y" — and recites his credentials: Undergraduate degree from Yale, medical school at Dartmouth, additional training in forensics and pathology in Florida and California.
"Our job is to tell the story of the dead person," he said of himself and his colleagues. "We are not responsible for saying 'whodunit,' we say what done it. And one of the things that I think is very important for the office's reputation is that we are an honest broker of what happened to the dead person, not necessarily an advocate for one side or the other."
Identifying "what done it" also reveals some of Utah society's biggest problems: drug overdose and suicide, which make up the bulk of their exams. The criminal cases are the minority of their investigations, he said.
"We are much more involved in public health than we are necessarily in criminal stuff," Grey said. "We're the ones able to say, 'Here are trends in mortality we need to pay attention to.' Probably the most striking example of that is the whole prescription drug death epidemic that is going on.
"We were the ones that first sounded that alarm, saying, 'From what used to be very uncommon, we are now seeing these cases on a daily basis.'" And that really was part of our public health role."
Grey's journey to the autopsy table as a medical examiner in Salt Lake City "wasn't right down a narrow path." The areas where he grew up sound like a bumper sticker: Tokyo, Paris, London and Hong Kong.
When he returned to the United States to pursue an undergraduate degree, he had planned on becoming an academic anthropologist. It was something that interested him, but he had his reservations.
"It was a much more limited field and also something where it was much more of a taking kind of a thing," Grey said. "You know you go visit these people in remote areas and base a career on the study of them and I thought, 'Well maybe I should do something which is both, which has more options and maybe more giving back' and decided medical school would be interesting.
"I wasn't one of those kids who was dissecting roadkill at the age of 6. It was a late decision to go to medical school."
Still, it was pediatrics, not pathology, on which he chose to focus his studies. He was already into his residency in pediatrics when he found that he wasn't happy. For one thing, he didn't like dealing with pain, much less having to inflict it. He also didn't mix well with sleep deprivation.
"Back then, when there were no rules about how many hours they worked you, sleep deprivation was a very big part of medical training," he said. "So I thought, 'Well what branch of medicine minimizes sleep deprivation and doesn't have to deal with pain? Ah, pathology.' And pathology was intellectually very interesting. I wasn't bothered by the 'ew' factor."
Any death that is sudden and unexpected requires an autopsy from his office. They range from violent deaths and suicides to unattended or suspicious deaths, as well as those caused by poisoning or drug overdose or disease that could constitute a public health threat. They perform autopsies on those who die while in state custody and in suspected cases of Sudden Infant Death Syndrome. They also examine all work-related deaths.
Last year, the state medical examiner's office completed more than 2,400 autopsies and exams. There is only a small percentage of cases, 3 percent to 5 percent, in which they can't determine both the cause and manner of death. And it has revealed another troubling trend:
The deaths they see with nearly daily frequency are suicides.
"If you don't look at the problem, you're not going to fix it," he said. "There's the argument that if we highlight them, more people will think, 'There's an idea, there's a solution.' But on the flip side, if you don't know how common it is, people aren't going to recognize the threat that it poses and that they need to do something if the person they love or know is getting to the point of considering that."
It's rare for his office to go a day without a suicide case. "I've had days where I've had five deaths downstairs and all of them were suicides," he said.
Those who have worked with Grey credit him for his professionalism, willingness to help and sense of humor.
Assistant Attorney General Scott Reed has worked with Grey as both a prosecutor and on the Utah Controlled Substances Advisory Committee. He said Grey has handled staffing challenges and statewide responsibility of his office with aplomb.
"He is a great guy, understated and wry and so bright," Reed said of Grey. "Just a really intelligent guy who is so down to earth. That, to me, is kind of a rare combination."
Robert Stott, who has been with the Salt Lake County District Attorney's Office, said Grey is among the best, if not the best, chief medical examiners he's seen.
"He's not only knowledgable and professional, you can talk to him," Stott said. "He'll meet with you any time and talk to you about a case, whether you're a prosecutor or defense attorney. He's always wiling to talk to you about the case."
He said Grey will do additional research when unusual circumstances arise, teach classes to attorneys and testify honestly. He said Grey's decision to stay in Utah has helped him gain a good reputation and rapport with those with whom he works.
"He's tested the time and the time has tested him," Stott said. "I don't know of a single person in the legal system who doesn't have a good opinion of him."
The first floor of medical examiner's office, adjacent to the Utah Department of Health, appears standard and innocuous. Just downstairs, however, is where they store, examine and receive bodies, keep tissue samples, allow for tissue harvesting and study biopsies under microscopes.
"If a body is here by 3 p.m. and we have the information we need, most commonly just the investigator's report, it will almost always be done that day," Grey said. "On weekends, it's dropped back to noon. If the body comes in after noon, it will be done the next day. We work seven days a week, 365 days a year."
Each doctor is assigned a day to conduct exams. Three exams is considered a light day, while anything over eight means they will call in another doctor to help. Grey said he doesn't keep certain cases for himself; whichever doctor winds up with a case is "pure luck of the draw."
"Obviously, if it's a high-profile case, I'll provide backup and discussion with whoever is handling that case," Grey said. "But if I hired them, I think they're good enough to do the job, so I'm certainly not going to step in and say, 'I'll do this one.' It's not fair. They need to have the experience of being on those high profile cases and dealing with those kinds of pressures that go along with those."
It is a job that Grey continues to be passionate about. He likes its fast pace, the detective work involved, and that it's never predictable.
But he admits there is a heaviness to the job that requires "defense mechanisms." It would be too much to handle if he focused solely on the tragedy of each death, but he says it's a fine line between being guarded and being callous.
"The trick comes in finding the right balance between protecting your ability to do the job right and not becoming hardened," Grey said. "For me, at least, that's sort of the area where you have to be careful. … Our job is as much for the living as it is for the deceased, because if I can't talk to and explain things to a family or a prosecutor or a cop or whoever needs to know that information, then I haven't done my job right."
Family and friends seek answers, law enforcement and attorneys want details to find the truth, and the public needs to be informed about what is killing people. Meeting these demands continues to grow.
In 2011, two doctors were added to the four to meet demand. But the case load began growing again in 2012 when motor vehicle accidents came under the medical examiner's jurisdiction.
Grey said the National Association of Medical Examiners will not give accreditation to an office in which pathologists do more than 325 autopsies a year. The recommended amount is 250 autopsies a year for one pathologist, assuming the pathologist has no other duties.
Last year, the six pathologists at the Utah Medical Examiner's Office performed close to 1,987 autopsies — about 331 autopsies each.
Grey personally performed 405 autopsies and exams in 1991 with that number rising to 516 autopsies and external exams by 2007. The numbers went down to 371 in 2011 and 351 in 2012, but are still above recommended levels.
Meantime, the office on the whole saw an uptick in caseload. A total of 2,206 cases were handled in 2007, with the caseload dropping as low as 1,928 in 2010. Last year the numbers again increased, to a total of 2,430 cases.
"We don't control our workload," Grey said. "That's controlled by a much higher power than me."