The images are difficult to forget. The man flattened beneath the treads of an earth mover. The boy cut in half by a train when his jacket got caught. The woman who hanged herself using a purse strap and the rungs of a ladder-back chair.
These are just a few of the stories that Dr. Leah Bush carries around after more than two decades on the front lines of death investigation. As Virginia's chief medical examiner, a job she took in 2008, Bush oversees all medico-legal death investigations across the state from her desk at Jackson and Fifth streets.
In the role supervising the statewide operations of the Office of the Chief Medical Examiner, Bush reviews cases, and instructs police officers, medical students and staff on how to deal with forensic cases. But until she took that position four years ago, she dealt mainly with corpses, dissecting bodies in the morgue down the hall.
Bush caught the body bug when she started working for the medical examiner's office while completing her pathology residency at the Medical College of Virginia in 1986. She joined the office full time in 1988 as a trainee. She later transferred to the office's Tidewater district, where she spent the next 18 years investigating deaths. The medical examiner's office handles roughly 6,000 cases a year, approximately half of which result in autopsies. The others are examined externally for cause of death.
While working with corpses might give some the creeps, Bush feels at home with the dead — even if the occasional wrong movement in the morgue leads to a corpse's arm wrapped around her waist.
"I always tell people it's not the dead ones you have to worry about — it's the live ones," she says, laughing. "I think the worst thing for me would be to find a pulse. Now what do I do? Call the rescue squad?"
Among the more than 5,000 autopsies Bush has conducted, a few stand out. There's the case where a man killed himself with a shotgun shell using a set of bicycle handlebars as a homemade gun. There's the homicide that the Star tabloid dubbed "Rock 'n' Roll Granny Kills Boy Toy Lover." And the man who died without a single bruise or broken bone after his tractor rolled on top of him, the tire compressing his chest so he couldn't breathe.
But Bush's forte was multiple gunshot homicides. In cases with multiple shooters, determining which bullet killed a victim and which simply grazed a leg can determine who will be charged with murder.
"Bullets will hide in the most unusual places, and they can be a challenge to find," Bush says. "I've searched sometimes for several hours looking for a bullet. You have to get it out because it's evidence."
The most difficult part of the job is talking to the families of the deceased, Bush says. If she can do so truthfully, she makes sure to tell families that their loved ones didn't suffer. But no matter the circumstances, addressing the deceased's parents can be particularly difficult.
"It doesn't matter if the kid is 40, 4 or 4 months," Bush says. "The parents react the same regardless. They're just devastated."
In the eyes of her predecessor, Dr. Marcella Fierro, Bush's sympathetic connection with the families of the deceased is one of her particular gifts as a pathologist. Fierro, a revered examiner who spent 14 years as chief of the office, also served as inspiration for novelist Patricia Cornwell's protagonist Kay Scarpetta.
"[Bush] has eternal optimism, which is important in the work that we do," Fierro says. "Every day you walk in there, you know none of the patients made an appointment to see you."
Bush's daughter, a senior at the College of William and Mary, says her mother never has been one for doom and gloom — though Bush did share a few cautionary tales before allowing her to get a driver's license.
"Despite the fact that she works with death, she's so full of life," Austin Elizabeth Butler says. "She takes her work very seriously, but when she's home she's herself."
Like Fierro, Bush has spawned some fiction of her own, serving as a consultant for "CSI: Crime Scene Investigation," aka "CSI: Las Vegas." She's given it up since becoming chief examiner, but for a number of years her suggestions for investigation lingo made their way onto the small screen. Though these television shows have been criticized for creating what's called the "CSI" effect, when real-life jurors have unrealistic expectations of how much forensic evidence is required for a conviction, Bush says the shows do more good than harm, helping people understand what forensic investigators do.
On occasion the practices of television investigators still make her cringe. She recalls watching one episode in which investigators pour latex into the stab wound of a body.
Had an investigator done this under her watch, she jokes, "they would have lost an arm at the elbow. … They're tampering with the body and screwing my evidence up."
Though Bush tells her staff she's willing to help out in the morgue whenever they're shorthanded, she rarely has a chance to get back in the action, and she misses the thrill of the case. After all, a forensic investigation is "like a giant puzzle with a whole lot of pieces," she says. "You get a great feeling when it all comes together. It's like a light bulb goes on." S