The phone keeps ringing.

April 7, 2020

I have worked in places where the workload sometimes felt overwhelming. Not just as a physician, but also in my pre-medical life. I remember days when I worked in childcare when co-workers were out and the kids outnumbered me, or when I was a phlebotomist and it seemed that every patient in the hospital needed their blood drawn at the same moment. Most of the time there was no choice but to swallow the lump in my throat, buckle down, and get through it. But what about people whose jobs feel like this most of the time? Those who feel like their funding, staffing, and/or resources put them on the brink of being overwhelmed ona regular basis? These are the folks I am thinking of today. And as a physician and more specifically as a Pathologist, I am thinking of my colleagues in Forensic Pathology. Mostly because they are the ones I know.

Most folks who know what Pathologist even are when I tell them what I do for a living get a glint in their eyes when they ask me “oh, you do autopsies?” Full disclosure- I am board certified in such matters, but rarely do them as I am a surgical pathologist- which is usually met with disappointment in said persons. I do find it humorous that Pathologists have gained some fame in the post-CSI era as quirky, fun doctors who for some reason do most post-mortem exams in immaculate, poorly lit autopsy suits on TV. (Seriously, why won’t someone turn on some lights?)

A recent study of the medical examiner system has found “Because of insufficient funding, salaries of medical examiners are much lower than those of other physicians. Lower salaries lead to difficulty in recruiting and retaining skilled personnel.” Anecdotally, the physicians I have known in this field are highly intelligent but overworked. It really requires a level of toughness I don’t know if most people appreciate. The work is hard, both physically and mentally. And while I realize that the medical examiner system is designed to investigate unexplained and suspicious deaths, its underfunding is emblematic of the cutting of corners on matters surrounding handling of the dead. Reporters have been beating this drum for years, with a flare up around the death of someone famous.

So it follows logic that a sudden influx of deaths would threaten to overwhelm a system not set up to handle such surges, and not just in the US. In northern Italy, funerals have been suspended, with caskets lining up at overwhelmed crematoriums and funerals being held without attendants because family members are all in quarantine or have also passed away. In Ecuador, the dead are being left on the streets. But the image of this overwhelmed system that has resonated with me is that of the funeral home in one of the hardest hit areas of New York City. The phone rings all day, and the family-run business cannot keep up. They struggle to comfort the loved ones who call, searching for information and hurting. And they worry for their own safety and worry about holding funerals which may spread the disease further. I have worked in places where each new phone ringing signals extra work, but never like this. I fear that the stories of overwhelmed systems have only begun, and that Americans are not ready for what is to come.

References: Institute of Medicine (US) Committee for the Workshop on the Medicolegal Death Investigation System. Washington (DC): National Academies Press (US); 2003.

[www.washingtonpost.com/news/the-...](https://www.washingtonpost.com/news/the-watch/wp/2017/12/14/state-lawmakers-wont-adequately-fund-medical-examiners-offices-this-is-a-huge-problem/)

[www.cnn.com/2020/04/0...](https://www.cnn.com/2020/04/03/americas/guayaquil-ecuador-overwhelmed-coronavirus-intl/index.html)

[www.washingtonpost.com/nation/20...](https://www.washingtonpost.com/nation/2020/04/04/funeral-home-new-york-city-bodies-coronavirus/?arc404=true)

[www.bbc.com/news/heal...](https://www.bbc.com/news/health-52031539)

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