Jan C. Garavaglia, MD, shows viewers the world of forensic

[ COVER STORY ]
A Real Life
By Amanda Koehler
I
t was just another day at the morgue for Jan C. Garavaglia,
MD—as well as the basis of another episode of her hit Discovery Health show, Dr. G: Medical Examiner. A man was
found dead and covered in blood in a car in the middle of
a park. While medical investigator Frank Tovar was at the
scene handling the bloody body, a glove ripped. Unfortunately, Tovar had a cut on his hand and was now exposed to
any bloodborne disease the dead man may have had.
Not only did Dr. G have to determine the man’s cause
of death (which, after opening him up and examining his
esophagus, she determined to be blood loss due to ruptured esophageal varices), but she also needed to determine whether he had any bloodborne diseases—not just
to solve the mystery of the man’s death, but for the sake
of her friend Tovar.
After testing the man for hepatitis B, hepatitis C and HIV,
Dr. G found out the dead man did have a bloodborne More on the Web
Attention bibliophiles—check out how forensic science has influenced fictional novels in our October 6 Web update.
ADVANCE spoke with novelists Mark Terry, Elizabeth Becka and Jonathan Hayes to find out why science is becoming
such a popular topic in books. Visit www.advanceweb.com/MLP. Also look for a podcast and more with Dr. G.
10
ADVANCE for Medical Laboratory Professionals ❘ October 6, 2008 ❘ www.advanceweb.com/MLP
©DISCOVERY
Jan C.
Garavaglia,
MD, shows
viewers
the world
of forensic
pathology
through her
TV show.
HEALTH CHANNEL
Role
Model
PURCHASE
DR. G’S
BOOK
r. G is
releasing
her first
book, How Not to
Die, on October 14.
Dr. G uses her tales
from the morgue
to show people
what they can do to
prevent themselves
from landing on her
examination table
prematurely. The
book is filled with
interesting tidbits on
various health issues
and instructs readers on how to live
healthier, safer lives.
To buy a copy
or for more information, visit the
ADVANCE Healthcare
Shop at http://shop.
advanceweb.com.
▼
FACE OF
FORENSICS:
Dr. G likes that
her show, Dr. G:
Medical Examiner,
helps audiences
see what medical
examiners do.
[ COVER STORY ]
act
disease—hepatitis C. Tovar was serially
tested for hepatitis C, and later found out
that, fortunately, he was not infected with
the disease. In one case, Dr. G helped close
two mysteries—and all in one episode of
her TV show.
The Road to TV Stardom
After graduating from medical school, Dr. G
completed her fellowship in forensic pathology at the Dade County Medical Examiner’s
Office, Miami. Before joining the District
Nine team, Dr. G was a medical examiner
for the Bexar County Forensic Science Center, San Antonio.
In the meantime, forensic science became
12
HEALTH CHANNEL
©DISCOVERY
Finding Her Niche
Long before she became the star of her
own television show and the chief medical
examiner of District Nine (Orange-Osceola)
Medical Examiner’s Office in Florida, Dr. G
was just a butcher’s daughter from St. Louis
with a love for science, specifically the medical field. But at first, she didn’t know what
she wanted to do with her interest.
Fascinated by abnormal human behavior and psychiatry, Dr. G spent 6 weeks
working with psych patients while going to
school at the St. Louis University School of
Medicine and realized it wasn’t for her.
“I think some of the psychiatrists get
changed in that profession,” she explained.
“It’s one thing to be interested in abnormal
human behavior, and it’s another thing to
have to deal with the people. I thought, ‘I
don’t think I’d like to do that day in and
day out.’”
She later tried out an internal medicine
internship, but that area of medicine didn’t
hook her either. She thought back to medical school and what fascinated her. She
remembered how intrigued she was by the
lectures of the forensic pathologists, especially those of prominent forensic pathologist George Ganter, MD.
“Forensics is abnormal human behavior,
putting a puzzle together, adding some
original thinking, and solving problems,”
she told ADVANCE. “I just realized this
could be my niche … and it has been; I’ve
loved it ever since.”
ke
SOLVING THE PUZZLE: Dr. G said one of the reasons she got into forensics is because she enjoys
how the field lets her solve a mystery and put a puzzle together.
popular with the emergence of television
shows like CSI and books like Patricia Cornwell’s series featuring her fictional medical
examiner Kay Scarpetta. The public was
intrigued by forensics, just as the subject had
fascinated Dr. G while in medical school.
Jumping on the forensics bandwagon,
Redbook decided to do a story on a real life
female medical examiner in the late 1990s.
“But they didn’t want someone like Kay
Scarpetta, they wanted someone more like
their reader demographic … maybe younger
with small children,” Dr. G noted.
A reporter called the National Association of Medical Examiners and was directed
to such a female medical examiner—with
her two young sons, Alex and Eric, Dr. G fit
the bill perfectly.
“They called me up and I thought they
were just asking for background information about an article on forensics,” Dr. G
recalled. “They really liked talking to me,
and they came and spent a couple days with
me and wrote an article about it.”
Already in the forensics limelight once,
a few years later, Dr. G was approached by
the Discovery Health Network to star in her
own medical documentary. At first, she told
them no. She had just spent time filming a
French TV documentary and realized how
much work it was.
“And I realized people just like to concentrate on the crimes and think that’s all
ADVANCE for Medical Laboratory Professionals ❘ October 6, 2008 ❘ www.advanceweb.com/MLP
medical examiners do, but it isn’t. Only 10
percent of our workload is murder,” she
added. “Some of the most fascinating cases
are how people end up in my morgue and
what’s happened to them … every single
body that goes through [our morgue] has
a story to tell.”
Dr. G told the producers the only way
she’d be interested in doing the show was
if they showed the profession in its realities
and focused on all types of different cases,
not just murders.
“I said if you can understand why I’m fascinated about this field and realize it’s the
everyday people and not just the crime, I’d
be willing to do the show,” Dr. G remembered. “And when the producer Craig Coffman saw that and said, ‘Yeah, we could do
it that way,’ then I agreed to do it.”
She filmed the pilot in 2003 and the series
premiered the next year. With the new season of Dr. G: Medical Examiner debuting and
a brand new special called “How Not to
Die” airing Oct. 14 at 9 p.m. EDT, Dr. G has
this reality TV thing down pat.
Each episode of the show follows two
cases where a decedent winds up on Dr.
G’s table. The cameras show real footage
of Dr. G performing autopsies and solving the mysteries of how her patients
died. The shows also feature interviews
with the family members and loved ones
of the deceased and dramatizations of the
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CSI PUTS FORENSICS IN THE SPOTLIGHT
ith its rock music, highly
stylized, three-dimensional
cinematography shots and
interesting storylines, CSI splashed onto
television in 2000. Since its debut on
CBS, it has become a favorite of many TV
watchers, won multiple Emmys and has
stayed near the top of the Nielsen ratings.
It’s produced two successful spinoffs, CSI:
Miami and CSI: NY. But behind the glitz
and glamour of the high-profile show
are real people with a background in the
forensic science profession.
Richard Catalani, producer, writer and
technical adviser for CSI, worked in various sections of the Los
Angeles County Sheriff’s
Crime Lab for 16 years.
In 2001, he decided to
retire from the lab and
go into private practice.
“I ended up becoming frustrated with the
government lab and
CATALANI
the lack of commitment
and attention that was
paid to the crime lab by the higher ups,”
Catalani told ADVANCE.
A friend of Catalani left the lab a year
before he did to work on a television
show, and he gave Catalani the idea
that he should do the same. Catalani has
had a hand in what goes on on CSI with
his triple role as technical adviser, writer
and producer.
Catalani said many of his story ideas
are based on his experiences. “We also
get stories from the news now, and the
really amusing part is that most of the
time, the real stories are too crazy for
television,” he said.
With a background in forensic science,
Catalani knows—and admits—CSI cheats
on a couple of things when it comes to
portraying a realistic view of the profession. The writers realize the length of time
it takes to run tests and solve cases is usually a lot longer than what is shown on CSI.
“DNA testing takes a lot longer than
over the commercial break,” Catalani
noted. “We also don’t show the tedium
involved. I’ve been at crime scenes for 24
hours getting evidence. If we would show
that in real time, nobody would want to
watch the show.”
However, Catalani said all of the science
portrayed in the show is fundamentally
accurate, and the instrumentation they
use in the labs is real equipment.
Catalani believes shows like CSI have
become so popular because they are a
take-off of old police shows.
“Everyone’s loved police shows forever,
and what we’ve done is added science
into the mixture. People discovered forensics … and it was a new turn on an old
CBS BROADCASTING INC. ALL RIGHTS RESERVED.
ashe
I’d
moffdo
HEALTH CHANNEL
©DISCOVERY
Fact and Fiction
Even though the appearance of forensic
science on television dramas has made
people more aware of the field, Dr. G
“All of the fictional shows tend to overemphasize the value of the forensic evidence and downplay some of the other
aspects making up a case and bringing the
pieces of the puzzle together,” she said. “It
gives juries the expectation that some of this
fancy forensic evidence has to be done on
every case, when it’s not necessarily so.”
Dr. G referenced a time when a prosecutor told her about a case where a gun was
used in a rape. After the crime was committed, the gun spent 6 months submerged
in a lake. The jury thought the prosecution
should have done DNA testing on the believes the general public is sometimes
getting false ideas about the profession.
“Do I think forensics on TV has made people more interested in the profession of crime
scene investigators? Yes. In the profession of
forensic pathology? No,” Dr. G explained.
“There’s still a shortage of forensics pathologists because I think the people who get
interested in it when watching TV get turned
off by the fact that you have to go through 4
years of college, 4 years of medical school and
5 years of training after medical school.”
Along with not realizing what goes
into becoming a forensic pathologist or
scientist, Dr. G said fictional shows often
distort how the job is done, confusing the
public’s perception of the job and of how
an investigation works.
©2008
ay
was
ies
es,
activities leading up to death.
Overall, Dr. G said the producers try to
keep her show as authentic as possible.
“Sometimes, in making the show, things
get stretched. Something I may be able to figure out in the first 20 seconds of the autopsy,
we maybe stretch that out a little bit to cause
some suspense,” she explained. “Overall, we
try to keep it as real as possible. The stories
are certainly all real. And sometimes that’s
unbelievable. You wouldn’t put some of the
things that happen [on my show] in a fictional
show because it would be unbelievable.”
MONTY BRINTON/CBS
10
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nd
gle
has
[ COVER STORY ]
A CLOSER LOOK: Gil Grissom (William
Petersen) searches for clues to the cause
of death of a 3-year-old girl on CSI.
theme,” Catalani explained. “When I used
to testify as an expert witness, I would
have to tell juries what I did. Now, everyone knows and they think they know
what science can do.”
Additionally, Catalani sees how CSI
has influenced viewers to go into science
professions.
“There’s tons of real life anecdotal
stories about kids being interested in science and forensic pathology programs
because of the show,” he said. “It’s one of
the things I am most proud of the show is
that it’s making science cool for kids.”
—Amanda Koehler
www.advanceweb.com/MLP ❘ October 6, 2008 ❘ ADVANCE for Medical Laboratory Professionals 13
[ COVER STORY ]
WE ASKED, YOU ANSWERED
We asked online readers what their favorite medical drama is. Here are some of the answers:
“CSI. LOVE WILLIAM PETERSEN as
Grissom. He loves his work and shows
perfection in all he does. It is nice to
see lab geeks solve crimes in the area of
forensic science.”
—Liz Rogers, CLS, MT(ASCP),
Technical Coordinator,
St. Helena (CA) Hospital
“DR. G: MEDICAL EXAMINER. I enjoy
the topic, plus Dr. G seems like a genuine,
nice person and brilliant!”
—Tammie, MT(ASCP),
Medical Technologist,
Cancer Center of the Carolinas,
Greenville, SC
“I’M NOT A FOLLOWER of TV shows,
but lately I’ve caught a few episodes of
Bones and also House. Both involve a
lot of detective work, and some forensics (in which I have a special interest).
Although still unrealistic in many areas, I
like the methodical approach both shows
gun, which wouldn’t yield results after an
object is under water for so long.
“[The public] doesn’t understand when it’s
appropriate and when it’s not. So that’s always
a problem: the higher expectations from those
shows. And then [fictional characters] do
things that would just not be done … and certainly they solve things quicker than would
normally happen,” Dr. G noted. “Sometimes,
they solve investigations that would take
weeks and months in 52 minutes.
“One person seems to be able to do it all on
those shows. And that’s not the way it is. A
person who does DNA analysis … that’s all
they do all day. They’re not usually collecting
the specimen or chasing down criminals or
interrogating anybody. People who collect the
evidence don’t go out and arrest people,” she
continued. “People who collect the evidence
don’t come in and tell the medical examiner
what to do or how to do it. That’s one I turned
off. I remember it was a crime scene person
coming in and telling the doctor what to look
for in the internal examination … I’m like, ‘oh
my.’ So, [the shows] are unrealistic.”
14
take in unraveling the mystery of the
day. Some of their recreations are quite
accurate, others are just silly to anyone
with actual forensic or anatomic knowledge. The autopsy scenes continue to be
nonsensical visually and procedure-wise.
However, it is nice to see the labs getting
some credit for their diligent behind-thescenes work.”
—Thom Marallo, MT,
Director, Laboratory,
UCVH,
Colebrook, NH
“IT USED TO BE ER but now it is House.
I love to guess along with the differential diagnoses that go along with the
patient’s symptoms. I don’t like it, though,
when the docs go to the labs to perform
their own tests.”
—Jean Allen, MT(ASCP)SBB,
Blood Bank Manager,
St. Vincent’s NYC,
New York, NY
Dr. G acknowledged people like watching these shows for their interesting stories and the mysteries they create. But she
thinks what she sees in “real life” at her
morgue is much more intriguing.
‘The show gives
people the insight that
we really are physicians
and that we need to
know medicine.’
—Jan C. Garavaglia, MD
“I really don’t have that much interest in
[forensic crime dramas], because I found that
the cases I work with day in and day out are
more interesting,” Dr. G said. “I think real
life is much more interesting. I would much
rather read a biography than a novel.”
Looking Up to Dr. G
Over the past few years of working on Dr.
G: Medical Examiner, Dr. G has seen many
ADVANCE for Medical Laboratory Professionals ❘ October 6, 2008 ❘ www.advanceweb.com/MLP
“M*A*S*H—IT’S A CLASSIC. The
medicine was correct both in content
and to the time period (Korean War).
I especially liked the episodes in which
Klinger developed thalassemia and
the one where they were dealing with
patients with hemorrhagic fever. I really
dislike shows in which the facts are inaccurate, such as the hero is racing against
time before the deadly virus “Serratia”
kills the world’s population or the episode of St. Elsewhere where the physician looked through the microscope
and typed a patient’s blood. It ruins
the whole show for me. Any medical
technologist would have caught those
errors. As for the modern shows, CSI is
pretty good, although they could probably get more done if they turned on
the lights in the lab.”
—Teresa Webb-Martin, MS, MT(ASCP),
Molecular Pathology Laboratory,
Maryville, TN
gains from doing the show. She likes that
audiences are getting a better idea of forensic pathology and what medical examiners do by watching her show. She pointed
out medical examiners don’t just deal with
corpses—they interact with police officers
and family members, too.
“It’s not just telling the police how [the
person] was shot. It’s telling a grieving
mother she didn’t do anything wrong
in the death of her baby—that the baby
died of a congenital heart defect,” Dr. G
explained. “There’s a lot of different good
and people see that and see the value of
forensic pathologists as something more
than just cutting people up to see where
the bullet is.
They see us as physicians. I think the
show gives people the insight that we
really are physicians and that we need to
know medicine.”
Dr. G also appreciates that the show
has let local viewers into their office,
continued on page 25
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[ RECRUITMENT / RETENTION ]
books and stem the professional shortage?
Be proactive! Go where the potential
applicants are, Bohlig advised. And don’t
wait until you have openings to launch
your recruitment and branding efforts.
“Whenever possible, clinical lab recruiters
should attend professional conferences,
visit colleges and universities, and support professional organizations,” Bohlig
said. “Offering attractive work schedules,
job sharing and opportunities for advancement attracts new applicants.”
Bohlig also stressed the importance of
recruiters joining and participating in their
own local recruitment association. The Nurse
Recruiters Forum, a local recruiters group,
formed in 2000. This group, now called the
Pacific Coast Association of Health Care
Recruiters, has continued to grow, and is
now a National Association of Health Care
Recruiters (NAHCR) chapter. At these meetings, recruiters come together to learn different recruitment strategies, discuss the
recruitment needs of the community and to
network with colleagues.
Dennis Yee, CHCR, NAHCR vice president, recruitment consultant, Children’s
Hospital Central California, Madera, also
advocates getting out there. He suggested
laboratory scientists start marketing the profession more aggressively to high school and
college students, especially those interested
in science who do not wish to become physicians. “The hospitals and labs need to invite
these students to come and tour their facilities and job shadow a clinical lab scientist to
truly understand what they do and the critical role they have in the treatment and care
of patients,” Yee said.
He also recommended getting a corporate sponsor to develop and promote a
national marketing campaign for the future
of the laboratory profession. “Offer more
scholarships at the college/university level,
support internal candidates who wish to
return back to school to obtain their bachelor’s degree and obtain CLS license, offer a
CLS trainee program, and support both the
state as well as national lab organizations
and their annual conferences,” Yee added.
King also stressed the importance of reaching out to schools, particularly guidance
counselors, to make sure they understand the
many career opportunities within the clinical lab. “They may not understand or know
how to counsel students in this area,” she
said. Saint Joseph Regional Medical Center
(SJRMC) is a member of Nursing 2000 North
Inc.—an organization uniting education and
service to bring nursing careers as an option
to the forefront. Nursing 2000 started in
Indianapolis, expanded to the northern area
of Indiana and has now grown to provide
nursing scholarships.
SJRMC also holds an annual job shadowing program bringing high school
students in to spend the day shadowing
a nurse. According to King, the organization tracks the results of this experience
and it has been pivotal in encouraging students to enroll in nursing school. She also
encourages labs to consider implementing
an extern program if it’s feasible.
Also key to the medical center’s recruitment efforts is supporting nursing students
by developing a close relationship with nursing programs and offering students a nurturing environment during clinical rotations.
“How students are treated and respected
during their time in your hospital is recruitment at its best,” King stressed. ■
Kerri Penno ([email protected]) is
senior associate editor of ADVANCE.
U.S. Postal Service
Statement of Ownership, Management and Circulation
ADVANCE for Medical Laboratory Professionals, USPS Publication No. 003-754, is owned and published biweekly, with the
exception of three consecutive issues in January, by Merion
Publications Inc., 2900 Horizon Drive, King of Prussia, PA 19406.
Ann W. Kielinski is Publisher, Matthew T. Patton is Editor and
Managing Editor and their address is the same as listed above.
Stockholder of Merion Publications Inc. is Ann W. Kielinski, 2900
Horizon Drive, King of Prussia, PA 19406. The Total Distribution
for the September 8, 2008 issue was 64,760 news magazines
mailed Regular Periodicals, with 160 office copies retained, for
a net bindery run of 64,920 copies. Of the 64,760 news magazines mailed for the September 8, 2008 issue, 36,225 were
requested by the recipients through mail subscriptions or telephone requests and 28,535 were sent as free complimentary
copies. The Total Average Distribution for the preceding twelve
months prior to October 1, 2008 was 65,343 news magazines
mailed Regular Periodicals, with an average of 157 office copies, for an average net bindery run of 65,500 copies. Of the
65,343 news magazine average distribution for the preceding
12 months, 37,621 was the average number of copies requested
by mailed subscription or telephone request and 27,722 was the
average number of copies sent as free complimentary copies.
[ COVER STORY ]
continued from page 14
made them transparent to the community and proved they treat decedents
with respect.
“People from the community have
written me and told me they were scared
at first to have their loved one come
through here,” she said. “But they see we
do treat everyone with dignity and made
it a little less scary for them.”
Additionally, Dr. G has learned
more about the process from the family members’ perspective. By watching
the family interviews sometimes done
6 months or longer after the loved one’s
death, Dr. G sees how what she tells
the family members can be so valuable
to them. “It’s a learning process for me
to listen to what the families have to
say,” she said.
But maybe most importantly, Dr. G:
Medical Examiner has presented young
women with a female scientific role
model to look up to. According to recent
research, “the CSI effect” may be bringing more women into the forensic science
profession. About 75 percent of graduates
from forensic science programs in the
U.S. are women, and the nation’s forensic lab workers are now about 60 percent female (Potter D. ‘CSI effect’ draws
more women to forensics. Available at:
www.msnbc.msn.com/id/26219249. Last
accessed Sept. 30, 2008).
But with Dr. G, girls can see a real-life
forensic scientist, not an actress, solve the
mystery of how the everyday person died
with intelligence and compassion.
“I get a lot of letters from parents of
young girls, [and it’s] very satisfying
these young girls see me as a strong,
positive role model, and it’s making
them interested, not just in the small
field of forensic pathology, but in the
fields of medicine and science,” Dr. G
commented. “And that’s a tremendous
positive aspect of the show I didn’t realize would happen.” ■
Amanda Koehler ([email protected])
is assistant editor of ADVANCE.
www.advanceweb.com/MLP ❘ October 6, 2008 ❘ ADVANCE for Medical Laboratory Professionals 25