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“The Scalpel is Passed,” a Conversation With Dr Vincent J.M. DiMaio

Dana, Suzanna MD

The American Journal of Forensic Medicine and Pathology: September 2019 - Volume 40 - Issue 3 - p 199–209
doi: 10.1097/PAF.0000000000000501
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Editor's Note This is the first article in a new series of interviews with mentors in forensic pathology. These interviews will also be recorded, and the audio files will be available online through the journal's Web site, http://links.lww.com/FMP/A31.

From the Central Texas Autopsy, PLLC, Lockhart, TX.

Manuscript received April 22, 2019; accepted May 16, 2019.

The author reports no conflict of interest.

Reprints: Suzanna Dana, MD, Central Texas Autopsy, PLLC, 1515 S Commerce St, Lockhart, TX 78644-4010. E-mail: sdana@ctautopsy.com.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.amjforensicmedicine.com).

Online date: July 13, 2019

For as long as I can remember, medicine and death were subjects that fascinated me. Growing up in Texas, I spent my free time reading mystery novels such as Ellery Queen and Nancy Drew. It was in high school that I thought about going into medicine or law, but as a female, I really felt I did not have a chance of getting into medical school. So instead I became a medical technologist and then a research associate at Southwestern Medical School in Dallas, Texas. I never gave up my longing to be a physician, so I decided to apply and, to my great surprise, was accepted. At that time, the number of females in medical schools was still relatively small. Because I had some background in clinical laboratory science through medical technology, I decided to pursue a career in pathology. It was not until my fourth year in medical school that I realized you could combine the fields of medicine and law by going into forensic pathology. I was thrilled to be able to take a fourth year elective in forensic pathology, and when I showed up at the Dallas County Medical Examiner's Office, I was very excited just to be in the building. Little did I know at that time that I was about to meet a person who would become one of the most influential persons in my career. I am speaking of Dr Vincent DiMaio who was, at that time, the deputy chief medical examiner for Dallas County. I will always be indebted to him for his willingness to teach me as much as he could during that short month. I will never forget his enthusiasm and his love for the field of forensic pathology. The second greatest opportunity of my career was that of meeting him again when he became the chief medical examiner in San Antonio, Texas, and he hired me as an assistant medical examiner. This began many years of working with Dr DiMaio during which I continued to learn on a daily basis. I feel very fortunate to have been blessed with a mentor with his experience, wisdom, and enthusiasm. I hope the readers will enjoy this interview with a true legend in the field of forensic pathology—Dr Vincent J.M. DiMaio.

Dr Vincent J.M. DiMaio was the chief medical examiner in San Antonio, Texas, for 25 years from March 1, 1981, to December 31, 2006. He was born in Brooklyn, New York, and completed his undergraduate studies at St John's University in Queens before attending State University of New York, Downstate Medical School. He completed his forensic pathology fellowship at the Office of the Chief Medical Examiner of Maryland in Baltimore, Maryland, after which he served the United States Army Reserve Medical Corps, where he was assigned to the Armed Forces Institute of Pathology in Washington, DC. After completing his military commitment, he joined the Office of the Dallas County Medical Examiner in Dallas, Texas, where he was the Deputy Chief Medical Examiner before becoming Chief Medical Examiner in San Antonio. During his tenure in San Antonio, he was also a professor in the Department of Pathology at the University of Texas Health Science Center Medical School. He also served as the editor-in-chief of the American Journal of Forensic Medicine and Pathology from 1992 to 2017 (Fig. 1).

FIGURE 1

FIGURE 1

Dr DiMaio is renowned throughout the world for his expertise in forensic pathology and ballistic injuries. He has published a huge volume of peer reviewed scientific articles in his field, and has authored and coauthored 4 textbooks that are considered criterion standards in forensic pathology, gunshot wounds, and excited delirium: Gunshot Wounds, Forensic Pathology, Excited Delirium, and Handbook of Forensic Pathology (CRC Press). He has held previous appointments on both the National Commission on Forensic Science and the Texas Forensic Science Commission.

Dr DiMaio currently lives in San Antonio with Theresa DiMaio, his wife of 50 years, a forensic nurse, and their dog, Sugar. He has 2 children, Dominick DiMaio, MD, associate professor at the University of Nebraska Medical Center, Omaha, Nebraska, and Samantha DiMaio, JD, assistant district attorney at the Bexar County District Attorney's Office, San Antonio, Texas.

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INTERVIEW CONDUCTED BY SUZANNA DANA, MD, ON DECEMBER 20, 2018

SD: I'm speaking today with Dr Vincent DiMaio, world-renowned expert in forensic pathology who I had the great privilege of training under back in the 1980s in San Antonio, Texas, at the Bexar County Medical Examiner's Office, which is what it was called at that time. I am honored to consider him my mentor in the field of forensic pathology, and I am very honored to be able to conduct this interview today. First, I want to thank you, Dr DiMaio, for agreeing to meet with me today to speak about your fascinating career in forensic pathology. As a student of yours, I can honestly say I feel privileged to have had the chance to train under you and be the benefactor of your guidance and instruction. I have many fond memories of the time that I spent doing cases at the Bexar County Forensic Center in San Antonio when you were the chief medical examiner and I was just a starting out fledgling forensic pathologist. I was so eager to do autopsies I would have done it for free, but luckily, you did pay me, so that was great. So I would like to start off with just a brief history of your early life, like where you were born, where did you primarily grow up. I think your father was a doctor and your mother went to law school. Can you speak a little about what influences they had on your decision to become a doctor? (Fig. 2)

FIGURE 2

FIGURE 2

VDM: Okay. I was born in Brooklyn, New York, in an apartment building across the street and down the street a little from where my mother and my grandparents lived. If you go through the book, you know Morgue,1 it mentions that my maternal grandfather was a physician. He was born and raised in Italy. There he met my maternal grandmother. Now, my grandfather came from a long line of physicians. I think they started—we've got data on physicians up to about maybe 1500 to 1600 and every male in the family continued to be a physician and maybe closer to 15 I think, I'm not sure. Anyway, every male was a physician up until the time my grandfather finished medical school. When he was in a hospital in Italy, he fell in love with my grandmother who was a nurse. Now, the problem was, in Europe at that time, and still at this time to a certain degree, you have various social strata and my grandfather's family refused to let him marry my grandmother because she was a nurse and he was a doctor and those were different social levels. But he decided he wanted to marry her. Now, he had some letters from Italian residents in Manhattan where they were looking for a doctor to come and practice there because they had a lot of Italians and they couldn't speak English. So my grandfather came over and he looked around, and he said okay he would do it. And you know, he went back to Europe and he broke with his family at that time. He came to Manhattan where he set up a medical practice and then he sent for my grandmother, and she came over in a ship accompanied by her brother as a chaperone, I guess. So she came here to New York and they got married. Then, they had a bunch of kids, one of which was my mother. At that time, Brooklyn was rural. There is a picture of her with the farm fields all around the house and everything. So they got married and they lived in a farmhouse when they first came. Well, it was still a farmhouse until forever, until it was torn down. But they were there and they had a couple of kids. My mother was one of the youngest. My mother then went to college. Now, you have to understand, at this time in the United States only 5% of men went to college, but my mother went to college, and then from college, she went to law school. If you can figure the low percentage of men going to college, then there would be an even lower percentage going to law school and an infinitesimal amount of women going to law school. And she graduated. And then my parents got married.

SD: How did she meet your father?

VDM: I don't know. Let's see. I think probably in college maybe.

SD: Was he already a physician?

VDM: Yes, he was a physician in the late 40s or so. And he wanted to go into obstetrics, but at that time, you were not allowed to be married if you were in obstetrics residency. You couldn't devote enough time to the field. And so they wouldn't let him go into obstetrics, so he went into the, not the Coast Guard, but a naval branch like that. When the war started, the Navy absorbed everybody. Anyway, they got married and he went into the naval program, and then he was put into the Navy during the war and …

SD: And that would be World War II?

VDM: Oh yes, World War II right. And so, actually, he was assigned to a hospital in New York Harbor, and so during the war, he actually was in New York Harbor the whole time. He had been assigned to a number of ships but it didn't work out, and that was good because the ships were sunk. Anyway, so they went there and my father just went into kind of private practice, which he didn't like and he really couldn't do much because he had this manner. If the patient was not sick, he told them that and to “go away.” And he didn't want to be bothered by them. My son has kind of the same thing too in private practice. But anyway …

SD: Was your father working then as an obstetrician?

VDM: Oh no. You know that was too late. And so he kind of did private practice and then he got a job in the Medical Examiner's office. And he was a pathologist by that time. He worked as a general physician and then did pathology. Now, he was very well qualified for doing forensic pathology because he was a pathologist.

Now, most people don't realize, in the New York City Medical Examiner's Office even in the beginning, most of the medical examiners were not pathologists. Of the people who worked with my father in Brooklyn, one was an internist and another one was a surgeon.

SD: How do you think your father got interested in forensic pathology?

VDM: He had a job!

SD: Is that it? Okay.

VDM: Well you know, they needed a pathologist. They needed a doctor and he actually was a pathologist, so he was a prize to them. And so he came in as a pathologist and started doing forensic pathology, and he stayed there the rest of his life (Fig. 3).

FIGURE 3

FIGURE 3

SD: So who would have trained him in forensic pathology? Or was it just more like self-learning on the job?

VDM: In those days, you kind of, well who was training the surgeons to do surgery? You work with who was there—Vance was there, and Gonzales. Vance was a surgeon. You know the book Gonzales, Vance, and Helpern?2 Vance was a surgeon. Gonzales, I think, was the pathologist, and the person who had been the medical examiner before then was Norris.3 That's when forensic pathology/medical examiner's offices started only around 1918. The first true Medical Examiner's Office was in New York and that was 1918. And Norris was there. And then when he died, Gonzales and Vance came in. Then, they hired a doctor named Helpern.

SD: Milton Helpern.

VDM: Right. Well, I'm giving you a history course now.

SD: That's great.

VDM: And so Helpern was there and I don't know if there were any other pathologists besides Helpern and Gonzales. But anyway …

SD: So when did your father become Chief?

VDM: Well, he became a medical examiner in the 40s, the late 40s. New York has 5 boroughs. I don't know if you realize that.

SD: Yes.

VDM: And what they wanted to do was put a medical examiner in each borough. Now, you think of Manhattan with all those tall buildings and everything, but that's not the largest populated borough. Actually, it is Brooklyn, and Brooklyn still is the largest. Now, Manhattan, with all those tall buildings and everything, you figure that's got a great population, and it does to a degree. Manhattan is really New York County. Now, this is important. If you go to the book and look up San Antonio in Bexar County, you know it is San Antonio. Anyone hearing that may not realize that San Antonio is principally incorporated in Bexar County. Bexar County has more people than New York County and more than Manhattan, which is a surprise. But anyway, to go back, my father ended up in Brooklyn and he was made Deputy Chief of Brooklyn, and he stayed there because Milton Helpern never retired—but that's another story. So he stayed there and then Helpern retired and then they opened it up for exams and they gave the first exam and my father had the highest mark on it.

SD: So that was the certifying examination in forensic pathology?

VDM: No. As chief medical examiner.

SD: Oh, as chief. Okay. So they actually had examinations?

VDM: For the chief, oral and written. And he passed the exam but someone didn't like him, so they said “No, no, the exam is biased.” So he took the exam a second time and got the highest mark, and then he took the exam the third time I think. Now, I don't know if he took it a fourth time, I think at least 3 times, and finally, they said “Listen we better give him the job!” So he became chief medical examiner then.

SD: I've never heard that story.

VDM: Yes, and then he retired at 65, you know.

SD: So when you were growing up then and your father was a physician, he was a medical examiner.

VDM: Oh yes, when I was growing up he was a medical examiner.

SD: What would be your earliest memory then of actually being involved in what he did?

VDM: I honestly don't remember. I remember going to, well, let's see—you might say involved. My parents wanted to go on a picnic and there were open fields behind the Staten Island morgue. So, they went there and the picnic was in the fields behind (the morgue). So, we had to get the picnic basket and it was in the trunk of the car along with a box of a skeleton or two you know. So we took it out from between the skeleton boxes and then went and had a picnic! So that's the earliest one that I remember. And let's see so that kind of took it there. So that's how I got exposed to it.

SD: Was it a subject that interested you?

VDM: Yes, it was kind of interesting.

SD: So, you weren't turned off by it in other words?

VDM: Oh no. No. I mean that was like a dead body or something like that who cares. You know I have 3 sisters.

SD: Yes.

VDM: And all of them became physicians.

SD: Are any of them pathologists?

VDM: The older of my 3 sisters became a pathologist, but she was a hospital pathologist. My other 2 sisters are pediatricians.

SD: So at what age do you think you really knew that you wanted to be a doctor, a physician?

VDM: I've been asked that a lot of times. I don't know. And they say—well, did your parents ask or try to urge you to be a physician. And the answer is, I don't know.

SD: Did you personally feel though that medicine was something you wanted to pursue?

VDM: I just went on. I didn't know. I guess I said I was going to always be a physician and I never thought about it. So, when I went into college, you go from high school and when I went to college I applied for the premed program but no one told me to do it—I just did.

SD: I was going to give a brief history of your formal education and training just real quickly and you can correct me if any of this is wrong. You went to college in 1958 at St John's College in Queens, New York. You started out in chemistry but you switched to biology as a major.

VDM: Yes. I couldn't take chemistry. I'm sorry.

SD: You found out that you could apply for medical school after just 3 years of college, so you took the MCAT at night when you were 19 years old and you passed. You applied to some medical schools, and the one that accepted you was State University of New York, which is SUNY.

VDM: Now, it's State University of New York—Downstate Medical Center. There is a whole bunch of these places and that one was in Brooklyn.

SD: Okay. So you started classes there in 1961 and you went through medical school. Then, you did your pathology residency at Duke University Hospital.

VDM: Right. That was considered internship at that time.

SD: It was the first year after the medical school training.

VDM: Right.

SD: And you followed that with 3 years at Kings County Medical Center in Brooklyn. At that time, even when you were in that phase of your education, you started doing autopsies.

VDM: Oh yes, I did them when I was in medical school because the medical school was just across the street from the morgue so I did some.

SD: Do you remember your first autopsy? I remember mine.

VDM: I don't know, but I actually have a book with all the autopsies.

SD: I have actual case files, yes.

VDM: Oh well, I don't remember.

SD: So that was Kings County Medical Center, and then when you were 28, you did a year of fellowship in forensic pathology at the Office of the Medical Examiner in Maryland, and that was under Dr Russell Fisher.

VDM: Now, you have to understand that those were the days when all doctors were subject to the draft. The physical requirements for a doctor was to have a beating heart. And so you knew you were going to go in, and so what you could do was sign up when you were in medical school, right before going to residency. And because I was a forensic pathologist, they would give me 4 years, but they would also give me the internship, and so the military didn't understand that I could run that all in. So instead of waiting 5 years before going into the military, I mean 4 years, I have 5 years. So I did the 4 years anatomical and clinical, and then I did the fifth year in Baltimore at Russell Fisher's office. Now, you were going to ask me also, I know—did I ever consider any other field?

SD: Yes.

VDM: And in medical school, I guess it was hereditary, I thought of another field that I kind of got interested in, and that was?

SD: Gynecology?

VDM: Right! Like my father. But then, I said I have to get up at night and I like to sleep, so I decided to go into forensic pathology. Now, regular pathology was boring. You know I would sit at a desk and they would bring these slides in and you looked at the slides. I said “Why spend my whole life sitting down in front of a desk looking at microscopic slides?”

SD: Of the same tissues.

VDM: Right. Now, the worst, most boring area of pathology is dermatopathology, right? It's true isn't it?

SD: I think so.

VDM: And with most pathologists, if you say dermatopathology, their head goes back and their eyes roll, right?

SD: Yes.

VDM: So I must have insulted one of the gods because my son is a dermatopathologist!

SD: That's Dominick, right?

VDM: Correct.

SD: But he's happy doing that.

VDM: He's happy doing that and he is in Omaha, Nebraska, and he's freezing right now, you know. And the snow is up to whatever! But anyway …

SD: What are your memories of Dr Fisher?

VDM: Okay. Now, I have to tell you—can I tell you about the office and everything?

SD: Sure.

VDM: Dr Fisher4 was one of the most important physicians in forensic pathology. He did a whole bunch of papers which most people aren't aware of, and of course, he wrote a book with Dr Spitz,5 which was called Spitz and Fisher, or was it Fisher and Spitz?

SD: No it was Spitz and Fisher.6

VDM: Spitz and Fisher. Okay. Anyway, my whole experience had been in New York offices. It's very interesting—the New York offices as I said were the first medical examiner's offices in the US and they had actually built some morgues in the 40s and 50s, early 50s, and then they froze in time. The New York offices beginning with the ascension with Helpern gradually deteriorated. Now, the book being used in pathology at that time was …

SD: Was it Adelson?

VDM: No, it was Forensic Pathology by Gonzales, Vance, and Helpern. That book was written in the 1930s, and the new forensic book in the United States didn't come out until Spitz and Fisher, which was what—the 70s I think. And so you were looking at history in reading that book. I read the book and I said there's something wrong with the gunshot chapter. And then I realized, they were talking about black powder weapons. And so I said, well that's interesting. So my father was still deputy chief at that time, and I told him that I wanted to go to a good place and be trained in forensic pathology, and I said “What about New York?” Now, he's deputy chief there and he said “No, no, and no”. He said go to Fisher, which is he said the best office there is. It may not be structurally the best office but was the best office.

SD: And that was in Baltimore?

VDM: And that was in Baltimore. So I went to Baltimore. And I have to tell you something—one of the benefits I had was I never ever worked in an old decrepit office my whole career. Now, I am going to put a little asterisk on it. When I went down to Baltimore, Fisher was there and he had a bunch of people there who were really good well-trained forensic pathologists. The building itself had been built sometime after the Civil War. No, probably 1880s or early 90s. And it was kind of decrepit. It was adjacent to the wharfs of Baltimore Harbor, and you could go out on the back area of the ME Office and pull bodies out of the water, which happened once or twice. But anyway, the office was kind of interesting. The good thing about it is, I only stayed there about 3 months and then we moved into a brand new medical examiner's office, which was probably the best in the country. But when I first went in, the autopsies were done on the bottom floor. There was a platform where you pulled up ambulances and they unloaded the body, and you go from the decking into the autopsy room, and then you would go on and you would go up the stairs into the secretarial area and the doctors' offices.

And on top was toxicology. But the secretaries were all young girls who had just graduated high school—most of them were, and the only way for them to get to their office was they would come in in the morning and they would get onto the loading dock, and from the loading dock, they would walk through the autopsy areas with all the bodies there and up the stairs. These were you know 18-, 19-year-old girls, 17, and they'd be walking through the autopsy room carrying their lunches, you know, in between the trays where the bodies were lying. And then we had our air conditioning in the autopsy room and that was the screens! And then, occasionally, there would be a hole, and the flies would get in and walk on the bodies with all the blood then walk on you. But it was an interesting thing. Everybody in the office I thought was well qualified.

SD: But that was the old building? You said you left that.

VDM: Yes, that was the old building. And, you know, it was really decrepit. And, you know, in the new building, it was I thought opened on either June 1 or July 1, something like that, and it was beautiful. It was the most modern office in the United States and they built it. And it was really real beautiful, a really beautiful building. And they just tore it down a few years ago. But we even had a neuropathologist in the office. It was K… something. I have to apologize for forgetting his name. If you go to Spitz and Fisher the early copies he wrote the chapter on forensic neuropathology. And he at that time was probably the most brilliant forensic neuropathologist in the United States.7 And he'd come into the autopsy room and help you remove the brain and he'd tell you things and we'd have conferences all the time and we learned. And a lot of things he told us didn't appear in the books until years later. Oh he gave a hypothesis I think this is this and this and this. And then, you know, 10 years later, you would read confirmation of what he had told us.

SD: So you were there for about a year right?

VDM: Yes, I was there a year. You know what it was, it was a 1-year residency.

SD: Fellowship right. And do you know how many cases, like actual autopsies, you did?

VDM: Oh something like 225 or something like that. We were never overburdened, you know, like some of the other offices. I said it was a brand new building. It was clean. It had good personnel. The girls who worked in the office were, you know, nice, and they did hard work and everything and …

SD: So, at that point in your career then, you were pretty much entrenched in forensic pathology?

VDM: Oh yes.

SD: And you had no desire to change or do anything different?

VDM: Oh yes. I mean, as soon as I went into his office—yes, 100%.

SD: So you did 2 years in the Army?

VDM: Okay. Now, so I spent the 1 year there, and then I had to do my Army service. And it was an amusing thing. There were at Fisher's office …he would train military people, you know, in forensic pathology, and Charlie Stahl was there and, you know, a whole bunch of people (Fig. 4).

FIGURE 4

FIGURE 4

SD: You became good friends with Dr Stahl didn't you?

VDM: Yes, but more with Dr Froede.8

SD: Froede?

VDM: Stahl8 kind of drifted away from forensic pathology. I think Dr Froede went on. He was a really nice guy and a gentleman. I really liked working with him. I worked with him for years after he got out of there, and I finished and came here to Texas.

SD: You introduced me to him at one of the national meetings once, and I thought he was an exceptionally nice person.

VDM: Yes, he is a really nice guy and I was there for… okay, the funny thing was how I got there. I was there, and there was an individual from the Armed Forces Institute of Pathology who was a colonel and he had worked for the military for at least 20 years if not longer, and he felt that, if he got out and did regular Pathology, he couldn't do it. He was too far in to it, and he had done administrative stuff. So he wanted to do a year in forensic pathology and then he could get a smaller job, which he did in Florida where he was a county medical examiner but not with a big population. Anyway, he was there and we were talking, and he said, “Well, what are you going to do next year?” I said, “Well, I go into the Army for 2 years.” He said, “Oh. Have you ever thought of going into the Armed Forces Institute of Pathology?” and I said, “Well, possible, but I think it would be hard to get there.” And he says, “Okay. Come with me. We're going to have lunch at the Pentagon with a colonel who makes the assignments.” I said, “You know the guy who makes the assignments?” He said, “Yes. Last year I made the assignments into the Army and Navy.” But all of the services, I think. But anyway, I had lunch with the guy and I said I was interested in forensic pathology and doing that in the service. He said, “You know, if you don't want to do it, we can send you to Vietnam for a year and then the second year you can just choose anywhere in the world you wanted to go.” And I said I'd rather go there. And he says, “Well, that's good because we don't have any forensic pathologists.” I mean, they had like 4 forensic pathologists for the whole Army, Navy, and Air Force!

SD: Wow.

VDM: Oh yes. So I got assigned to the Armed Forces Institute of Pathology.

SD: Now, it's not still in existence though, right? The AFIP? It closed down, I think.

VDM: Yes. One other story about the neuropathologist in Baltimore. He was a real nice guy and everything, and he told me how he got … well, I'll tell you the other case. You know, he was really nice and we got along well, and one day, I'm in his office and he says, “Come on over here. I'm going to show you something.” He said, “During the war, I helped design cockpits for airplanes to make them safe,” because they had one plane that was a great plane, but when it landed it would tip forward onto the propeller and the pilot would go forward and break his neck. So you had a nice new plane, but the pilot was dead. So he designed the cockpits and everything. He says, “You know, I got a medal for that.” I said, “Yeah?” He says, “Let me show you,” and he digs in his office desk, lifts paper, and goes to the bottom of the drawer. He says, “Yes …here's me getting a medal.” And he's in uniform standing at attention, and Adolph Hitler is pinning a medal to his chest! But he got picked up in Operation Paperclip.9 And so they brought him here to the United States. Actually, he was here in San Antonio and he was here, but he got to thinking. He said, “I have no paperwork. I was just picked up, put on a plane, and brought here.” He says, “When this ends, they're going to just ship me back to Germany and I don't want to go to Germany.” So he and a couple of his friends who were all doctors got in a car and drove down across the Mexican border because, you know, in those days you could just drive across, who cares. They drive there and he drove down to Mexico City, and there he went to the German council and got a green whatever they are things. And then he drove back. Now, he had legal permission to come into the United States and he filled in the application to become an American citizen, and that's how he became an American citizen. But now, where were we?

SD: Well you did your 2 years at the AFIP.

VDM: Yes, it was really nice and they actually asked me to stay.

SD: So that would have kept you out on the east coast if you'd stayed.

VDM: Oh yes, in Washington. But they said they wanted me and they offered me a sweet deal. They said, “You know you're a major. In 3 or 4 years, we'll make you a lieutenant colonel. And about 5 years after that, we'll make you full colonel.” And he said, “We will also guarantee you this. We will assign you every 3 to 4 years to the Armed Forces Institute of Pathology and give you an assignment and paper on that. If, however, we don't do that and you want to leave, just leave.” But they said, “You're going to be here 20 years.” I didn't take the deal. Somebody did and he did stay. They kept their word and I didn't mind the Army. I really didn't mind the Army. I got along with everybody, and, you know, the people who complained about the Army were people who were just discontented with anything they did in life. The Army was nice. You knew exactly where you were and I was a major at that time. So, we drove down to North Carolina, I think, and we'd go to an Army base there, you know, where they serve all the meals and everything.

SD: The commissary?

VDM: No, the commissary was different. Anyway, so we went down there and I walk in, and there is like, you know, hundreds and hundreds of soldiers in there eating and I look. There are 3 people who outrank me in the whole thing. You know, being a major was a big thing and if I had become a lieutenant colonel and then you know you don't see generals but you see the colonels. The colonels have lots of power in the military, and they would have given me a hospital probably to run.

SD: But you wouldn't have been doing necessarily forensic pathology.

VDM: In the AFIP I would. And there was only 1 slot for a colonel in the AFIP—the guy who ran it.

SD: So there was no guarantee that you'd be assigned to do the forensic pathology?

VDM: Well, they said that was one of the conditions, that they would assign if you didn't want it.

SD: From there then you ended up in Dallas. So what took you to Dallas?

VDM: The military was boring. Okay. I'm sorry—very boring. If I had been doing active medical examiner work, I probably would have stayed. What happened was, you know, the AFIP was doing a lot of teaching and people would come up like a chief medical examiner from New Mexico and up came Petty10 and he was trying to find someone.

SD: That was Charles Petty?

VDM: Charles Petty. You know, to work for him and I got very good reviews from everybody, you know, that he'd be great. But then he offered me the salary and it was… Well, Fisher wanted me too and he offered me $51,000 a year. And he said you can make more money doing regular pathology on the side, but I wanted to do full time forensic pathology. Petty came up and offered me a job, and he said, you know, it's like $41,000 a year. And I said, “You know that's not enough.” Then … who came up too, you know who it was, the head of the pathology department in Dallas?

SD: Stembridge?11

VDM: Stembridge came and he tried to hire me for …

SD: For the pathology department.

VDM: No, no—but for Petty, not the pathology department.

SD: Oh, I see.

VDM: And he said, you know, $51,000. I said, “I've got an offer here.” So I think they paid me $53,000. Now, $2000 or $3000 in those days was significant.

SD: So that was early 70s because 1972 is when you joined the ME office right?

VDM: Yes. So Theresa and I went down to look and we had decided to stay in Baltimore and we came into Dallas and we didn't realize how big Dallas was, the lights and everything. They showed us new houses and things and all that, and in the end, we decided to take the job and we came down to Dallas, and I stayed there about 6 or 7 years. You can figure it out.

SD: Right, because 1981 is when you moved to San Antonio to become the chief in Bexar County.

VDM: When did I come to Dallas?

SD: 1972.

VDM: 72. Okay.

SD: So you were in Dallas for at least 9 years.

VDM: Was I that long? I thought it was 8 years.

SD: And, actually, Dallas is where I met you because I was a medical student at Southwestern.

VDM: Right, that's how you knew Stembridge's name.

SD: And I took the elective my senior year in medical school in forensic pathology so that would be the first time I actually met you because you were the acting deputy chief at that point. I remember you just being so enthusiastic about forensic pathology. I mean you were truly, you weren't faking anything. You just really loved what you were doing and it was so inspiring just to be with someone like that. And I got ridiculed by a lot of the medical students for taking the forensic pathology elective. Because nobody even got …you know, there was just no interest in forensic pathology back then.

VDM: I don't know if there's interest now.

SD: I think it's fallen off a little bit.

VDM: Now, the thing is … I said I only go with new buildings. Remember, I went to Baltimore and they had a new building. I went to Dallas and they had a new building.

SD: And it was right there at the medical school.

VDM: Right. I went to Dallas and Dallas had just built a medical examiner's office. And that's what I said. I've always gone to new buildings. Now, the thing about the Dallas Medical Examiner's Office is Petty had taken the Baltimore design and made it better. So the new Baltimore thing was similar to the Dallas one because Petty had worked in Dallas, you know, for a year or so and he essentially copied it and made improvements. And so it was, you know, nice, really good, and I learned techniques of operating and everything, and I got to head certain sections.

SD: And you taught.

VDM: And I taught. And it was a nice time. Then I went to …

SD: San Antonio?

VDM: Okay. What happened then was I decided that it was time to move on. Okay? And I was looking around and that's when I found out how bad off some medical examiner's offices are. I mean like … “Well, there's my x-ray machine, you know. What's the cover over it? It hasn't worked for about 6 or 7 years, but we're thinking of fixing it!” I'm not kidding. One office was like a man was going to run out into the hallway and yell “He's alive! He's alive!” I swear to you. You could have done another Frankenstein picture in there. And so, you know, it was like that. So, I came down there and I figured I wasn't going to do anything because they had a lot of problems in San Antonio. I came down and they showed me the building, and the building was about 4 years old. It was too small. It was about 17,000 sq ft but kind of adequate. But one of the biggest problems they had was when they built it they wanted to save some money, so they didn't build 2 separate air conditioning plans. So if you did a decomposed body, the stink went through the whole building and all the girls who were the secretaries put spray on their hair and they had the spray of decomposed bodies when they went to sit on the buses.

Then, of course, they built a new building in '93, which … what I had was I could rob it off the Dallas building. So I made some improvements. I could have done some more things, but it's still a beautiful building.12 The only problem is, it has too little space. The reason was that the building has 50,000 sq ft, which is more than enough for a medical examiner's office in San Antonio in the county, but the crime lab was given the top floor and then as time has gone on the office has extended upward in the medical and downward from the crime lab and the crime lab doesn't have enough space and we don't have. So they're going to get a separate building for the crime lab. When they do that, the medical examiner's office is going to go up to 50,000 sq ft and is good probably close to the end of this century because, you know, I found out that the limit of the tables in most offices is 10. Once you exceed 10 autopsy tables, you can't operate. There's no control (Fig. 5).

FIGURE 5

FIGURE 5

SD: What is the Bexar County one up to? They expanded into that extra area now.

VDM: I think they're up to 10 now. So I don't think that's any problem. The problem is labs, offices for people, you know, they don't have enough offices now for another medical examiner, but once they get rid of the crime lab, it will double their administrative and clerical spaces and that'll be enough. You know, there will be adequate room for the toxicology and adequate room for the clerical.

SD: Right. So then you retired from San Antonio in 2006 as the chief.

VDM: When I became 65. I had told people for years I was going to retire at 65 and no one believed me. And finally, I convinced them, and they bought me a clock that was ticking off on that (Fig. 6).

FIGURE 6

FIGURE 6

SD: I believed you.

VDM: Right. But because every office I have seen where the medical examiner is 65 years and older has deteriorated or become a downhill deterioration and by 65 if you do, you know, I've done you know 40 years maybe 50 years of forensic pathology. You get tired. And the other thing is you become … well, you stonewall. Well, you know, I don't know what with these new computers. I remember when we wrote everything out, and I thought it was much better that way. I mean the medical examiner's office here in San Antonio was one of the first offices in Bexar County to have a computer.

SD: Really?

VDM: Yes. And when they started getting them, we had the most number of computers. I think we had 2 or 3 and they were astounded, and you may remember how we did the dictation and things years ago.

SD: So things have evolved. You're right and if you don't keep up with that then …

VDM: I have to compliment the Bexar County Commissioner's court. They have provided adequate monies to keep the building up and to keep sufficient people. You go to Dallas, they just shut down for I think like 10 years.

SD: So it sounds like you had a very memorable career the whole career, starting out even at the AFIP and then continuing on into Dallas and San Antonio. I know you're an expert in guns and gunshot wounds. In 1985, you wrote the classic widely referenced book Gunshot Wounds that is now in its third edition.

VDM: That's correct.

SD: Can you share with me why you became interested in the subject of guns?

VDM: High school. The high school I went to was just a building with 4 walls. It was very big and had a lot of students, but there was nothing to do at lunch hour. If you played basketball, you could go downstairs and play in the gym. So, what could you do if you didn't want to play basketball? I went to the library and they had a whole big section on guns and I read it and read it and read it and read it, and that's how I got interested in guns.

SD: That's fascinating. So it was just kind of fortuitous then that that was the subject that you got presented and then you took an interest in it and just became an expert in it.

VDM: Right, because in New York the only people that have guns are criminals and police. That's it.

SD: I knew nothing about guns until I trained under you.

VDM: What can I tell you?

SD: So I was very fortunate there. When you're doing autopsies, how do you stay detached from getting involved emotionally in the case?

VDM: Well, I have never gotten emotionally involved because I am not autopsying people. I am autopsying the shell of people.

SD: So, in other words, there's a difference between a live person and a dead person?

VDM: There always is. Haven't you noticed?

SD: Oh yes.

VDM: There's a difference.

SD: Yes. The deceased person becomes kind of like an anatomical specimen more or less.

VDM: I have always used the description as you have an ear of corn and it's wrapped in a husk, right? You strip it off and it's different. So, when we see we don't see the body—we see the husk.

SD: Right. And the other thing I've always found, and you may have too, is that by doing the autopsy and determining what the person died of you're actually helping the family.

VDM: Yes.

SD: You're giving them some ability to have some closure.

VDM: That's right.

SD: And if nobody wanted to do our job then that would never happen.

VDM: That's a very good explanation. Don't use the word closure. I want to strangle people when they say that.

SD: Sorry. Do you ever think about how your experiences have shaped the physicians who have trained under you like me? Do you take some enjoyment in knowing that you've actually inspired other people to go into forensic pathology?

VDM: Yes. You notice I've always tried to recruit people to go into forensic pathology.

SD: Yes. I remember.

VDM: So at lectures and everything I say it's a great field. I say you may not make as much money but it's a great field. You'll enjoy it, which makes some people frown when I use that word, but it's interesting. It's not like sitting behind a desk. Every day is different. You never know what the spectacular case is going to be.

SD: Right.

VDM: And I know you asked me about the cases in the book.

SD: Well, I was going to get to that in a minute. But when you're talking about helping other people in forensic pathology, I remember one thing that you did for me. I thought the one thing I would really hate about forensic pathology was having to testify in court.

VDM: Yes.

SD: And when I was in that elective where I first met you, you were so enthusiastic. You offered to take me one day to court with you because you were getting ready to testify. And I went with you and I sat in the part where the spectators sit. And you went up and you started talking and they started talking to you and it was just like night and day. And then you came afterwards and you told me exactly what the questions would be to be asked, and it just made it so much easier for me to this day. I still remember that day when you took me to court. And it was like to me that was just one of the highlights of my career was being able to see you testify in court. I don't know if other people have thought that about mentors that they've had but …

VDM: Oh yes. In the end, you've got to explain to people and do things like that and stuff. And certain people just never seem to get to do it in court. Like I told my wife, she could never testify in court (Fig. 7).

FIGURE 7

FIGURE 7

SD: Why is that?

VDM: She gets too emotional and you have to be dry. The one thing I do enjoy, I have to admit, is annoying some of these attorneys, especially ones who say, “Don't you think we should take a break?” I say, “No let's keep going.” You know?

SD: Sometimes I don't enjoy dealing with the attorneys but I guess that's part of the job.

VDM: It's part of the job. But the people who annoy me are the ones who say, you know, “Well, you're paid for this,” you know and everything. I feel like saying “So are you!”

SD: What do you think is the most unique part of being a forensic pathologist?

VDM: You don't know what you're going to get and you do it and you're absolutely shocked. You do things that are supposed to be cut and dry and they aren't. I mean, all of us have a case where someone says, “Oh yes, this is going to be a typical murder and we'll be able to prosecute the guy,” and you say, “It's a natural death.” And, you know, I've had a lot of people say “but you can't say that.”

SD: Right.

VDM: I did the case, you know, in Florida. And they said, “How can you say that? Are you just testifying to get him off?” I said, “No. I'm testifying to what the evidence shows.” “Well, did you talk to him?” I said, “No. Why did I have to? I was testifying to what the scientific evidence shows, not what you think.” A lot of people don't understand that.

SD: And you're talking about the Trayvon Martin/George Zimmerman case in Florida?

VDM: Yes.

SD: Yes. I've had some of those too. So what are some of your favorite things to do outside the field of forensic pathology? Like do you have any hobbies other than the guns?

VDM: The only thing I used to do and used to enjoy was reading books, and so now, of course, I can't read the books.13 But what they have is …

SD: Books on tape.

VDM: Books on tape.

SD: Audio books.

VDM: Audio books. And the audio books I really like are the books that were published from 1880 to about 1920 or something, and it's fascinating to read the books. These are crime books to what they thought about science and how you can convict people and things. They're saying “Yeah we got this blood here,” and you realize they can't type it and the things that I like is also how they acted. The Courtesan Trial, it's a murder case, and say the maid has to testify and she gets on the stand and starts testifying and then starts crying and everything and, you know, she's really emotionally upset. And the judge would say, “Gentlemen. We're going to stop this case and we will resume tomorrow morning when the witness is in a better emotional state.” They would just do that!

SD: Now, are these books that you're talking about?

VDM: They're tapes, not video tapes. They're audio tapes and you hear the things like, “He was in the truck but it turned over. Luckily, the horse did not strike him when it turned over.” And you know, “The doctor jumped in the cab and whipped his horse on.” Oh and it's really funny, not funny, it's just to change the era and it's like if someone knocked on your door and I opened it and it was a woman I would take my hat off and say good morning or something but I couldn't call them by first name because I needed permission to call her by her first name.

SD: So where are you getting these?

VDM: You can go on the internet.

SD: So you're getting them from the internet.

VDM: Yes, they're all free because the copyright has expired. And you read these things and, you know, there are certain rules … you always know such as you can tell that 3 of the people in the book will not be accused of murder, are not the murderers. And you can sometimes figure just what the customs were, how they addressed them, and some you can figure out. Some you can't. And it's interesting, you know, with the horses and “Luckily we have a telephone in the club” and things like that and it's amusing. But here's the whole thing, once they convict you, “Yes, we'll have the trial in about 6 weeks and the hanging will be …

SD: Tomorrow!

VDM: No, but I mean, they hanged everyone in the British books, man or woman, you got hanged. But, usually, they tried to get the women out, like the woman who was going to be hanged ran into the street while trying to escape and got run over by the horse and things like that. Or there was another one I liked. There was a guy who was murdered in his office, and finally, his next door neighbor admits to the murder. He says, “What happened was on Monday I had all my money and investments” and you know he did something and “I lost my money and how was I going to go home and tell my wife and children that I was completely penniless because of this man and so I went over and got in an argument with him and I took the gun out of his desk drawer and I shot him.” And he tells them that and you know he had been wounded and he's dying and he'd say, “But please will you agree not to tell my wife I killed him? Just say it was a hobo,” and the district attorney and police chief say, “Yes, I think we can probably do that. It won't cause any harm.”

SD: I think times have changed.

VDM: Just unbelievable you know, just wonderful you know.

SD: So if you hadn't gone into forensic pathology—let's just say you hadn't gone into forensic pathology or even medicine, can you picture yourself doing anything outside of medicine?

VDM: Yes. I would have liked to be a history professor in a college in a small town, you know, a small college.

SD: Well, that's interesting because I know you have a love for history.

VDM: Right.

SD: What do you think is the biggest misconception of what forensic pathologists actually do?

VDM: Misconception?

SD: The general public's misconception?

VDM: The general public thinks you're a coroner. They don't realize you're a physician and trained, and they're very excited in your stories in telling these things. They think it's great. Many physicians look at you like you're a weirdo. You're doing all this work and you're not being paid that much and how could you deal with these things, you know.

SD: But I think, you know, going back to the salary, you were a real champion for getting higher salaries for the medical examiners.

VDM: I have always been.

SD: And I think you were on the forefront of that because some of the salaries now have come up across the nation, across the country.

VDM: Yes. You know, I always tell people—they say, “Well, what happens if you couldn't do forensic pathology?” or something like that. I say, “Well, you go in and do regular pathology. Don't you realize that regular pathologists are being paid twice what your salary is?”

SD: Right.

VDM: It's true.

SD: But the base salaries now have come up across the country.

VDM: I know. I know.

SD: By quite a bit. Which I think, you know, you foresaw that and …

VDM: Well, I kept telling people. I'd say you're stupid to go to work for these salaries because you're making it bad for everyone. I had one guy talk to me and he was a medical examiner in a small state that he liked. He said, “It's so beautiful to work in this state and it's beautiful and the people are nice and everything,” and I said, “That's nice. Who's going to pay your kid's college thing?” “Well, I really, you know …” And I said, “Who's going to pay it and when you retire what are you going to live on?” You know, they're so unrealistic some people and I guess if you're single and want to remain single the rest of your life.

SD: So, in May of 2017 you wrote a book, Morgue—A Life in Death, which was coauthored by Ron Franscell. And in it you talk about your childhood, your training, your experiences in regards to several high profile cases. In some of those cases I don't know if you want to talk about them. Like starting in 1969, the Martha Woods case, which was very interesting to me because that's where I first heard about Munchausen syndrome by Proxy and this was a woman who was a serial baby killer where she was killing children from 1946 until 1969 when you were instrumental in putting this together that she had too many children dying around her.

VDM: They invented a hereditary disease rather than accepting the fact that she was murdering children.

SD: I never saw the exact number, but she killed some of her own children, a niece, a nephew, and then an adopted son, and I think the adopted son was the one that you may have had some experience with.

VDM: Right. That is the most important case that I have ever done. Because of that they realized these women were killing the children. Before that, they were ascribing the deaths to a hereditary thing or some mysterious lesion of the brain and everything, and what I find funny is that even now people say “Oh maybe due to this disease or that disease and everything” and “There's a new paper out on lesions in the brainstem” and I look at that, and I say “Listen 30, 40 years ago they were saying the same thing until they went to the new cause.” In all of my career and I think your career, you've seen different causes ascribed.

SD: Oh absolutely yes. And then there was 1981 where you assisted with the exhumation of Lee Harvey Oswald with Linda Norton I believe. She was actually the one who spearheaded the whole exhumation.

VDM: Yes, I didn't think that was very exciting.

SD: I think to me one of the most memorable parts of that story is what you told me about the ring.

VDM: Right, the ring.

SD: And do you want to tell that little story?

VDM: The wife Marina gave the ring that he was wearing to Linda Norton and she said “You know, I don't like possessing it,” so she gave it to me and I looked at it and I said “No” and I threw it back in the coffin!

SD: So, Marina never knew really that it ended up back in the coffin?

VDM: Yes.

SD: And then there was the case of Jeanine Jones who was that nurse in the San Antonio area convicted of killing numerous babies and children in the 70s and 80s, and the first one they actually caught her on was the Kerrville case.

VDM: The Kerrville case, which was one of the cases in San Antonio that was just sent from Kerrville for autopsy.

SD: Yes, but then you figured out as far as the deaths that were occurring previous to that at the University Hospital in San Antonio.

VDM: Right. Yes. No one knows how many really. I have heard figures from 17 to 27 to 37. Who knows? The records were destroyed by the hospital.

SD: And she's still in prison.

VDM: Yes. She's due to go on parole. I think that if she goes on parole they are just going to try her on another one of the cases, and I think the agreement that they made with her is that if she pleads to all the cases they'll only give her life and not ask for the death penalty.

SD: Then there was the 2003 Lana Clarkson murder where Phil Spector was involved in that. I think he's serving time right now, but you were involved as far as like evaluating again the physical evidence.

VDM: Yes. There were a lot of problems with that case for the state, but they didn't matter. What was interesting is that if you read the records the medical examiner who signed the death certificate and such put the cause or manner of death as being homicide and then he said in his report or in the charts, “I have ruled the case as a homicide because the sheriff told me.”

SD: Wow. And then in 2012 was the Trayvon Martin/George Zimmerman case.

VDM: Right.

SD: So my question was going to be, of all the cases you've worked on, what is your most memorable? But you have had so many that are memorable and you did say that the most important one was the Martha Woods case.

VDM: Yes—US versus Woods. Well, she's dead now if you've read the book.

SD: I know that you've had a number of honors and recognitions and such, what would you think is your most treasured honor in regards to your career in forensic pathology?

VDM: I think you should say not just honor, you should say …

SD: What I said, in regards to treasured honor or recognition let's say.

VDM: You go with recognition. One was the book Gunshot Wounds.

SD: Which is widely recognized.

VDM: Right. But the other one was the Bexar County Medical Examiner's office has been named after me.

SD: Yes, just recently.

VDM: Right.

SD: That's a true honor, yes.

VDM: Right.

SD: What advice would you give to forensic pathologists just starting out in the field?

VDM: Have a hard skin because during their career lots of attorneys and newspaper people will attack them because the medical examiner doesn't come up with the results they want. The regular citizens will look at you as a great person and call you a coroner.

SD: And don't be offended by that, right?

VDM: Right. As I said, the lawyers and the newspaper people won't like you. You will not make the money that you would have made as a regular pathologist. I know that from my son. And it will be interesting, but you will not be appreciated.

SD: That's a good point. Yes.

VDM: I think that's it.

SD: So I don't know if you have any regrets in your life, but is there anything that you've regretted not doing in forensic pathology?

VDM: Well, you mean in forensic pathology?

SD: Right. Is there anything that you would have wanted to do that you didn't get a chance to do? I think you've done quite a bit.

VDM: I think I've done everything. I think I would have liked to have done more research on gunshot wounds but I didn't have the time, and when I had the time I didn't have the money so I did a lot of work. In forensic pathology, I really don't regret anything.

SD: It sounds like you truly had a passion for the field and enjoyed every single day that you worked in the field.

VDM: That's true. That's true.

SD: And I don't think a lot of people out there can say that in a lot of different fields.

VDM: Right.

SD: So I am very grateful that I got to meet you, learn under you, and you know I truly treasure those times.

VDM: Thank you and thank you.

SD: So, thank you again for allowing me to do this interview.

(Fig. 8)

FIGURE 8

FIGURE 8

1Morgue—A Life in Death by Dr Vincent DiMaio and Ron Franscell, Picador, NYC, NY, 2016.
Cited Here...

2Legal Medicine and Toxicology by Gonzales, Vance and Helpern, D. Appleton Century Co, Inc, NYC, NY, 1937. Thomas Gonzales, MD, was a pathologist and at the time chief ME of New York; Morgan Vance, MD, was the deputy chief ME of New York; Milton Helpern, MD, was assistant ME of New York. The book, a classic and currently out of print, served as an introduction to medicolegal science and divided subject matter into legal medicine and toxicology.
Cited Here...

3Dr Charles Norris was the first official chief medical examiner of New York City. He took office February 1, 1918, after the office of the Coroner was abolished by an act of the NY State Legislature. He served as chief until 1935.
Cited Here...

4Dr Russel Fisher was a renowned forensic pathologist who was chief medical examiner in Baltimore, MD.
Cited Here...

5Dr Werner Spitz was Deputy Chief Medical Examiner in Baltimore, MD.
Cited Here...

6Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation by Werner U. Spitz, MD, and Russell S. Fisher, MD, Charles C. Thomas, Springfield, IL, 1973.
Cited Here...

7Dr DiMaio is referring to Richard Lindenberg, MD, chief neuropathologist of the state of Maryland. Dr Lindenberg was a Luftwaffe captain for Germany during World War II.
Cited Here...

8Dr Dick Froede, an air force colonel, and Dr Charles Stahl, a Navy Captain, worked with Dr DiMaio at the AFIP.
Cited Here...

9Operation paperclip was a term applied to German scientists who came to the United States after World War II under a contract with the War Department.
Cited Here...

10Dr Charles Petty was the chief medical examiner in Dallas, Texas.
Cited Here...

11Dr Vernie Stembridge was the chairman of the Pathology Department at UT-Southwestern Medical School.
Cited Here...

12In 2018, the Bexar County Forensic Science was officially renamed the Vincent J. DiMaio Forensic Science Center in honor of Dr DiMaio.
Cited Here...

13Dr DiMaio suffered a stroke in 2017 resulting in partial neurological vision loss.
Cited Here...

Keywords:

Vincent J.M. DiMaio; mentor; interview

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