Forensic Pathologist rates 11 autopsy scenes in movies and TV

• Dr Joye Carter was the first black female chief medical examiner in the United States, and has more than 30 years experience in the field of Forensic Pathology.
• She rates the realism of post mortem scenes in movies, such as "Se7en" (1995), "The Autopsy of Jane Doe" (2016), "Contagion" (2013) and "The Silence of the Lambs" (1991).
• She also rates autopsy scenes from "House" (2009), "NCIS" (2017) and "CSI: New York" (2009).

Below is a transcript of the video.

- Nyssa: It has bifurcated masseter muscles. Overdeveloped, allowing for a much stronger bite.

Hello, my name is Dr. Joye Carter. I've been a practicing forensic pathologist for more than 37 years. I am what they call "the doctor of the dead." Since I am examining deceased people and I can't get their history, I have to do a complete evaluation of their body, which is called the autopsy. And today, I'm going to be looking at the realism of autopsy scenes in movies and TV shows.

"House" (2009)

[bone saw buzzing] House: If we cut to the money shot, it's his heart. So let's look at his heart.

Foreman: Opening postmortem incision, beginning at the midline of the sternum. [bone saw buzzing]

Carter: First of all, is either one of them a pathologist? Second of all, the person's supposed to be confirmed dead by electrocardiogram. Third, no one's wearing a mask. Fourth, you do not open the body with a saw like that. You make an incision with a scalpel. Unbelievable. Generally, you have a mask over your nose and mouth, you have eye protection on. Nowadays, I wear a transparent shield over my glasses or goggles so that I am protected from splashes of blood and tissue getting onto my skin. You usually have an apron on, and you don't want blood or tissue soaking through that very thin apron that he's wearing.

Foreman: That's odd. Almost looks like he's bleeding.

[screams] [metal clanking]

Carter: I've never heard of anyone waking up during an autopsy. There have been a few close calls. I've actually had a case of someone got to the office and they did have a minor, fake pulse. They were immediately sent to the hospital. They were not in the autopsy suite. But this is why you're supposed to make sure, electronically, by the EKG, that there's no electrical activity of the heart. Well, again, there's usually medical records, whether it is from someone pronouncing the person dead at the scene, which could be a home or in a hospital setting. I usually look for that pronouncement time, and someone who's qualified to pronounce them dead is not just feeling for a pulse, as they do on some shows. That doesn't always get it.

But, generally, those who need to be in the autopsy suite would only be allowed in the autopsy suite. Because you're taking a risk on exposure to disease, blood-borne pathogens, and also, everybody's not suited to view an autopsy.

I have to give this a four. [laughs]

Rating: 4/10

"Se7en" (1995)

Santiago: He's been dead a long time, and I can tell you it was not from poison. He was hemorrhaging internally, and there was a hematoma in the rectus and the transverse abdominis muscles.

Mills: So he did die by eating.

Santiago: Yes and no.

Carter: Well, at least they are showing a proper Y-shaped incision on the decedent. There's a Y shape there, coarsely sutured. He's trying to describe the fact that the stomach is distended with food and that it has burst from gluttony, but he's pointing to something that doesn't even look like stomach. And he's using language that doesn't make any sense. One thing the forensic pathologist is supposed to be doing is being a bridge between the medical community and the police, so make them understand what you're talking about.

Well, the condition is called morbid obesity, and that is where you have a lot of fat not only under the skin but surrounding your tissue, and it actually can make it more difficult to even receive medical care. This is not unusual, I must say. But the doctor said it took four orderlies to move the body. If they're well-trained autopsy assistant, probably two could do that. Well, I have worked on a decedent that weighed over 710 pounds. The first problem was getting the decedent removed from the place of death. I was working and there was the - the weight of the decedent was over 300 pounds, and I had myself and two assistants, and we were actually trying to turn the body and photograph the back because there was an injury on the back of the body, and the body began to shift the weight and was coming off of the autopsy table, so we all reached out to keep the body from falling off the table. I received an injury. I kind of pulled my back out, but sometimes I have used a step stool or a step ladder if I have a really, really long, large body and I need to get into body cavities.

I'm gonna go back to the number four here.

Rating: 4/10

"The Silence of the Lambs" (1991)

Starling: Two of her fingernails are broken off, and there's dirt or grit under them. It looks like she tried to claw her way through something.

Carter: I worked with the military. I was a military medical examiner, and the FBI agents do not, do not examine the bodies. This is not appropriate. It's not realistic at all. Generally, the forensic pathologist works closely with the local law enforcement, and they have detectives who are specialized in investigating homicides or death scenes. Pretty much at the scene, the body belongs to the medical examiner and the scene belongs to law enforcement, but they're not really supposed to be touching the body. They are trying to depict a decomposed body, which has a very strong odor. Some people try to apply things like Vicks VapoRub or something strong-smelling within their safety mask. Just having it on the top of your lip does nothing.

Starling: She's got something in her throat.

Carter: They took a photograph, and then from the photograph, the main character says she can see something down in the throat, and you can't. That's looking into the mouth, and then they pull out this thing from deep in the throat, and there's no way you can see that from that picture. Decomposition begins in the mouth area. There's generally bloating, green-black discoloration, and gaseous distension or swelling. The tongue usually is protruding from the mouth, and it's dark, and the skin changes color, so this is not a realistic portrayal of a decomposed body. That's just, like, a tongue with some coloring on it. It's not the way it would look. And it gives a misperception of how the postmortem should be conducted.

I'm gonna give this a three.

Rating: 3/10

"Snowpiercer" (2020)

Bess: Stumps look sawn off. Looks like this way. Down.

Pelton: Hacksaw, maybe.

Carter: Yeah, the body looks so fake. I have received bodies for examination where limbs have been removed, and they're never that smooth and clean, and the muscle's usually a lot darker and redder. These do actually look like, I hate to say it, but they look like ham. [laughing] It's like a center-cut ham with a bone.

Bess: Multiple ligature marks.

Andre: Yeah. Choked in and out.

Carter: They are talking about ligature marks, and just, you see some faint, it looks like makeup on the body or mannequin, whatever they're using. It absolutely does not look real. You would expect more of a human skin tone. One ligature, you can see, there's a little area of roughened skin. The other just look like marks. If you chopped the legs off with a machete, you would expect some irregularity in the skin and some blood oozing out, maybe some fragments of bone. If you use a different type of saw, you might have a different cut, but you would absolutely have what we call striations in the bone, and that would give you some information as to what tool was used, so I have to give this one a one. It's just... it's not realistic.

Rating: 1/10

"CSI: NY" Season 3 episode 4 (2009)

Sid: There's a ligature mark that stretches across the victim's neck.

Lindsay: The width looks consistent with the twine we found.

Carter: There are occasions where you have to examine whatever is found. I've come across similar scenarios, where I'm presented with a part of the body that has to be examined. What's really important is working closely with the police officers to try to determine the identity of the person. So, if you don't have the body and you can't get fingerprints, and you can, in this case, there's a head, so you would actually do a dental examination first. Or if there is, perhaps the body is somewhere else, if the torso was found somewhere else, you wanna see if those match up, then you wanna try to do DNA. You can still get DNA evidence from the body, from the mouth, from the tongue, from the skin.

[suspenseful music]

This is a very dramatic depiction of getting what we call vitreous fluid, which is fluid obtained from the eyeball or the ocular globe. That actually is what we do, and pretty much only we do that. But it's very dramatic to show the needle enlarged like that. It looks like they just got the fluid out of the eye and they automatically have an answer, like, within seconds, they know exactly what's in that fluid, so, unrealistic.

I have dealt with body parts, having been a military medical examiner and investigating plane crashes. Sometimes you have body fragmentation or explosions or war crimes. For me, the challenging part is I wanna make sure that the families get their loved one back. This show gives a lot more power and authority to crime-scene investigators than they actually have.

Well, I would give this an eight out of 10.

Rating: 8/10

"The Autopsy of Jane Doe" (2016)

Tommy: No sign of inflammation, no fluid, and no foreign substances. And the ear canals are... clear.

Carter: He's making statements of things he really can't see. He's going over and peeking at the ear and saying nothing's there. His vision is not going into the ear itself.

[suspenseful music]

I'm not saying that cannot happen, but generally, the flies coming out of the body, there's usually maggot activity. Generally, the flies lay eggs on the outside of the body, and then the eggs hatch into maggots, and the maggots actually do the additional work going inside of the body.

[bell ringing]

The bell on the toe. That actually was true. Back in the 19th century and the 18th century, when we didn't have an electronic means of determining death had occurred, they actually would have things like bells. They would even have clear glass in the casket. Some caskets even had daggers that were applied, and if they did, if they weren't dead, then if they moved around, they'd actually be stabbed to death. Yeah, back in the day before we had the electronic means, you could have a brainstem injury and you could have very shallow breathing, that could be mistaken for you being dead. We don't put bells on toes. We use things like toe tags, and they have their written identification information, so I'd give it a four.

Rating: 4/10

"Independence Day" (1996)

Okun: Right along the ridge. Microprobe thingamajig goes right here.

[screaming]

[laughs]

Carter: There is very little of merit, but what's interesting is they're doing an autopsy and all this fluid's hanging down, and I don't know why you would have bags of fluid hanging down to do an autopsy. You're not resuscitating anybody. So, that's a surgical setup there.

Okun: All right, now spread it very, very gently. Let me get in. Uh-huh. Disgusting.

Carter: I don't know what style of blade this person is using. Well, that blade looks like something you would use to fillet fish. Generally we use a scalpel, and we have removable blades. That looks like a very - it's curved, so if it tilts up, not the kind of blade I would use to open up the body. And of course, generally, we would cut the ribs or use a bone saw for the ribs, so not the right instrumentation. Also, looks like just one thin pair of gloves, and you have no idea what that alien substance is. I always wear at least two pair of gloves, sometimes three. I'm gonna rate it a two because they tried to set up a surgical suite. [laughs] They tried to make it look scientific. I'll give them effort for that.

Rating: 2/10

"Contagion" (2011)

[machine buzzing] Medical examiner: Oh, my God. Assistant: Do you want me to, um, take a sample, or...?

Examiner: I want you to move away from the table.

Carter: Well, good. They actually have on appropriate protection, personal protection equipment. They have on mask, they have on shield, they have a hair bonnet on. It is realistic in that you actually can reflect the scalp, but then you have to take some time to open the skull, and then say there's something wrong with the brain. You do have to very carefully make an incision into the scalp, and usually way behind the head. Actually, behind the ears, so that you can reflect the scalp and see what is underneath the scalp itself, which is tissue and fibrous tissue. There should be a bit more blood than that. And then you take the bone saw and you actually have to open the skull. You would have to actually take the brain out of the body and dissect the brain to say there are problems with parts of the brain just by looking into the top of the head. So, I expect to see the skull, which also contains blood vessels, then there's fiber that's attached to the skull, which we call the dura. Basically, the skull can have fractures and discoloration, and you can expect that the brain would be soft, sometimes liquidy, discolored, perhaps a bloody film over it if somebody has an infectious disease.

Well, I would give this an eight out of 10. It is more realistic in what it's trying to depict.

Rating: 8/10

"NCIS" Season 14 episode 4 (2017)

Jethro: You called me, doc?

Mallard: Yes, Jethro. My initial assessment of Petty Officer Katherine's cause of death has proven to be correct.

Jimmy: It was strangulation.

Carter: I - [laughs] I just don't understand. [laughs] They pulled the sheet up on the cadaver, but they're not showing any incision, and you would have to have an incision and examination of the neck in order to talk about strangulation, and you are looking at the neck organ just to see if the hyoid bone is broken.

Mallard: A damaged hyoid bone would be a telltale sign of strangulation.

Jimmy: But it's not applicable in this case.

Mallard: And why is that?

Jimmy: Because our victim is 26.

Mallard: Which is relevant because?

Jimmy: Because the hyoid bone doesn't fully form till the age of 30.

Mallard: Very good, doctor.

Jimmy: Thank you, doctor.

Jethro: Why do I need to be here?

Carter: Now, we're born with hyoid bones. They're just not fused. So, not that it's not formed, it's present, and it can actually fuse in the late teen years. So that doesn't mean that it doesn't form until age 30, so that's a misnomer.

Mallard: During our examination, we found this rash on her neck and lower back.

Jethro: Poison ivy?

Mallard: Oh, not at this time of year. No. Whatever caused this is inorganic.

Carter: One doctor, I presume he's a doctor, I'm not sure. The younger person, I don't understand why they're giving a cause of death in the way that they are and changing it. Hypoxia is lack of oxygen, and that's the outcome of asphyxia. But you can have hypoxia from multiple forms, and I don't understand how they switch over from that to talking about an inorganic rash. I think I would give this a, I'll give it a six for effort.

Rating: 6/10

"Blade II" (2002)

Nyssa: It has bifurcated masseter muscles. Overdeveloped, allowing for a much stronger bite. Neurotoxin.

Carter: This scene is [laughs] is so ridiculous. First [laughs] there are so many things wrong. The main one is, when you put the neurotoxin and smell it, [laughs] inhale it into your own nose, that neurotoxin's gonna go straight into the central nervous system. Second of all, rigor mortis begins within generally two hours of death, and it begins actually in the head region, goes down from the head to the toes, and it's all about the muscles being stiff, so when they're talking about masseter muscles, and the tongue is a muscle also, that can get stiff, as does the jaw. Can I give it a negative? [laughs] If I can't, then I will give this a one.

Rating: 1/10

"Heroes" Season 1 episode 4 (2007)

Medical examiner: Secondary injuries are postmortem. Base of skull was punctured by a broken tree branch.

[laughs]

Carter: The doctor just reaches over and pulls out this big stick from the head. Well, the first thing that I would do is an X-ray to see where the tree branch is penetrating, and then you'd get good photographs. I would probably shave the hair around where it's entering so I can get a good look at that, and I wouldn't just yank it out. You wanna determine what part of the skull is damaged, what type of entrance it was. They have the skin reflected but the ribcage is not opened, and so she didn't finish the first part of the job. The last thing you generally do is the head examination.

If I were to rate this scene, it would probably fit in the one category. It's not realistic at all.

Rating: 1/10