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Health, Science, Environment

After three decades as medical examiner, Michael Graham can still say, 'I like a mystery'

This article first appeared in the St. Louis Beacon, July 6, 2012Kathy Reichs was looking for a new way to murder someone.

She checked with a few friends, including Mike Graham. He suggested ricin, a substance so toxic that the equivalent of a few grains of sand is sufficient to quickly kill an adult.

It worked beautifully.

Kathleen Joan Toelle Reichs is a forensic anthropologist, professor and crime novelist. She’s also the producer of the hit television series, "Bones." She got some of her deadly poison facts for her latest novel, "Flash and Bones," from Dr. Michael Alan Graham, chief medical examiner for St. Louis and professor of pathology at Saint Louis University.

“I heard she mentioned me in her acknowledgments,” Graham smiled, admitting he hasn’t read the book yet. 

She did and he might want to read the book; it made it to No. 1 on the New York Times best seller list last September. 

Graham has also consulted with Patricia Cornwell, who has written a series of novels about a medical examiner, Dr. Kay Scarpetta.

He quickly disavows any interest in writing novels.  His five books are all deadly serious, tending toward titles like "Forensic Pathology in Criminal Cases. They are all textbooks.

Unraveling mysteries

Graham has contributed chapters to more than 20 other books and written hundreds of papers. He lectures all over the country and has the golf balls to prove it -- about 300 of them, souvenirs from the courses he’s played during his travels. They are neatly displayed in his spacious but far from lavish office on the top floor of the medical examiner’s building, a two-story granite affair that’s plain even by mausoleum standards.

Tall, irregular stacks of paper cover every inch of surface, except the space reserved for a high-powered digital microscope and coffee-making paraphernalia, including four containers of Coffee-mate (“I can’t take a chance of running out,” Dr. Graham explains.) 

The M.E.’s office will not be relocating when its next door neighbor and primary patron, the police station, eventually moves from the 1300 block of Clark Avenue downtown to parts westward.

“We are specialized,”said Graham’s assistant, Roberta Steele, a former embalmer, explaining why the office would stay put. “You, know, the refrigerators and all.”

That would be the morgue in the basement.

It’s where Graham and three other pathologists unravel the mysteries of death.

“He is very brainy and he likes to solve puzzles,” said Dr. Jane Turner, assistant medical examiner and an associate professor of pathology at SLU med school. 

“He takes an intellectual approach to forensic pathology.”

He has seen a lot of changes in the field.

“With technology, like digital microscopes, we can do more with less. We understand more about basic diseases like crib death, and DNA has been a big change for diagnostic purposes,” Graham said.

What hasn't changed is human nature, ensuring steady work for him and his staff of a couple dozen people, including three other forensic pathologists and four investigators. 

“I like a mystery; I still enjoy unraveling them,” Graham says. “I try to pick up the pieces and get the right story.” 

But some pieces are harder to pick up than others.

The hard cases

On a mild winter day in February 1983, two men were sifting through debris in the basement of an abandoned house looking for some useable metal. 

What they found, instead, has haunted Graham ever since. 

“My most frustrating case was the little girl whose body we found with no head,” he said.

After more than three decades in the city’s medical examiner’s office, the 61-year-old M.E. has determined how thousands of people died, but this is the case that lingers in his mind for one simple reason:

“We still have no idea who she is,” Graham said. 

From time to time, Graham still takes another look at little Jane Doe’s file. 

It has been one of his most troubling cases but perhaps not the biggest. Two national cases vie for that honor:  the 1993 federal raid on the Branch Davidian compound in Waco, Tex., and the murder of child beauty queen JonBenet Ramsey in Boulder, Colo., three years later.

Graham spent a year reinvestigating the actions of government agents at Waco as part of a committee led by former U.S. Sen. John C. Danforth. The agents were exonerated.

“It was pretty interesting to be on the inside of a federal case,” Graham said, still marveling at the “impressive” size of the government’s resources.

He reviewed the piles of conflicting information in the death of 6-year-old JonBenet, who was killed in her home one day after Christmas in 1996. That “very difficult” case has never been solved.

“Mike is highly recognized nationally as an outstanding person in his field,” said Dr. Mary E. Case, chief medical examiner of St. Louis, St. Charles, Jefferson, and Franklin counties.

The lives of the two M.E.s have been intertwined since Graham did a fellowship in forensic pathology at Saint Louis University under Case in 1981.

Weird science

Graham graduated from Saint Louis University School of Medicine in 1977, four years after receiving his bachelor’s degree in biology there. He did a residency in anatomic and clinical pathology at St. Luke’s Episcopal Hospital in Houston from 1977 to 1981, then returned to SLU for his fellowship with Case.

He became her colleague in the pathology department at SLU and joined her in  St. Louis' M.E.’s office. He has been a professor of pathology at SLU since 1996 and the two co-direct SLU’s forensic division in the pathology department.

“He is mild-mannered, calm and easygoing, but we are all weird,” Case said of forensic pathologists.

“We don’t find our work morbid,” she added.  “It is kind of odd what we do, but it’s extremely interesting; when you actually do the work, you don’t think of it as strange in any way.” 

Graham agrees nothing strange is going on.

“If you are just focused on the macabre aspects of death, that would be pretty morbid,” he said. ”Our role is to resolve issues around a particular death and help a family get through a very difficult time.”

The unflappable Graham has been the city’s chief M.E. for the past 23 years. He was appointed by Mayor Freeman Bosley Jr.

“I’ve never met the mayor,” Graham says with a sly grin, “but we aren’t really involved in city politics.  They pretty much leave us alone to do our thing.” 

Their “thing” is performing around 700 autopsies a year, after investigating approximately 3,000 cases of people who died alone, suddenly or unexpectedly. 

“Like a 14-year-old dying during football practice,” Graham explains.

Or suspected homicides. 

As an expert witness, Graham has given his share of testimony in high-profile, sometimes controversial, cases.

In 1999, two city police officers said that a burglary suspect they encountered on a roof, Julius Thurman, died from falling on his head. Graham begged to differ. He said his autopsy showed that Thurman’s death resulted from a powerful blow that fractured his skull. No one was convicted in the killing.

The Paula Sims case had a much different outcome. 

In 1990, Graham testified that Sims’ 13-day-old daughter, Loralei, died in 1986 from “homicidal violence.” The Alton woman eventually pleaded guilty to murdering both Loralei and another daughter, 6-week-old Heather, three years earlier. 

Saving suspects and children

The two cases are emblematic of areas of particular concern to Graham.

“I have an interest in why young people suddenly drop dead and death in (police) custody,” Graham said.

The two types of death have something in common: They are often preventable. Graham has researched, written and lectured extensively on both.

His work includes teaching police officers how to restrain safely suspects who are in no mood to cooperate. He advocates the “three-minute rule"; getting control quickly helps prevent deaths.

He received the 1986 president's award from SIDS Resources for work that led to a decrease in sudden infant deaths, the stuff of parents’ nightmares.

“My interest in infants was because they made up the bulk of sudden deaths,” said Graham. At SLU "we were involved in a lot of the early studies in the ‘80s and ‘90s about why the babies were dying.

“We investigated and found that a lot of the infant deaths were preventable.” 

The most common culprit for SIDS is smothering from unsafe sleeping practices: parents rolling onto babies in a shared bed; face-down sleeping; teddy bears, crib bumpers and covers.

“We were surprised that ordinary soft adult bedding could kill a baby,” Graham said. 

The worst offenders, comforters, cause swaddled babies to inhale their exhaled breath, which is high in carbon dioxide, a toxic gas.

The cure is education. And therein lies the challenge.

“I knew we were going to have problems getting people to change, but we have had reasonable success,” Graham said. “It takes time to break old habits.”

The SLU research was also used by the Back to Sleep campaign, a federal program begun in 1994, which encourages placing healthy babies on their backs to sleep.

Graham is as devoted to saving lives as he is to finding out why a life was lost. It’s the latter for which he may be best known and least understood.

“Most people don’t have a clue what we do,” Graham said, “and I consider it a success when people don’t know much about us. We are not the type of office you want to see on the front page every day.”

Some who know his work have acknowledged it.

Graham, whose clinical research includes forensic issues regarding cardiopulmonary pathology and diagnostic cardiac pathology, has received numerous honors. They include being named health professional of the year in 1992 by the Combined Health Appeal of Greater St. Louis for transplantation activities and the outstanding service award from the National Association of Medical Examiners.

A special personality

A small room that resembles a chapel is near the entrance of the medical examiner’s building.  It’s actually a waiting room for grieving family members.

He's compassionate, thoughtful and extraordinarily patient with families," said Turner.

He’s also direct. 

“I always tell the family the truth, even if their child died of a heroin overdose,” Graham said. 

“Chief,” as Baxter Leisure, Graham's executive assistant, calls him, “is honest with families because they are hearing so many different things about their loved one’s recent expiration.” 

Their work, Leisure says, takes a special personality, recounting the time a promising investigator left his resignation on Graham’s desk the morning after he’d had his first encounter with a decomposing body. 

Graham takes it all in stride.

More Clark Kent than Superman, he golfs, attends every Blues game his schedule permits, and reads spy and detective novels.

“No highbrow stuff,” he says.

When they were young, he often took one of his two sons, Christopher, 25, and Patrick, 21, on business trips with him. He doesn’t watch forensic television shows, not even "Dr. G: Medical Examiner," which he heard is “more realistic than CSI.”

The now world-class forensic physician – don’t call him a coroner – was born in East Liverpool, Ohio, home to football great “Lou” Holtz. He grew up in nearby Salem, a farming and steel town in northern Ohio. His father was a hospital controller, his mother a homemaker, and he a happy, only child.

He is married to Dr. Irene Graham, a physician in the Center for Vaccine Development at SLU. The two met when Graham was a resident in Houston and she was a medical student at Baylor College of Medicine.

They live in Frontenac with two playful Abyssinian cats. The male, Angel, belongs to his wife; Graham gets the “obnoxious, in your face” female, Blue.

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