By Aaron Collins

Imagine that it was your job to watch movies every day. But you are allowed only tragedy or crime dramas—no comedies or romances allowed. Spliced in between the scenes of high anxiety that are typically condensed into a 90-minute film, you must watch hours or even days of tedious technical or dry documentary footage that lacks any easy-to-follow narrative, leaving it to you to piece together the facts.

That might describe the professional life of forensic nurse Kris Gray, R.N., a Registered Medicolegal Death Investigator. Her profession is also called CSI nursing for “crime scene investigation nursing;” “legal nurse consultant” is a similar role, but one that serves the legal profession rather than law enforcement.

“Unlike TV shows and movies, which are specifically structured and paced to enhance drama and keep the viewers tuned in, real life doesn’t care who tunes in or for how long. (Movies) can get the details right but the context is fiction. Real life can be slow and tedious, routine and sometimes it doesn’t smell all that good,” Gray says, giving one of the downsides of her occasionally unseemly work.

The life of forensic nurses can be painstaking as they collect and comb through evidence, with bursts of higher-intensity moments should they encounter suspects of crimes like sexual assault, or the victims of homicide, attempted homicide, or domestic violence. Forensic nurses can be employed in-house with an insurance company, legal firm, or hospital, or have a private practice such as Gray’s.

Gray knows a thing or two about movie-making. When she was a paramedic with American Ambulance, she served as a medic on the set of a Donald Sutherland movie, a sci-fi thriller called “The Puppet Masters.” Gray was drafted into a scene with Sutherland in which, fittingly, she played a paramedic. “They say the first five minutes you spend on a movie set are the most exciting of your career. All the five minutes that follow are the most boring of your career,” says Gray. “Take after take, I taped up (Sutherland’s) IV and we’d load him into the ambulance with me climbing in behind him and off we’d drive into the sunset…the blazing, hot sunset,” she adds, recalling the summer shoot in Fresno.

Gray’s other projects have included concerts, rodeos, sporting events, and a video shoot for singer/songwriter Michelle Branch.

Following her stints as an entertainment industry medic she worked aboard cruise ships on medical units for Holland America Cruise Lines. “Movies were fun but cruising was the best. I went to work for Holland America in 1994 because there was no nursing shortage then and no one was hiring new graduates. I got to go around the world, see things I never imagined I’d get to see, meet people from everywhere and got to do some real by-the-seat-of your-pants medicine,” she says.

She says readers may be surprised to learn that people do die on cruises. “If being on a cruise ship could magically protect you from serious illness or injury, I would live at sea,” she jests. One of the things she learned while at sea was to improvise treatment with occasionally limited resources. It was on those cruises where she began to learn the basics of death investigation.

Gray now specializes in criminal investigations and mass fatality incidents.

Haunted by Katrina

Her professional life turned stranger than fiction in 2005, when her work took her to a New Orleans deluged by Hurricane Katrina, a national nightmare that still haunts her. “Talking about Katrina is navigating a very fine line. It still elicits strong emotions of anger and grief,” she says.

Of the bodies she helped recover, perhaps none resonate as much as the gentleman she found in his attic, awaiting a rescue that never came.

“There were so many who died in their attics, so many who waited for help that never arrived,” she recalls. She doesn’t know why the memory of this particular man stays with her, but that’s the nature of her business, she points out. “You never know which person is going to strike that chord that lies so deep within you often don’t even hear it,” says Gray.

While Gray’s work is often considered police business, few people are aware of how nurses are involved in solving or prosecuting crimes, or investigating deaths. Forensic nurses collect evidence around the clock, whenever they are called to the scene of a crime or to a hospital when a crime victim or suspect has been admitted. Their findings often prove instrumental to police, district attorneys, and the victims themselves in securing justice.

As a Legal Nurse Consultant (LNC), Gray’s job is to clarify medical issues for attorneys, insurance companies, and sometimes for families. So while she may work at the scene of a death, her role is shaped by which kind of client has contracted her services to be there.

Gray points out that working with the dead can be a challenge, but that working with the living in New Orleans was more haunting still. “The first time I notified a family of a positive identification, I called the victim’s sister, who had been relocated to Texas. I delivered the news to the woman and she began screaming, “They’ve found Richard!”

To Gray’s surprise and horror, she heard people in the background clapping and cheering. “I felt physically ill. I was certain they had misunderstood and thought he had been found alive. But no, they understood he was dead,” she recounts. “These people had nothing; were crammed together in a hotel room in Texas and yet they were rejoicing over discovery of a body.” Such were the upended sensibilities following one of the most devastating hurricane disasters in U.S. history.

Professional Development

The term forensic nurse was coined as recently as 1992, a fact that reflects the nascent status of a profession whose standards continues to develop. Gray says that about ten to fifteen years ago, death investigation in the U.S. started to undergo a transformation.

“Across the country it was kind of hit and miss with regards to training and procedures,” she says. Then in 1997, the Department of Justice published a booklet: “Death Investigation: A Guide for the Scene Investigator.” The push for standardization, rigor and uniform credentials under the tenure of Attorney General Janet Reno was expressed in the publication’s motto: Every Scene, Every Time.

Not long afterward, in 1998, some of those same folks helped develop the American Board of Medicolegal Death Investigators (ABMDI) whose function was to establish high standards with regard to professional practice as well as ethical conduct. Gray, now a diplomate of ABMDI, having earned their credential in 1999, points out that the impetus behind the initiative is that while the circumstances surrounding a death may be of a legal nature, death itself is a medical event.

In a short time the profession has advanced considerably. Tennessee law, for example, now requires anyone working with a medical examiner to have some sort medical background. The National Association of Medical Examiners now requires the chief investigator or at least one principal investigator within a Coroner’s or Medical Examiner’s department to be a Registered Diplomate of the ABMDI (D-ABMDI) in order to received accreditation. This requirement is evolving so that in the future the majority of investigators’ credentials will read “John Doe, D-AMBDI” in order to receive accreditation.

Gray says that, as a result of the new standards, lots of jurisdictions are using RNs such as herself (who are also now or will soon become D-AMBDIs) as death investigators: Places like Harris County, Texas; Charleston County, South Carolina; Miami/Dade County, Florida; and Washoe County, Nevada, to name but a few.

Thanks to new professional standards, when victims and suspects come in to the hospital, either via law enforcement, ambulatory services, or voluntarily, the forensic nurse is immediately paged. The nurse collects every strand of evidence from the patient. Evidence is cautiously and systematically labeled, packaged, sealed, and sent to the crime lab for further police investigation. The evidence is then brought to the Department of Justice during prosecution of the case resulting from much more systematic procedures that just a couple of decades ago.

No ‘Typical Day’

Gray says that a self-employed forensic nurse experiences a wide variety of scenarios, which can be both a blessing and a curse. “I have no ‘typical day,’ I just shape-shift into whatever I need to do that day: Working cases in the office, I try to put in as many hours as I can for the Sheriff’s Department either studying, training, traveling,” she says, and as with any freelancer, marketing to keep her business afloat. She is a well-known entity at the Tulare County morgue, volunteering there frequently as part of her professional life and development, earning high marks from Sgt. Tom Wright with Tulare County’s Coroner Unit.

Among her many tasks on any given day, Gray may review, interpret, evaluate, analyze, and summarize medical records. She looks at pre-hospital, hospital, and autopsy records, researches various medical topics and how they relate to a particular case. She creates timelines, graphs, and narrative summaries. She also may analyze and assess crime scene and autopsy photos. Depending on the client, she also may do scene investigations and be present at an autopsy.

How does Gray find peace in a profession that deals with the results of others’ chaos? “You have to be able to compartmentalize. You don’t want to become uncaring by becoming indifferent, I think, would be even worse than letting things tear you apart,” she says. “You have a front row seat to everyone’s worse nightmare and there are horror stories I’ll take with me to my grave. You have to maintain your humanity but if you don’t learn to leave it at the door, you’re going to drown in your own tears. I try to treasure every day and the people in it because it can all change in the blink of an eye.” And finally, says Gray, “I try not to take myself too seriously.”

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