Death investigation in Maui County, Hawaii is managed by the police, and the chief of police is the . In 2015, I interviewed for a job there: an open position for a forensic pathologist to perform autopsy death investigation. My husband took the kids to the mall to shop for sunscreen and bathing suits while I was in the interview; we were there on a family vacation. Maui was paradise to us.
When you apply for a job in forensic pathology, some of the process is just like that for any other job. I asked about the routine things that would make our lives possible in a new place -- salary, relocation costs, the best schools. We had been to Maui a few times before as tourists. Our entire family had fallen in love with the islands, over and over. The idea of living and working in Hawaii was enticing. The morgue I would be working in was in the hospital complex and I recall two autopsy tables. The job description stated that I would perform approximately 220 to 240 postmortem examinations per year, with only two to four homicides, "...and probably more 'nature-related' accidents (ocean fatalities, hiking accidents, etc.) than most locales." The salary was lower that what I expected, given the high cost of living, but colleagues who had done it referred to that pay drop as "island tax" -- the price of living in paradise.
Now, looking back at that job description after the catastrophic wildfires, my heart aches and my stomach lurches. A morgue with only one forensic pathologist used to doing one or two autopsies per day cannot hope to handle the scope and magnitude of body recovery and death investigation work engendered by this disaster. Even if you fly in the Federal Emergency Management Agency (FEMA) or a federal Disaster Mortuary Operational Response Team (DMORT) -- with their refrigerated trucks, mobile morgue, pathologists, anthropologists, technicians, and morticians -- the lack of local mass fatality experience is going to make coordinating those resources and personnel extremely challenging, even for the most experienced and best-drilled locals. FEMA and DMORT bring resources, but they're . That has to be done by the local, county, or state authorities in the affected region. Compounded with the displacement of so many of their own workers and the entire community's grief over the loss of loved ones and whole swathes of homes, businesses, and cultural institutions, the pressure coming down on local agency managers will be tremendous. The head of Maui's emergency management agency resigned for health reasons in the immediate aftermath of the fires, and his replacement is being sought. A challenging aftermath lies ahead.
Aerial images of Lahaina -- former capital of the Kingdom of Hawaii and a lovely, historic port town of 13,000 people -- look like a war zone. Most of the buildings have collapsed and burned to the ground. Ash and debris cover the earth. But in my experience, you still cannot comprehend the scale of a disaster such as this from photos -- you have to be on the ground to see it and smell it and feel it. With your feet on the ground you breathe the toxic air, feel the pulverized rubble and heat-shattered glass, assess the impediments to transport, and experience first-hand the difficulties in communicating in an environment where networks have literally melted down. On the ground, it's a vast field of ruin, and somewhere in there are human remains that no longer resemble anything human.
One of the biggest challenges to the recovery of these remains in the ruins of Lahaina will be in finding and accurately counting them. The missing currently number over a thousand, and when decedents are located in the rubble, their bodies may not have any identifying features due to the destructiveness of the blaze. Fires rarely incinerate human bones completely, but under the temperatures that the Maui fires generated, bones will become very fragile. They look like black chalk, and are hard to distinguish from surrounding debris like concrete and charred drywall. Over 40 trained cadaver-detection dogs have been brought into Lahaina and are currently doing their job, guiding forensic anthropologists -- experts in the identification and recovery of human skeletal remains. When bones and other remains are found, the anthropologists will have to first confirm they are human. Then they will work carefully to contain the immolated remains of each person along with any identifying property, so the fragments stay together throughout the recovery process. There are limited numbers of people with the skill set to do this, and well-meaning volunteers might end up inadvertently complicating or even ruining the identification process if they try. If victims of the fire had huddled together for safety and died in groups, then the commingling of their body parts will make the separation of the remains and the identification of each and every person more difficult.
With communications down, families all over the island are having difficulty reaching one another, thus increasing the list of missing persons. Once the missing are identified, living or dead, their families may have lost their homes and relocated, and may not be reachable. Tourists frequent the islands year-round, but especially in summer, and some of those will be foreign nationals. DNA exemplars will need to be sent internationally to confirm identification. So, while current DNA technology can identify an individual in about 30 minutes, it will be getting the samples from the living relatives that will slow the process down considerably.
Given the news reports of the of the devastation (over 2,000 acres and 2,200 structures, most of which are residential), it may be many weeks to months before everyone is even found. Given the intensity of these fires, some bodies may not be identifiable at all using scientific modalities; fire can destroy everything we're made of, even our DNA. We also know there were many people who escaped the fires by jumping into the ocean under a nightshade of black smoke, into waves whipped up by hurricane winds. Many of them will have perished there, and some of their bodies may have been swept away forever. So we might find, as we found during the recovery effort after the September 11 attacks, that some of the victims might need to be presumed dead based on circumstances, and declared legally dead without evidence of a body.
I worked on the 9/11 recovery effort on the island of Manhattan. The scenes I'm seeing on the island of Maui bring those experiences back to me now. A disaster like this one unfolds over hours, but the devastation to a community will have repercussions for years to come. With donations, federal support, and a whole lot of aloha, I am hopeful that Lahaina will rebuild and return to paradise.
Here is to a GoFundMe from the company that runs the condo complex where our family used to visit and hope to again, for staff who lost their homes in Lahaina.
Judy Melinek, MD, is an American forensic pathologist and the CEO of PathologyExpert Inc. She is currently working as a contract pathologist in Wellington, New Zealand. She is the co-author with her husband, writer T.J. Mitchell, of the New York Times bestselling memoir , and two novels, First Cut and Aftershock, in the Jessie Teska forensic detective series. You can follow her on and .