On average, there are more than 5,000 deaths that occur each year in Vermont, and every death certificate is processed through the office of the chief medical examiner for the state: Dr. Steve Shapiro.
At the University of Vermont Medical Center, Shapiro spoke to VPR about the stark challenges inherent in the job he's held since 2006.
Shapiro greeted us casually, in his socks, wearing his medical scrubs. He's in his early 50s, with a mop of grey hair and an energetic, candid manner that's not unfriendly, but he was skeptical about being interviewed.
"I'm not sure what good is gonna come out of this kind of stuff, 'cause I hear from the families and when they see things printed or on the media, and now everybody's got the social media and the comments that come out, these are profoundly hurtful things for people," Shapiro explained.
Why then would someone want to work in a profession that deals with death on a daily basis?
"You know, you follow your interests. I ended up in the morgue. What can I tell you? What we do here helps people every day. Sometimes it's not as obvious as others, but we do," he said.
Offering that help is not easy, and if he's reluctant to talk about the work, it's because death examination is not your typical 9-to-5 job.
"We deal with peoples' worst nightmares on a regular basis," Shapiro said. "Peoples' universes are collapsing, the most stressful time probably in their lives. The only people who really know what we do are the people who do it or the unfortunates who have to be involved with our system."
Involved in the system is a staff of some 50 investigators who get called to locations all around Vermont at all hours of the day and night, analyzing various causes of death — some of them quite violent. Shapiro often refers to these investigators as "his people," because he's well aware of the stresses they're under.
"A lot of my folks are called from home — sitting at home in the middle of the night, you get this thing, you go to these horrendous scenes, and you go home and you're alone," he said. "You know, processing this stuff is hard, and ... sometimes we forget about, you know, that emotional component of this stuff — and you can't. It's real and you never know which cases are gonna set you off. We all have our little things that bother us."
"I have no idea what what sets things off for [another person]," Shapiro said. "I know what sets things off for me, but you know, I don't think you'd be human if these things didn't affect you. And as I said, some of these stories and some of the cases will, you know, trigger something in each of us and it might not be the same."
When asked what set him off, Shapiro says that "these days, it's the stench of loneliness." When pressed, he explains: "I live by myself. People die alone. And sometimes it takes weeks for people to find them. I think that's really sad. So, yeah, those things set me off these days."
But Shapiro is also quick to point out that there are others in the medical profession who have to deal with emotional challenges that a forensic pathologist like him does not. He can't imagine, for example, being a pediatric oncologist treating a child suffering with cancer. But that doctor sometimes gets to see his patient recover from an illness, where by contrast, a medical examiner will never see a patient get better.
"Dr. Shapiro has never lost a patient. ... I've misplaced a few, but we've always found them," he said. "But, you know, the satisfaction of this job is helping the living folks. I mean we do work on the dead, but the living — you know, helping a family understand why their mother died ... is profound.
"For my investigators out there — you know, helping clean up a scene so the family doesn't have to come home and see this stuff. These are the little things that, you know, nobody thinks of. A calm voice who's going to tell you what the process is is huge for some people."
And in many ways, every Vermonter has Shapiro as their doctor.
"I consider the state of Vermont my patient," he says. "I monitor how it's doing by keeping track of what's killing its citizens."
And that's a job Shapiro does very much for the living, as well as the dead.