Jonathan Hayes: Notes On Forensic Medicine

Jonathan Hayes


While Lee is away having a little rest on the operating table, I’m going to take this time to introduce myself. I thought it’d be a worthwhile exercise, since I’m hoping to be guest blogging on the Graveyard Shift on the first Monday of every month – unless Lee wakes up from anesthesia and regrets his decision!

I’m an English forensic pathologist, a senior medical examiner in New York City, where I’ve worked for the last 18 years. I went to medical school in London, trained in general pathology in Boston, and in forensics in Miami. I am a clinical assistant professor at New York University School of Medicine, and teach forensic pathology to cops, lawyers, medical students and physicians – pretty much to anyone who’ll listen.

I’ve been a freelance writer for the last decade or so, writing mostly about food and travel. I’ve written for the New York Times, Food & Wine, Gourmet, etc; until this year, I’ve been a Contributing Editor at Martha Stewart Living; there are samples aplenty on my web page, .

This year I quit (or, at least, semi-retired from) journalism to focus on writing fiction. My first novel, the forensic thriller Precious Blood (Harper) was published last year; the paperback edition has just come out this month, but I think you’ll find the hardcover makes a much nicer gift! Precious Blood is the first in a series of five books featuring Jenner, a (what else?) New York City forensic pathologist. Since I’m avoiding working on the sequel, I leapt at the opportunity when Lee floated the possiblity of a guest slot here on the Graveyard Shift.

Each month, I’ll be discussing a different topic of interest to me; hopefully of interest to you, too. If you have any suggestions for things you’d like to see covered, don’t hesitate to pipe up in the comments section!


A few years back, during preproduction for CSI: New York, some of the show’s producers and actors visited my office for research. In the scene where the medical examiner is introduced for the first time, the camera was to pan back to reveal him poring over a book; when Hill Harper, the actor who plays the ME, asked me what book an excellent forensic pathologist would be reading. I suggested the Russian Criminal Tattoo Encyclopedia.

Medical examiners love tattoos. Whenever I see someone with an interesting tattoo, I always ask them about it – what it means to them, where they got it, how they chose it. When I was a medical student in London, one of my attendings – a brilliant man and a physician to the Royal Household – liked to say, “Remember, Dr. Hayes: the patient is telling you the diagnosis.” It’s exactly the same thing with tattoos: people choose their tattoos to tell us who they are, where they’re from, and what sort of life they lead.

As many as 30 to 40% of young to middle-aged adults have tattoos. While the vast majority are decorative, chosen by the wearer, some individuals have medical tattoos placed for radiation treatment, or as a reconstructive cosmetic procedure after cancer surgery. And we still occasionally see elderly people who were tattooed in the concentration camps. Identifying a tattoo and reading its significance can be a case-making moment for a forensic pathologist.

The bodies we examine are sometimes in terrible condition. Severe injury, as in a plane accident, may destroy the face, and occasionally, individuals are decapitated and dismembered to disguise identity, so the pathologist may only have a single limb to work with. Sometimes, even when the body is intact, deterioration may mask the identity – when a decedent is recovered after weeks in the water, it may be impossible to recognize even the race just by looking at the body. In these instances, a tattoo can be a critical clue, since identification of the victim is a key first step in death investigation.

In my work, tattoos are most frequently useful with decomposed bodies. Within two or three days after death, bacteria spread through the body and break down the blood, converting it to green and brown pigment, and discoloring the skin. As the skin deteriorates, the epidermis becomes loose and begins to slip off; however, since the tattoo ink is embedded in deeper scar tissue, the pathologist can just wipe away the sloughed skin to reveal a tattoo now as pristine as the day on which it was made.

Tattoos are distinctive, and often very personal. Names, dates, slogans, area codes, flags, pictures of children, even the very language of the tattoo can give answers. Some individuals (too few!) are actually inked with their social security number. The more tattoos an individual has, the easier it is to ID them. The same tattoo may have very different meanings in different contexts. (By the way, in the photo below, notice that while Angelina has tried to remove and cover over the “Billy Bob” tattoo on her left upper arm, it’s effectively impossible to completely erase a tattoo without leaving telltale scarring.)

Pathologists divide tattoos into professional and amateur-appearing. Professional tattoos are characterized by fine, clean lines, the use of color, and, well, skill. Amateur tattoos tend to be poorly drawn, executed in coarse lines of faded blue-black, often “beaded” from multiple individual punctures rather than the smooth line of a machine-driven tattoo. Amateur “stick and poke” tattoos may be self-inflicted by bored adolescents or drunk adults, may be crafted by slightly more organized and gifted “scratchers”, and are often a relic of time spent in jail – “prison ink”, “joint ink”. The simplest form of tattooing is done by dipping a needle into ink, then pricking the skin with it repeatedly, or by drawing the tattoo onto the skin and driving the pigment in with a needle; this is the basic tattooing technique practiced around the world. This process is more painful, since it takes longer to make the design puncture by puncture than it does with a machine driving a needle 100 times per second.

Tattooing is very common in prison, with many gang members arriving with elaborate ink already in place, others getting tattooed in the joint. Prisons frown on their homegrown tattoo artists – the technique spreads disease, and enforces tribal divisions in the inmate population. Usually the tattooing is done with a needle and ink; if no ink is available, pigment may be made from burning tooth brushes or the heels from shoes. More advanced jailhouse tattoo artists fashion a tattooing machine out of a small motor – from a cassette player, for example – the body of a ballpoint pen, guitar wire and a 9 volt battery. Some of the jailhouse work I see is quite good, but it’s always easily recognizable as prison ink.

There’s a significant overlap between gang ink and prison ink – membership of one of those societies tends to earn you membership in the other sooner or later. Some prison ink is fairly generic – for example, tears tattooed on the face, which originally expressed “grief” over having murdered (one tear for each victim), but now may also represent loss of a friend or a family member during incarceration.

Tattoos seem particularly prevalent among Latino gangs. The most common symbol is the pachuco cross, a cross with three radiating lines, most commonly seen on the back of the hand, between the thumb and index finger. Sometimes this may be stylized as three dots arranged in a triangle on the hand or by the eye, a reference to the three words “Mi Vida Loca” – my crazy life outside the law. The words themselves may appear, usually tattooed large and professionally. The meaning of the cross is highly variable – some associate it with having committed a trinity of major crimes – rape, murder and arson – others with the confluence of Honduras, Guatemala and El Salvador.

Another common Latino tattoo is the Virgin of Guadalupe, an image of Mary standing, usually surrounded by a halo of stylized flame shapes. Most typically, you see these on the arms, or covering the back; part of the tattoo’s function in this position is to protect the wearer against sexual assault.

While the pachuco cross and the Virgin of Guadalupe are common among gang members, they’re also quite common in the community at large; there are many more gang-specific tattoos. Often they’re quite literal – LATIN KINGS for the Latin Kings, AB for the Aryan Brotherhood etc. There’s been a movement away from explicit gang tattoos, which are a bit of a gift for law enforcement types (and medical examiners!), so tattoos may be more subtle – for example, a crown to designate a Latin King, for example, a shamrock or a Viking to refer to the white supremacist Aryan Brotherhood, instead of the more obvious swastikas and SS symbols.

A double M or the number 13 may represent the Mexican Mafia (M being the 13th number of the alphabet); Mara Salvatrucha 13 also use a 13 (a nod of respect for the Mexican Mafia, it is said).
But the number 13 found on the body of a young white suburban man would be more likely to refer to marijuana, again navigating backwards to M being the 13th letter of the alphabet. As always in forensics, context is key…

The criminal organizations with the most rigorously codified approach to tattoos are the Russian gangs. The skin of a Russian criminal can be an extremely literal text detailing that individual’s background, affiliations and achievements. Russian underworld tattoos are so rigidly formalized that demotion in an organization may result in having the tattoo indicating the former rank burned off the skin, traditionally using magnesium powder bandaged to the skin.

When the first episode of CSI: New York ran, to my chagrin, when we first meet the medical examiner, we see him intently reading a standard forensic text, something someone who’s experienced in the field does pretty rarely. I was pleased, then, three years later when I saw the critical role Russian tattoos played in David Cronenberg’s film Eastern Promises; I like to think that screenwriter Stephen Knight was in some way inspired by those Russian tattoo encyclopedias.

And over on, the first volume of that encyclopedia is now out of print; not to worry, though: there’s a link to purchase a secondhand copy of this little book- for $395.

13 replies
  1. Jonathan Hayes
    Jonathan Hayes says:

    Michelle, don’t make it too easy for us! Hide that number somewhere not immediately visible – inner thigh, inside the armpit, just inside the hairline on the nape of your neck… Forensic pathologists LOVE a good challenge!

    Paul, embarrassingly enough, I know only a couple of the Brit forensic pathologists – Dick Shepherd and Chris Milroy are friends. Even more shameful for a Briton, I have more French forensic pathologist friends than British. As if in payment for my treason, I’ve been invited to give a two hour lecture on gunshot wounds at a French forensic meeting in June – in French.

    Next time you’re coming to town, drop me a line via my website and let me know what/where your tattoos are – always happy to help identify the body of a fellow Englishman!

  2. Falcocop
    Falcocop says:

    Hello Jonathan, I am more or less a lurker on here but I enjoy reading what goes on. I am a writer but in the main I do biographies. Mt job though is that of Coroners Officer in West Berkshire, England so I may know some of the Home Office Pathologists that you possibly know. Interesting article you have written about Tattoos. I for one have used them as the first point of identification on a body and probably will again sometime.

    I can also relate to Harold’s demise when the arrow struck him through the eye. The archer as you probably know was named Tyrrell and is a decesendant of my wife.

    I look forward to your next blog and if you are stuck I would love to know more about they NYC M.E./Coroner System.

    P.S. I visit NYC from time to time and if anything happens I have four tattoos that will assist you.

    Best wishes

    Paul Beecroft, Coroners Officer, England

    “I see dead people”

  3. Michelle Gagnon
    Michelle Gagnon says:

    That’s it, Jonathan, I’m rushing out to have my SSN tattoed somewhere prominent. It will be my first–I’ve never gotten one before thanks to my commitment issues, but you’ve convinced me…

  4. Jonathan Hayes
    Jonathan Hayes says:

    Probably the best example of an identification by tattoo was at the Battle of Hastings, in England in 1066. It was the definitive moment of the invasion of England by the Normans of northwestern France. At the end of the battle, the last Anglo-Saxon king, Harold II, lay dead on the field, killed by an arrow through his eye.

    The invading Norman leader, William the Bastard (I kid you not), wanted to be sure that he was indeed looking at the body of the dead king. Harold’s face, however, was so badly disfigured by his wounds and the bleeding that he was unrecognizable.

    They summoned Harold’s mistress, Edith Swan Neck (still not kidding), and she identified him based on the tattoo on his neck: “Edith and England”.

    At that moment, William the Bastard was dead forever, now renamed William the Conqueror.

  5. Jonathan Hayes
    Jonathan Hayes says:

    That was fast!

    SZ’s 420-instead-of-13 is a pot tattoo, of course, not a Mara Salvatrucha thing.

    I’ve not actually seen a magnesium powder tattoo removal, but it’s a chemical burn, and I would expect it to be an ugly white scar with blotches of blue tattoo ink showing through.

    I’m not going to talk about my current tattoo! Like many first tattoos, it was an impulsive adolescent decision. Luckily, the world already contains enough people with whom I’ve been intimate enough that they’ll be able to ID my body by my tattoo!

    My next will be a quote from Wagner’s opera Tristan und Isolde – “Oed und leer das meer”. After that, I want to get a larger piece on my back.

  6. Jonathan Hayes
    Jonathan Hayes says:

    Also, I have ideas for the next few columns, but if there’s any particular subject in forensic medicine you’d like me to cover, shout it out!

  7. minichno
    minichno says:

    A great blog gets even better — thanks Lee and Jonathan. I’m putting this to immediate use in a short story I’m writing.

    One question, Jonathan: what’s YOUR tattoo like?

  8. Jonathan Hayes
    Jonathan Hayes says:

    Thanks, all – glad to be here!

    I’m sure they’ve made the M.E. very interesting – Hill Harper is a fairly intense actor, and I’d bet they’ve developed his character nicely. That said, I don’t watch CSI:NY – I don’t mind the distortions in forensics on TV shows, but I work in NYC, and the sheer discrepancy between reality and TV is just too much for me to take. Same thing goes with CSI:MIAMI, since that’s where I trained in forensics. I’ve stayed true to the original Vegas CSI though, because unlike NYC or Miami, I don’t know what happens in Vegas.

    Largely because what happens in Vegas, stays in Vegas…

  9. SZ
    SZ says:

    Welcome Jonathan, awesome post ! Your book idea certainly beats what they used for CSI.

    Well, guess I am easy to figure out. A small eighth note on my left leg and, believe it or not, the ol’ gal still maintains a tan-too of a heart on my stomach from the 80s (you know, Madonna, belly shirts and bangles, more music)

    As for San Francisco, 13 may be out. Now it is 420.

    Question: How does it work bandaging magnesium into a tattoo ? How long ? Doesn’t it just make a big scar ? . . .

  10. Carla F
    Carla F says:

    Jonathan, welcome and thanks for sharing this info!! What a fascinating concept! I never thought tattoos would be all that useful in identification. Very enlightening! Now I’m disappointed that CSI:NY didn’t use your suggestion; it would’ve made the ME character that much more interesting.

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