Twin Falls

During my last year of residency in Long Beach, my husband John and I agreed that we didn’t want to stay in Southern California anymore. The reasons have faded into the misty past, but in general we felt that it was too crowded. I had visions of either starting my own lab, or at least finding a situation where I could build my pathology department without anybody telling me what I could and could not do. John wanted to manage my lab.

Two situations with potential presented themselves. One was a community hospital in Paso Robles, a lovely medium-sized town in central California surrounded by live oaks and rolling hills. The pathology group in nearby San Luis Obispo was only too happy to offer me whatever coverage I might need. Everyone there was excited about acquiring me, and made me an offer I couldn’t refuse.

Then I found out that the lab was actually owned by the lab manager. That was a deal breaker for me, because I would be responsible for the lab in the eyes of the medical staff and the regulatory agencies to which I would have to answer, but I’d have no authority whatsoever. John wanted me to buy the guy out so that we could run the lab instead, but when I suggested that to the medical staff, they informed me that they were quite happy with the way things were and didn’t want to change anything.

So I turned them down.

Then I got a call from a recruiter about a small doctor-owned hospital in Twin Falls, Idaho that wanted its own pathologist instead of sending everything to the county hospital.  This was the opportunity I’d been waiting for; the opportunity to build my own pathology department.  Back then, in 1977, Twin Falls was predominantly agricultural, with a population of 26,000 and two traffic lights.* It’s high desert, at an altitude of 4100 feet, and not nearly as pretty as Paso Robles. But it did have two hospitals, a brand-new community college and a fairly new suspension bridge over the scenic Snake River Canyon replacing the old toll bridge, and was only 80 miles from Sun Valley. It also had a sugar factory in which sugar beets were converted into White Satin. When we stepped off the plane, the air smelled like manure. It took me back to the way my hometown, Cooper Mills, Maine, always smelled in the summer, and I knew I was home.

The day that John and I left our Long Beach house for the last time was the day Elvis died. It was also the day the hospital in Paso Robles called and said they’d still not found anyone for the pathologist position and would I please reconsider?

I said no.

So over the next 24 years at the Twin Falls Clinic & Hospital as a solo pathologist, I built my department from scratch, and we finally achieved accreditation by the College of American Pathologists in 1997. But it was short-lived.

In 2002, due to increasing unfunded mandates from the federal government, we were forced to sell out to the county hospital, Magic Valley Regional Medical Center, and I joined their pathology group. In 2006, the county hospital was bought out by the St. Luke’s Health System, based in Boise, who built us a beautiful new hospital. St. Luke’s Magic Valley is a 250-bed tertiary care hospital, in contrast to the 40-bed hospital I’d started out in.

John never did get to manage my lab, which ultimately led to our divorce, in 2004.

Twin Falls now has a population over 40,000, which is expected to reach 50,000 in 2020.* There are numerous traffic lights now. We have a mall, a Costco, a Walmart. There are 2 high schools. The scenic Perrine Bridge is now a mecca for countless base jumpers.  Numerous industries other than the sugar factory have made Twin Falls their home, including Chobani Yogurt. But it only has one hospital now.

This is the background for my Toni Day mysteries, and Toni herself is loosely based on me and my own adventures as a solo pathologist in a rural setting. The old hospital, Perrine Memorial, is loosely based on the Twin Falls Clinic & Hospital, and the new one is loosely based on St. Luke’s Magic Valley.

Some of Toni’s adventures have started out as situations that I have actually been in, but none of my adventures have ever included putting my life in danger to track down a murderer. Those are all products of my overheated and lurid imagination. Indeed, my first three books featured villains based on persons in my life that I really wished I could kill. Since I couldn’t do it legally, I did it cathartically by writing about it, and felt much better.

*To find out more information about the population of Twin Falls, Idaho, please visit:

Real-life stories from a pathologist

Once, I had occasion to autopsy a 5-year-old boy who had dropped dead on the playground at school where his mother was a teacher’s aide acting as recess monitor and witnessed it. The coroner told me that the parents wanted to talk to me before I did the autopsy, and I obliged. The mother was angry about how long it had taken the ambulance to get there, and wanted to know if her boy would have survived if they’d gotten there sooner and given oxygen. The father could hardly talk at all through his sobs. I found the difference between the parents’ reactions striking. Daddy was grieving, Mommy was pissed.

At autopsy, I found his airways clogged with a thick brown substance. Other than that, everything looked normal. When I called the parents back and told them that, the mother told me he’d eaten a brownie just before going out on the playground.

The parents sued the school, the county, the ambulance company, and the paramedics. The lawyer for the defense, who interviewed me in my office, told me that the boy had vomited and aspirated in the ambulance while the paramedics were doing CPR, which left me without a cause of death. He asked about laryngospasm, and I told him that wouldn’t show up at autopsy because one has to be alive to have any kind of spasm. At his request, I sent the case to the county hospital pathologists for a second opinion. Their report said the child died of a cardiomyopathy.

I called them to ask what it was that I had missed, and they said it was because the weight of the heart indicated that it was much too large for a 5 year-old. Cardiomyopathies generally result in an enlarged heart.  I pointed out that this child was big for his age, and that his height and the weight of his heart were both in the normal range for the average 9 year-old. That left us, again, without a cause of death.

I didn’t have to testify in court, but I did give a deposition. The bottom line was that there was no way to know if giving oxygen sooner would have made any difference. The parents lost their case and ended up having to pay $37,000 in court costs.

Another time, I had occasion once to be involved in a murder case. I didn’t know it was a murder case when I did the autopsy, though. The young lady had died at home. Coworkers said she had complained of a headache, stiff neck, nausea, and a fever the day before. I was thinking meningitis, and took extra precautions not to expose myself in any way. I took spinal fluid and blood for culture. I took blood and urine for toxicology, just in case.

Toxicology was negative. Nothing grew on culture. There were no specific findings at autopsy. Later it was found that she had been killed with insulin by her boyfriend’s ex-wife. I had to testify before a grand jury, where I explained that since insulin is a naturally occurring substance in the body, testing for it wouldn’t prove anything.

At a grand jury, one is interrogated by the prosecuting attorney and the members of the jury, none of whom had any medical background. I know that, because I’ve been called for jury duty umpteen times and never picked because nobody wants a doctor or even a nurse on a jury, let alone a pathologist!