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Diagnosis of violence is worth repeating


FIRMLY devoted to the scientific search for truth in the deaths of his fellow human beings, John Smialek seldom gave away his personal feelings about what he saw every day inside the examining rooms at his office on Penn Street. It could have been his Canadian upbringing that kept him so unemotional, level-headed, friendly and patient, says Bruce Goldfarb, a Baltimore writer who 15 years ago watched Smialek handle a mob of reporters who crammed into a small room to hear the state medical examiner's report on the death of University of Maryland basketball star Len Bias.

"I remember the room was packed and very hot with all the camera lights," says Goldfarb, at the time public information officer for the University of Maryland School of Medicine. "The room was so full that there was no path for Smialek to get to his spot, and it took him a while to work his way through the crowd and get in front of the cameras."

Smialek's presentation took only a few minutes, but reporters came after him for another 45. They repeated questions, but Smialek didn't seem to mind. Repeated answers to repeated questions might make things clear. "He never scowled," Goldfarb said. "He answered all their questions, and he amazed me with his limitless patience and his friendliness. He explained everything very well and very clearly."

And convincingly.

Smialek, then in his first year as medical examiner here, concluded that the cause of Bias's death was "cocaine intoxication." He said Bias was "a very healthy person" with a slightly enlarged heart from his physical conditioning. There was no sign in his exquisite body of any previous drug use, Smialek said, no change in the mucous membranes that would be associated with snorting cocaine. The coke Bias ingested was unusually pure, Smialek told us. Once in the basketball player's bloodstream, the high concentration of cocaine "interrupted the normal electrical activity of his brain," Smialek said, and the disturbed electrical current traveled through his brain stem to his heart within seconds, throwing off his heartbeat, cutting off the supply of oxygen to his brain, sending the brain into seizure, causing unconsciousness and the end of breathing and the beating of his heart.

It was left to John Smialek to provide the gruesome but scientific details of death, and he did it thousands of times over the years he served as Maryland's chief medical examiner.

Smialek, who died Wednesday of a heart attack, was a modest man of considerable accomplishment, well-published in his field, the forensic investigator whom countless police detectives, prosecutors, attorneys, judges, and families relied upon for the best possible information about the worst possible events.

One winter day, I was sitting in Smialek's office and he was doing the same thing just for me - calmly and patiently answering questions, explaining things clearly and precisely. It was January 1993, and Baltimore was then in the midst of its epoch of violent crime. The Barry Levinson-produced television series, "Homicide," was about to have its premiere.

Until then I had only known Smialek as the "offiicial source" who provided the press with information in that fully detached, painfully sober way expected of him.

But something happened that day in his office. From different perspectives - mine from the street as a reporter, his from the autopsy room as a forensic pathologist - we both seemed to have reached a point of exhaustion when it came to contemplating the loss of lives in Baltimore over the years. It was a terrible, spiritually debilitating phenomenon, and there were no signs it would get better.

Too many bleak lives. Too many drugs, like the cocaine that killed Bias and the heroin that fueled the commerce that wrought much of the killing. Too many guns.

On this day, John Smialek wanted to say something about that.

He read from a report on a shooting. The victim was 20 years old, black, of Baltimore. He was shot in the front seat of a Nissan Maxima. Smialek handed me some photographs that showed a tall, lean, muscular man-child, in hooded sweatshirt and jeans, laid out on a coroner's shroud. "They are, almost all of them, physically perfect specimens of good health," Smialek said. "Except for the little hole in their body."

In that case, there were eight holes.

Smialek ran the numbers: In 1992, Maryland saw 621 homicides, of which 454 involved guns. Among the victims, 194 were between the ages of 18 and 26, another 76 were younger than 18. "In this job," Smialek said, "you can't help but become overwhelmed by the waste of life, especially young lives, that is occurring in our society."

Then he added some numbers I hadn't expected - suicides involving guns.

In 1992, there were 723 deaths from gunshot wounds (more than total traffic deaths statewide), Smialek said. That included the 454 homicides, plus 258 suicides, 80 percent of which were white men between the ages of 20 and 35. "We have," Smialek added, "in our society today, young black men killing each other, and young white men killing themselves."

What do we do?

"Look at the numbers, this waste of life, the homicide rate among young black men, the suicide rate among young whites," Smialek said. "What would be the difference if you subtracted the gun from the equation? The number of guns heightens the threat to all of us."

He saw it as a public health matter: People with guns kill more frequently and more efficiently than people without guns. It happens among drug dealers, husbands and wives, troubled teen-agers.

"This," he said that day, "is the price we pay for establishing a culture of guns in America."

Preventive medicine was not John Smialek's chosen field. But that winter day, with the photograph of another murdered man-child under his fingertips, he offered a dose. I wrote of this then, I write of it again. I think he would have appreciated the repetition.

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