The Toe Tag: The Last Responder 

In this installment of The Toe Tag, we meet the woman behind the lab coat.

click to enlarge Sarah Atwood-Cotton - BERLIN GREEN
  • Berlin Green
  • Sarah Atwood-Cotton

Now that I’ve told you a couple of Oklahoma stories about death, it’s only fair to share my own.

What I do is not for everyone. It’s not even for a select few. I graduated from the University of Central Oklahoma with my double bachelor’s degree in forensic science and criminal justice in 2011. Through the Forensic Science Institute, I was able to participate in the internship program for the Office of the Chief Medical Examiner. It was right then and there that I decided I didn’t want to be in law enforcement like my parents. During my time at UCO, there weren’t any classes that taught forensic pathology or medico-legal death investigations — this was a job that was so tainted by the raw nature of what investigators would see daily that it wasn’t socially acceptable to discuss openly. But I couldn’t help but be intrigued by the investigative side of things, and how I could potentially help deceased victims and bring some closure to their deaths.

At the age of 22, I started what I thought would be a lifelong career as a medicolegal death investigator for the state of Oklahoma. I found out right away that this job was not for the lighthearted or the emotionally weak. Death investigators respond to scenes and cases that fall under investigative standards by state statute, meaning they are violent, unusual, and unnatural in nature. These are your homicides, suicides, and accidental deaths.

I saw people on the worst (and final) day of their lives. For me, it was just another day. At every scene I responded to, I felt like the most dreaded person in the room. I was the bearer of bad news — the undertaker. I couldn’t help but feel a sense of sadness knowing that there was nothing I could say or do to bring their loved ones back. I could offer no help or relief other than to take their loved ones away with the promise I would do my job to the best of my abilities to get the family the answers they sought, needed or demanded.

Having to deny a family the right to see their loved one that was the victim of a homicide for evidence preservation purposes, not letting a mother hold her child that was beaten to death by her boyfriend or telling a grieving father that his son was not viewable because he put a shotgun in his mouth was the most difficult part of the job. But it was the job.

I don’t remember the very first scene I worked, but I remember some of the most horrendous cases I would work throughout my six years with the medical examiner’s office. The glorified field of forensics tends to leave out the part where you’re crawling through a hoarder’s house to recover a body, the houses with no electricity or running water, bodies that have been decomposing for weeks or months, or removing bodies from burning buildings. And the smells ... I didn’t wear nice suits or heels to scenes. I had to throw away most of my clothes after some workdays.

I thought this was going to be my lifelong career. It’s why I went to school, after all. But as I got older, the cases got harder to handle, the long hours, low pay, and sleep deprivation started to follow me home. A motor vehicle fatality, overdose, a suspicious, and a dead baby or three are what a normal shift was like as a death investigator; sometimes more, sometimes less. Most shifts as an investigator, I worked alone. I covered the three busiest counties in the Oklahoma City metro, responding and answering calls from hospitals, law enforcement agencies, hospice, and funeral homes. Sometimes with little to no sleep, as an investigator, I would typically respond to between three to 15 scenes and answer anywhere from two to 40 phone calls or reports in 14 hours. The remaining 10 hours were spent in the autopsy lab. Most people enjoy Christmas or holidays with their families, but I would be working a suicide or collecting evidence from a homicide victim. As a death investigator, it almost felt taboo to talk or discuss cases with people outside of the job because they just wouldn’t understand. It’s not something to talk about at dinner or over a cup of coffee.

My career was six years, which may not seem like much, but the average death investigator only lasts about two due to the burnout and low pay. I worked and participated in close to or maybe over a thousand death scenes and autopsies during my tenure. I have seen young people, healthy people, unhealthy people, old people and innocent people taken way before their time. Even now, some of the cases I have worked are too macabre to share with you, but they remain in my mind for the unforeseeable future and an integral part of who I am today. I learned so much and value everything I learned. I still have the best relationships with people I met while in the field. I enjoy educating in the field of forensics and sharing my experiences and knowledge.

But, as I said in the beginning, this job is not for the faint of heart or the weak of mind. This job can — and often does — take more than it gives. While death investigators may seem “cold-hearted,” we have feelings and emotions that we suppress so that we can speak for those who are no longer able. We live to serve the dead.


Sarah Atwood-Cotton left the Medical Examiner’s Office in 2018 to further pursue her education and started her Instagram (@the_toe_tag) in 2020 to spread awareness and information about death scene investigations. She is a part-time teacher’s assistant at the University of Central Oklahoma, which has since expanded its forensic pathology and medico-legal death investigations curricula.

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