As chief medical examiner for the Commonwealth of Virginia, Fierro's job is to deliver medical findings to family members, the campus community and the world _ all waiting anxiously.

Fierro is charged with directing a staff in four regional offices on how to proceed with autopsies amid tragedy. Currently, she has more than 30 families desperately seeking details of how the last minutes of their loved ones' lives played out.

"We still see them as patients. We're their last doctor, the last one to care for them," said Dr. Kim A. Collins, a forensic pathologist at the Medical University of South Carolina in Charleston. She has worked closely with Fierro in national pathology organizations over the years. "Dr. Fierro has always conveyed that when I've worked with her."

In the relatively small, close-knit community of medical examiners, fellow doctors say Fierro rises to the top.

"There is no one better prepared than she is. She is absolutely spectacular," said Dr. David Wilkinson, chair of the department of pathology at the Virginia Commonwealth University School of Medicine in Richmond. He has worked with Fierro for 15 years.

"Under pressure, she is solid as a rock."

Fierro is also known as the inspiration for author Patricia Cornwell's fictional protagonist, Virginia Medical Examiner Kay Scarpetta, the main character in a series of 14 mystery novels.

In a press conference Tuesday morning at the university, Fierro stressed that the process of identifying and examining the deceased will not be rushed.

"This is a process that cannot take place in haste," she said. "This will take several days. ... We will work as quickly and as carefully and as efficiently as we can, so that families can be assured we have taken care of their child."

Fierro said her team will first work to confirm the presumptive identities of those who have been killed and to find the identities of any unknown persons. As needed, they will work with the families to collect information to confirm identities, she said. They will also work with police to recover physical evidence to reconstruct the crime.

Her office did not respond to a request for an interview for this story.

Fierro has worked with colleagues in Virginia to develop "Guidelines for Reporting and Managing Mass Fatality Events with the Virginia Medical Examiner System." To develop the guidelines, Fierro studied how the autopsies were conducted following the Oklahoma City bombing and the 9/11 attacks, Wilkinson said.

"They will be going through a well-planned, well-rehearsed game plan to handle this," Wilkinson said. "They won't be making it up as they go along."

Collins said that when the cause of death is clear, other details become important. Gunshot wounds to different parts of the body cause different times of death. She said Fierro will work to determine the interval between injury and death, something that is often important to family members.

Fierro has worked in forensic pathology for more than 40 years, according to her biography on the Web site of the State University of New York at Buffalo, where she earned her medical degree. She coordinates between 700 and 800 autopsies per year in the Richmond area alone, Wilkinson said. Fierro has a great deal of experience with trauma, including work on the 2002 sniper deaths in Virginia, he added.

Colleagues said Fierro's experience, expertise and care will help her now. Collins spoke of Fierro's ability to focus on the job at hand while working compassionately with the families. Fierro echoed that Tuesday.

"Our staff grieves with Virginia Tech families, friends and those who survived, those who died in the event," Fierro said. "We're as heartbroken as they are."

http://www.scrippsnews.com/node/21500