Thursday, January 26, 2006

Cause of Death

How do you arrive at the cause of death?

As I mentioned in a previous posts, by statute in Illinois the final decision of cause of death is up to the inquest jury. The testimony given in the inquest pretty well lays out the cause of death. Most of the decision making during jury deliberation pertains to the manner of death (accident, homicide, suicide, or undetermined). Natural deaths are decided without jury input.

Unless there is a very obvious cause of death, such as the individual’s head is no longer attached to their shoulders, arriving at a cause is like solving a mystery (indeed it is a mystery until it is solved). Each case is a bit different, but involves piecing together clues from a variety of sources with some cases needing more pieces to discern the cause.

We investigate the scene of the death on our own and in conjunction with other agencies, like police and fire. We interview family, friends and other “witnesses”, getting information regarding events surrounding the individual’s death, their history and other pertinent information. We talk to the individual’s health care provider, review their medical records and piece together their medical history.

We examine the decedent, looking for evidence of pre-existing medical/health problems and for evidence pertinent to their death. “Reading” an individual’s body for clues may include an autopsy, if it will provided needed information; opening them up and looking inside for clues to the cause of death. The autopsy is done by a specially trained and experienced Forensic Pathologist.

We do toxicology testing on a large number of individuals who have died, looking for the contribution of illicit drugs, medications and other toxins. We test blood and vitreous (eye) fluid, the body fluids most reflective of the state of the individual at and near the time of their death. Testing urine tells about the individual’s internal state a bit more remote from their death (hours to few days). Testing bile tells about what the decedent had consumed within a couple of weeks. Hair testing speaks to use/exposure within a 3 month time frame. (All approximate times)

Other tests are done as indicated based on other findings. We may do tests looking for indicators of disease processes, e.g. Diabetes Mellitus. We sometimes look at organs and tissues microscopically for clues and information. We may do other tests as well, for example testing the electrical conduction system in the heart looking for problems there.

At times we also do other things, testing and examinations, specific to an individual’s death, e.g. product safety testing.

After all the data is collected it is then the Coroner’s responsibility (along with my great staff) to arrive at a “cause” that can be presented to the jury for their consideration, deliberation. This is the time for synthesis, for building a case, for putting together the clues to solve the mystery of an individual’s death. This provides the challenge in a Coroner’s job/life (for it is the Coroner’s ultimate responsibility), it provides the “fun” in the job.


Anonymous said...

Is it possible to die from a broken heart?

Dr. Richard Keller said...

I do have an autopsy picture of an individual's heart damaged in an auto accident. Other than the fact that a heart isn't really heart-shaped, the injury looks quite a bit like a drawing made of a broken heart.
On the other hand, a "broken heart" can contribute to someone dying from suicide. There also can be a contribution to a more "natural" cause of death. I have seen instances where the remaining spouse (or some other family member) dies of apparent natural causes within hours or days of the death of a loved one. Other deaths do occur because greif can "run down" the immune system of the "survivor" leading to infection or even cancer related deaths.

So, yes you can die of a broken heart, but fortunately it is a rare occurrence.

Anonymous said...

Are all autopsies performed in the same manner whether there is an investigation or not (jury)?

Dr. Richard Keller said...

Autopsy procedure is pretty standard in that the same things are done in all autopsies. In some special cases there may be some ‘extra” work done, for example with suspected child abuse there may be more exposure of the musculature looking for deep bruises not readily apparent on the skin surface or examination of the sinuses in a possible drowning.