Tuesday, February 28, 2006

Interest in Death in the Sunday Comics

Is there an interest in what we do through the Coroner’s Office? You bet.

Do the Sunday Comics at times tap into normal social behavior as the basis of their humor? You bet. See Frazz from February 26, 2006 and their discussion of the interest in the cause of death generated by seeing someone's name in the obits.

I do get questions about the deaths of individuals, from the media, from other individuals, from County Board members, from many sources. People die from a variety of causes and there is a different story with each of the deaths. Most of the time an individual’s death is a private matter, while at times it is public and those cases that go to inquest are a matter of public record. It is important to be gentle with the information to avoid causing others’ pain, but there are times that it is in the public interest for some or all of the information “to come out”. I strive to be cautious, to reason and consider the disclosure. I will do my best. Information on this blog will, near always, be more general in nature.

Monday, February 27, 2006

Choice of cremation increasing

In addition to its other responsibilities the Coroner’s Office issues all cremation permits for those done within the County. It seemed recently that we were seeing an increased number of requests for those permits, so we looked back at what the trend has been. Indeed, (comparable to Cremation Association of North America’s national and Illinois data) Lake County has seen increasing numbers of individuals being cremated after their death.

Cremation “reduces” the body of the deceased individual through the use of heat. The cremains are then placed in a permanent urn or temporary container, the latter for those individuals who choose to have their cremains scattered. Most cremated individuals are buried or are placed in a columbarium, a building with individual niches or family units for memorial storage of remains.

There are likely many reasons for the growth in the number of individuals being cremated. In many cases it can have a lower cost for the family, as well as meeting an individual’s environmental concerns and/or desire for simplicity in after-death arrangements. It is something I would choose for myself after my death (which of course, will not occur for many years).

There are some who object to cremation on a personal basis and some on the basis of their religious beliefs, e.g. Orthodox Jewish, Islamic, Eastern Orthodox, and some Fundamentalist Christian faiths. Nonetheless, it is a choice individuals and their families are making in increasing numbers (nationally over 25%) and it appears that will continue into the future.

Friday, February 24, 2006

Chronic Stress Kills

Stress itself causes medical problems and complicates existing medical problems. It has been known for a long time that stress, particularly chronic stress, results in constricted blood vessels, elevated blood pressure and increased heart rate, all of which put more demand on the heart and can tip the scales toward death.

Chronic stress can also lead to self-medicating with licit and illicit drugs in an attempt to get some relief. Those drugs can lead to death in and of themselves in self-medicators. As well, some of the drugs these individuals turn to can compound and worsen the physiologic picture painted above of constricted blood vessels, elevated blood pressure and heart rate, hastening death.

Chronic stress can also lead to depression. Depressed individuals tend to exercise less and take less care of themselves. These things, too, can contribute to a hastened death. Also, if the depression deepens enough it can contribute to death by suicide.

Chronic stress must be faced and dealt with. Early on it may be sufficient to “take a breather”, take a vacation, to make a change in your life to relieve/escape the stressor. As the chronic stress becomes more intense and problematic, you might need the help of a professional (e.g. a counselor or psych professional) to recognize and deal with your stressors (and possibly the dysfunctional ways you are dealing with the stress). The first step is recognizing and accepting that you have a problem and seeking the help. It could be a matter of life or death.

Thursday, February 23, 2006

Forestall Death Tip

In one of the books M. Scott Peck, MD wrote, he said something to the effect that he would know he was in heaven when he no longer had to do stretches every morning to get going. I agree and I think of that most mornings as I do my daily stretch and exercise routine. While at times it does seem like drudgery and some days it is tough to get motivated to do it, I do recommend it and it will warm you up on a cold winter day.

Yes, both as a doctor and a coroner I recommend it. Daily stretching and exercise is good for the psyche, good for the body, and may postpone your use of my office for a bit. Throw in some daily meditation and you have a great way to start the day. It may not fill your stomach, but I think those activities are the real breakfast of champions, Dr. Peck’s and my complaining aside.

Wednesday, February 22, 2006

Death by Lack of Insurance III

A young (that is, younger than me) individual died of treatable natural causes because the medical condition was not treated. Surgery likely could have corrected, or at least temporized, the problem. Medical treatment (medications) could have helped in forestalling the inevitable. The individual didn’t get treatment because of lack of medical insurance coverage. That should not happen.

I have had many discussions regarding the “right” to healthcare over the years (I founded and ran a free medical clinic, so you can imagine I support the position that it is a right). I recently ran across a quite good and succinct explanation of why it is just as much a right as others we hold dear.

The government provides a basic education as a matter of right because we in America believe that the rights of citizenship are meaningless if you can't read, and also that a country whose citizens are ignorant and ill-trained will be a poor and weak country. That the same arguments apply to health care is obvious: the rights of citizenship mean precious little to people who are suffering from untreated asthma or ulcers because they can't afford health insurance, or who are afraid to open their mouths because their teeth have rotted away after too many skipped dentists' visits.

As this issue continues to force its way to the fore, remember that people are dying because this “right” is unfulfilled.

Tuesday, February 21, 2006

CSI vs art of investigation

The CSI effect was defined by Linda Deutsch in an AP report as a “TV bred demand by jurors for high-tech indisputable forensic evidence before they will convict”. We have seen a bit of that in our inquest juries, but it is expressed primarily in the questions they ask and in their deliberation discussions.

On example occurred at an inquest pertaining to an individual who had shot himself. The question arose as to whether his fingerprint was on the trigger to prove that he had indeed pulled the trigger. While things like that come up often on TV, in real life it is difficult to pick up a fingerprint on gunmetal, and, besides even if a print could be found the very partial (sliver) print would likely be unidentifiable (not enough information for comparison).

Another example we often encounter centers around suicide notes. Jurors always expect a note to be present (just like on TV). But, in reality, they are present much less than 50% of the time. In regard to notes found we get questions about handwriting analysis/comparison (not really an exact science) and/or if it was searched for fingerprints as evidence of some sort of mischief (not often worth the effort because the yield is lower than “expected).

While we do use some high-tech tools when appropriate, most of the work in medicolegal death investigation relies heavily on looking and seeing, asking and listening, communicating, thinking and reasoning. A bit old fashioned perhaps, but effective and it represents the “art” of medicolegal death investigations.
My staff and I went to a Memorial Service today. The individual was much loved by her family. It was nice.

May God bless.

Monday, February 20, 2006

Natural Causes

Most deaths are from natural causes. But how “natural” are these deaths? Natural causes of death include cancer, heart disease, lung disease, liver disease and the like. They are natural processes rooted in the natural process of living, aging and dying.

We say dying from cancer is “natural”, but how natural is lung cancer resulting from smoking, despite tobacco being a plant product (and therefore natural). We say dying from heart disease is “natural”, but how natural is the metabolic syndrome caused by over-eating and being overweight, with our blood fats clogging our heart’s feeder arteries? It probably isn’t all that “natural” when we contribute to and hasten our natural cause of death.

We in the Coroner’s Office really are plenty busy without so many individual’s seemingly working hard to come through our office early (and I don’t mean for a tour), with a cigarette in one hand and a plate of fries in the other.

It is important to make good choices.

Eye on Chicago

Had fun on Eye on Chicago talking with Antonio Mora (CBS 2 Chicago) Sunday.

Friday, February 17, 2006

Odor Chemistry

One of the things that can make the Coroner’s “business” tough are the odors we encounter (I guess that is really more than “one of the things”). They are certainly part of what makes this work “not for everyone”.

Not infrequently we are called to a death that has not been discovered for some time, a week or more. These individual’s are still treated with the dignity they deserve, but these cases can be particularly tough on everyone involved. After several days the body begins to decompose and several odiferous amines are given off into the surrounding effluvium. Chemicals like pentamethylenediamine (cadaverine) and butanediamine (putrescine) are products of protein hydrolysis.

I bring up these facts for several reasons. One, to demonstrate that Chemistry can have practical applications and can come up in real life (teachers particularly love when I do that on tours and presentations; keep studying kids). Two, these can be interesting facts to bring up as you chat around the table at Starbucks, things you might not learn on CSI. Third, as a bit of a warning to those contemplating or taking a tour of the Coroner’s Office, these chemicals may be in the air despite our using air deodorizers and other state-of-the-art chemicals to control the occasional odor in the non-“office” parts of our office. And fourth, as a warning to those charging into the field of Forensics because of the attractiveness of the plethora of CSI-esque TV shows that this field is not for everyone and while it can be very rewarding in many ways, it at times lacks glamour.

As a side note and/or "plug": I taped a brief interview for Eye on Chicago" with Antonio Mora that will be shown Sunday, Feb. 19 at 10:30 am. It was fun to do.

Thursday, February 16, 2006

Illicit licit drug abuse

First a couple of “housekeeping” items:
Sorry for the appearance of what prior to “publishing” yesterday’s blog were 2 columns containing zips and the corresponding number of deaths by suicide.
Please note that all comments to this blog are moderated/reviewed prior to posting, so sometimes it takes a while for them to appear. Virtually all get posted, but some with references to specific names or Coroner’s cases will not be posted and there may be other reasons I feel they should not be posted. Others, like for today’s post, I use for idea source material.

Rx Abuse

Abuse of prescription and over-the-counter medications is on the rise. I got a question recently regarding the hazards of “snorting” Adderall at a “party”. While it remains at lower numbers than our cases of heroin and cocaine related deaths, deaths from prescription (and OTC) med use/abuse is a significant and anecdotally may be on the increase (we will continue to watch the trend). Also realize my office only becomes aware of fatal cases, so this may not reflect what is really happening on the “party’ scene. Nationally, there does indeed seem to be a trend.

We have seen more abuse of prescription pain meds, particularly Vicodin/Lortab (hydrocodone), with lesser amounts of OxyContin and others. As well, Adderall and Ritalin have been involved in a few cases, either swallowed or “snorted”. The latter drugs, being amphetamines, have the effect as “Meth” and/or Cocaine. Those effects would include euphoric high, elevated blood pressure, racing heart, heart attack, stroke and death. To many individuals prescription drugs seem “safe” because they are not illegal in the same sense as heroin, but it is illegal to divert, sell or give away someone else’s prescription drugs (let alone “fake” an Rx to get them). And, very importantly, prescription drugs are just as deadly when not taken as prescribed and under the advice and care of a licensed healthcare provider.

I should also add, in further response to the question that started this post: Snorting any drug brings on the effect greater and faster, the "amount" delivered to the system is greater, and ther risk of "over-dose" death is greater.

Use and abuse of prescription drugs can be deadly and they should not be a “party” snack.

Wednesday, February 15, 2006

Suicide Deaths in Lake County

As discussed at the first meeting of the Lake County Suicide Prevention Task Force this morning:

Death by Suicide in Lake County (Inquest result data for the last 5 years):

45-63 individuals per year; approximately 3 : 1 male to female, peak 41-50 yrs old, no seasonal trend although somewhat of a trend for more suicide deaths in spring and summer, the top 3 methods are firearms, hanging and drugs. Of some note was that in about 50% of the deaths there was a positive screen for drugs (including alcohol),with the direct cause of death in about 20% being drugs (including alcohol).

Death by Suicide occurs everywhere in the county: (by police jurisdiction zip codes)
60002 = 14 60010 = 8
60015 = 8 60020 = 6
60030 = 15 60031 = 19
60035 = 12 60044 = 3
60045 = 5 60046 = 14
60047 = 6 60048 = 11
60060 = 22 60061 = 8
60064 = 7 60073 = 23
60083 = 4 60084 = 2
60085 = 26 60087 = 9
60088 = 3 60089 = 8
60096 = 3 60099 = 17

It was a good start this morning and I look forward to the work progressing.

Tuesday, February 14, 2006

After-death Myth

I found an interesting website through Eric Zorn's blog this morning: Live Science: Most Popular Myths in Science

Of the 20 "myths" listed I was aware that many of them were myths before looking at the site, but that may not be true for everyone. I'd also caution you that not all the "myths" are myths, so do click and read them.

The one I wanted to highlight is Coroner-related and I have gotten questions regarding the subject and tried to set the record straight. Is it true that your hair and fingernails (and toenails) continue to grow after you are dead? The answer is no. That growth would require the continuation of circulation and metabolism that cease at death.

Sometimes these myths take on a life of there own.

Monday, February 13, 2006

Got Ink?

Identification is an important part of what the Coroner's Office does. We want to be certain that the decedent that we think is the decedent is the decedent we think they are. Many activities go in to identification and range from the "simple" visual identification to the "complex" DNA profile match.

Many times identifying marks on the body provide important information in assisting to know who is who (or is it who is whom?). Tattoos are certainly among the most obvious of body "marks". Unique tattoos have proven to be very useful in our work and I recall at least one case in which it was the most crucial bit of information we had available in identifying an individual.

While many individuals (particularly parents) would likely object if I were to recommend unique tattoos for everyone, to assist us in post-mortem identification, I wouldn't be adverse to such a recommendation. So, if you get a tattoo, make it a unique tattoo, and make sure others know about it if you want it to assist in post-mortem identification.

(By the way, I saw some pretty neat ones in a book--500 Tattoo Designs by Henry Ferguson-- we were looking at after supper tonight.)

Friday, February 10, 2006

Jane Doe Identified

A woman known only as Jane Doe was found murdered December 9, 1999 in the Greenbelt Forest Preserve. She had been brutalized prior to her death. The men involved in her death were caught, charged, and either convicted or pled guilty. Despite multiple attempts to identify her , both locally and nationally, she continued to be known only as Jane Doe. Jane Doe waited for her identity and the dignity that comes from being a person again, not just Jane Doe. Jane Doe was finally given a dignified burial July 29, 2005 (having remained in the freezer in the Corner's Office since her death, before I took office).

Early this week an Investigator from Racine County, Wisconsin checking for leads to identify a murder victim killed in their county in 1999 came across a reference to an individual missing from Carpentersville since 1999. This Investigator, Eileen Reilly, knew of our Jane Doe because of her investigating her murdered Jane Doe and called the Lake County Major Crimes Task Force with information that at least in general terms (age in early 30s, height less than 5 foot, etc) the missing woman from Carpentersville seemed similar to our Jane Doe. That information was than shared with our office (Lake County Coroner’s Office). The photo on the Charley Project website really bore limited similarity to our Jane Doe, so while we had some hope we remained uncertain.

When our personnel contacted the Carpentersville Police Department we were told they had a better picture and dental records of their missing woman. Our Chief Deputy, Steve Newton, conferred with Carpentersville Police on Wednesday and took possession of the photo and dental records. That photo looked much more like our Jane Doe would have looked in life. The dental records were an obvious match, assisted by our consulting Forensic Odontologists, Russell Schneider, DDS and Carl Hagstrom, DDS. Jane Doe was finally found to be Mary Kate Sunderlin-Chamizo, a woman previously living in Carpentersville, IL reported as a missing person in October 2000, but missing since September 1999. Mary Kate Sunderlin would have been 41 this year.

We have talked with her family and let them know that their sister has been found albeit deceased. They have expressed their grief at their loss, their relief that their waiting and wondering is over, and their appreciation that someone cared enough to arrange for a proper burial for Mary Kate.

Thursday, February 09, 2006

Media attention

I don't know if I will ever get used to the notoriety connected with this job. I really don't think I want to get "used" to it.

For example, last night I was watching the 10 o'clock news and all of a sudden they were talking about the Lake County Coroner and his move into cyberspace, and it dawned on me that they were talking about me. Granted it was a story about the Daily Herald writing about this blog, but its not the first time (and likely not the last time) I've watched the news or picked up the paper and heard or seen my name.

Along those lines, I did a video tour (actually one of two) that is running on the Lake County Community Access channel run by the County. The channel is always on on a big screen TV in the lobby of the County Building. My video tour seems to play quite often, I think the guys who shot are proud of the result. The TV is right next to a coffee kiosk where I stop and buy coffee before meetings I need to attend in the County Building. It really is disconcerting to be standing in line for coffee watching me, nearly life size on the screen, giving a tour of my "office".

I'm sure I won't ever be quite comfortable seeing me or my name in the media.

Of course then I have this press conference tomorrow...

Wednesday, February 08, 2006

Ubiquitous Suicide

I am convinced that there are more than one kind of knowing/knowledge, e.g. intellectual knowing, emotional knowing, visceral knowing. Intellectually I knew that many people have been touched and will be touched by suicide. I even put in a recent letter: “For every Suicide, an estimated 8 to 10 lives are severely impacted”. I know that my life has been impacted by suicide of a close relative, but until I started getting notes back from people I have invited to take part in a Suicide Prevention Work Group (another one today) I don’t think I really knew. Many, many individuals have been touched. People I have had contact with without ever knowing. It has been eye opening.

Also I knew that deaths from suicide occurred in all areas of our county, in every socioeconomic group, but when I started mapping them out I could see and really know.
There are 40 to 60 deaths by suicide throughout the county every year. While in the grand scheme of things maybe not huge numbers, but when you think about it and know it, it is staggering. All socioeconomic groups, all areas, all ages, more deaths than by homicide and acts of violence, but those prompt out-cry and calls to action. Should suicide be any different?

Tuesday, February 07, 2006

Heroin or is it?

I do a number of presentations to teenagers. No matter the beginning subject matter, I almost always get in a bit of “preachiness”. I throw in something about forestalling death. I don’t want to have to be the one to go and tell their parents that their child has died.

Because I am quite convinced that you can’t scare someone, particularly a teenager, into doing something or not doing something (I can’t with my own kids). My “preachiness” entails: “Stop and Think, Make Right Choices, Don’t Take Chances”. That covers a lot of ground, a lot of causes of death. It also brings me to something that I’ve been getting a lot of Media calls about over the last couple of days.

There was a cluster of seemingly heroin-related deaths in Chicago recently. It appears that the heroin in one “sale area” was cut (mixed) with a potent narcotic pain reliever. It is a very effective medicine for controlling severe pain, e.g. that experienced by someone with bone cancer. It is a 100 or more times potent than heroin, depending on the specific chemical analogue. As a matter of fact one of its analogues is used to “bring down” and anesthetize large animals (think elephant). So cutting heroin with fentanyl produces a highly lethal substance, as can be seen in the recent cluster of deaths. The heroin we typically see here in Lake County is cut with Diphenhydramine (an antihistamine that is also used as a sleep aid). That is not to say the local stuff is safe.

The “take home” message here, (one that I bring up in my presentations, in addition to the inherent killer potential of so many drugs) is that you never know what is mixed with the street drugs you buy or are given. There are no FDA or USDA standards for these drugs; you aren’t buying them from some chain drug store. You don’t know what’s in that sh*t.

Stop and Think, Make Good Choices, Don’t Take Chances.
The death you avoid may be your own.

Monday, February 06, 2006

Poor self-estem can cause death

So many behaviors whose end result is death and an investigation by the Coroner’s Office are rooted in poor self-esteem. Drug use and abuse is often self-medicating self-esteem. Violence, specific or indiscriminant, is often traced to poor self-worth or bullying on someone exhibiting poor self-worth. Other self destructive behaviors grow out of poor self-esteem and do cut lives short.

Because poor self-esteem is so ubiquitous, so multi-faceted, so legion in how it presents itself in a given individual, it is a difficult problem to counter, but it is necessary to act against it to improve the health of the community and stop so many preventable deaths (particularly in young people).

This is something I have been thinking about recently for a variety of reasons, including the suicide prevention we are working on, but it also popped up in a recent Eric Zorn (columnist, Chicago Tribune) blog post. He highlighted a new ad campaign and social campaign (including website) from the maker of Dove products. Yes, they are trying to sell product but their website discussing how serious a problem low self-esteem is among girls is definitely worth recommending to everyone, young and old, with or without obvious difficulty with self-esteem.

Another preventable cause of death that we can impact, no matter how difficult.

Friday, February 03, 2006

Busy day

As I have said before there is never a shortage of business to be cared for in the Coroner's Office. People do die from a variety of causes and with a different story behind each one.

Today we had 2 unrelated deaths due to drug overdoses (heroin and cocaine). In addition to the usual tasks involved in each of the cases, one of those deaths also involved a discussion with one of the lead attorneys in the State's Attorneys Office about an autopsy to support a case for charges of Drug-induced Homicide.

An individual died about a month after a fall began a cascade of events leading to his death. A fall fractured his hip led to impaired mobility setting up the development of clots in the veins of his leg that traveled to his lungs and the immobility also contributed to his developing a pneumonia. The latter 2 problems then led to his death.

A house fire took the life of a 79 year old woman, despite her husband's valiant efforts to save her (he required medical treatment in a local ER because of his injury and smoke inhalation). That fire is still under investigation as I type this.

I'm told that there may also be an auto accident in the County with the possibility of a fatal injury.

I was also still talking with the media today, in their attempts to get more information than I a willing/able to give out regarding the death of a 20 month old who died of multiple injuries a couple of days ago.

A typical day at the Lake County Coroner's Office?

Wednesday, February 01, 2006

Death by Lack of Insurance II

In response to a question about the last posting "Death by Lack of Insurance", I should mention another contribution of the lack of insurance.

One large gap in accessing needed care encountered by the uninsured and underinsured is the inability to get mental health care. (I should note that under-insurance, i.e. non-coverage of certain categories of health care or health needs, is considerable for mental health services. Even many individuals that have great medical coverage have little or no coverage for mental health services.)

For many individuals, not unlike problems with lack of access to medical care, lack of access to mental health care can result in death. This effect can be direct from increased risk of suicide death, lack of intervention in self-medication with illicit (or legal) drugs, or lack of treatment for high risk behaviors. The effect can also be indirect from behavior problems not addressed by mental health professional contributing to job loss, ill health and increases in risk taking.

Just as lack of medical care contributes to increased risk of death, so too does lack of access to mental health care.