Posts
At the pre-prom crash re-enactment this morning, one the last speakers asked for a show of hands of all the teens that were certain that they were going to have a safe weekend. This was his attempt to get them to “pledge” that they would be careful and not take chances with their safety this weekend (specifically not drive drunk or with someone who was drunk). Most, if not all, of the students raised a hand. I didn’t, I wouldn’t. With my experience, having seen what I have seen, I am never certain that I will have a safe weekend (or weekday for that matter) Fear mongering? Cynical? I’d just say realistic (not that I let it make me crazy).
Later in the day, actually just a couple of hours later, my opinion was reinforced. A car vs. semi truck collision with the car totaled and the truck cab on fire. One individual dead at the scene and one airlifted to a Level 1 Trauma Center. Somebody blew through the stoplight with tragic results.
Can you ever be certain you will have a safe weekend? You can do your best (think, be careful, don’t take chances, and make good choices), but you can never be certain.
Have a safe weekend (and a safe rest of your life).
Friday, April 28, 2006
Thursday, April 27, 2006
“Going Steady with Alcohol & Other Drugs”
The family (actually, the 17 year-old’s mother) that told their story at the Underage Drinking Town Hall meeting the other night gave out a copy of a “framework” that was used as part of rehab/therapy that they had gone through (unfortunately not a good enough copy to get the reference) and discussed it briefly. It was apparent that the family found it quite useful, so I thought I’d share it as well.
The “framework” compares the development of addiction with courtship and marriage. The first stage in the “courtship” is attraction/experimentation. It is flirtatious, concentrating superficially, thrilling with the risk. The next stage is dating/regular use. This is characterized by increasing familiarity (use), increasing influence in one’s life, experiencing pleasurable aspects. The third phase is going steady/abuse with increasing “connection”, thoughts occupied with the “other” when not together (using), obvious effects, and “everyone knows” (although the parents are usually the last to know). The fourth phase is marriage/addiction. This stage puts “the other” as the main life priority with lifelong commitment. By this stage, it is quite difficult to “break up”. When you develop/see problems at this point you either divorce (die from addiction) or fix your life, with addiction that will entail treatment and a life-long commitment to recovery.
Interesting analogy.
The “framework” compares the development of addiction with courtship and marriage. The first stage in the “courtship” is attraction/experimentation. It is flirtatious, concentrating superficially, thrilling with the risk. The next stage is dating/regular use. This is characterized by increasing familiarity (use), increasing influence in one’s life, experiencing pleasurable aspects. The third phase is going steady/abuse with increasing “connection”, thoughts occupied with the “other” when not together (using), obvious effects, and “everyone knows” (although the parents are usually the last to know). The fourth phase is marriage/addiction. This stage puts “the other” as the main life priority with lifelong commitment. By this stage, it is quite difficult to “break up”. When you develop/see problems at this point you either divorce (die from addiction) or fix your life, with addiction that will entail treatment and a life-long commitment to recovery.
Interesting analogy.
Wednesday, April 26, 2006
Underage Drinking Prevention
I went to a Town Hall meeting regarding underage drinking last evening. It was run/sponsored by the Lake County After School Coalition. Beyond the great coffee and the profoundly uncomfortable seating in the high school cafeteria, it was a very good meeting. This meeting is taking place part-way through a process to get community input into the “root problems” and “solutions we can implement to prevent underage drinking”.
The meeting began with a 17 year old recovering alcoholic and drug abuser and his family telling their story. This certainly put a human face on the problem and I applaud the 53-days sober teen (and wish him continued sobriety). That sort of presentation does have an incredible “power”. After “voting” to allow for ranking a list of “problems” and solutions brought up at previous meetings, we broke into small groups to come up with a list of “next steps” (first steps?) for the Coalition, or a sub-group of the Coalition, to pursue to begin to tackle the problem of underage drinking (I believe all of this material will eventually be available on the Lake County After School Coalition website).
The attendees were a fair community cross-section. The small group I was in was interesting. In addition to a local school official, someone who works for an insurance company and someone who works for a social service agency dealing with substance abuse, we had 3 kids (elementary to middle school age). While our group came up with several “next steps” to pursue, it was interesting to listen to the draconian measures the kids suggested (e.g. $5000 a bottle of beer prices and jail terms for selling/giving liquor to a minor). We felt (particularly in light of our opening presentation) that there should be an emphasis on peer education to combat underage drinking and drug use. Kids/teens are more likely to listen to a peer who has “really been there”. Also, we felt a lot of information needs to be put out into the community, e.g. that it really is a minority of kids that are drinking and using (not “everyone is doing it”) and how early exposure to drugs and alcohol (pre- and periadolescence) changes brain chemistry and structure making addiction more likely and harder to escape. Education, information, continued/repeated education can combat this serious problem (and many others).
I look forward to the Coalition’s future efforts and the results of the community input.
The meeting began with a 17 year old recovering alcoholic and drug abuser and his family telling their story. This certainly put a human face on the problem and I applaud the 53-days sober teen (and wish him continued sobriety). That sort of presentation does have an incredible “power”. After “voting” to allow for ranking a list of “problems” and solutions brought up at previous meetings, we broke into small groups to come up with a list of “next steps” (first steps?) for the Coalition, or a sub-group of the Coalition, to pursue to begin to tackle the problem of underage drinking (I believe all of this material will eventually be available on the Lake County After School Coalition website).
The attendees were a fair community cross-section. The small group I was in was interesting. In addition to a local school official, someone who works for an insurance company and someone who works for a social service agency dealing with substance abuse, we had 3 kids (elementary to middle school age). While our group came up with several “next steps” to pursue, it was interesting to listen to the draconian measures the kids suggested (e.g. $5000 a bottle of beer prices and jail terms for selling/giving liquor to a minor). We felt (particularly in light of our opening presentation) that there should be an emphasis on peer education to combat underage drinking and drug use. Kids/teens are more likely to listen to a peer who has “really been there”. Also, we felt a lot of information needs to be put out into the community, e.g. that it really is a minority of kids that are drinking and using (not “everyone is doing it”) and how early exposure to drugs and alcohol (pre- and periadolescence) changes brain chemistry and structure making addiction more likely and harder to escape. Education, information, continued/repeated education can combat this serious problem (and many others).
I look forward to the Coalition’s future efforts and the results of the community input.
Tuesday, April 25, 2006
Prom Time
Prom season is here and with it local schools will be doing their pre-prom “shows”. These usually consist of a car crash re-enactment in the football field. There are students dressed as prom goers and moulaged to look injured or dead. The plot consists of a drunk driver student prom attendee crashing and killing someone while injuring others. I play the role of Coroner (not much of a stretch) and give a talk about my office’s involvement, reemphasizing that someone died because of this drunk driver. This is to convince the prom goers not to drink and drive (or ride with someone who is impaired) prom night and by extension all the rest of their lives.
These tend to be quite impressive extravaganzas with a lot of work involved by many people pulling it together and making it happen. I hope they work. I hope they make an impression, really I guess my hope is that they make an impression on the teens that would drink and drive and not only on those not likely to have done it anyway. One life saved would make all of them worth doing. However, we need to remember most teen deaths related to drinking and driving don’t happen prom night. The message to not drink and drive (and not to ride with someone who is drunk and driving) has to be out there repeatedly. It can’t be an attempt to scare the teens, which rarely works. The message must be educational, as well as hinged on the consequences. It seems most prudent to me to not just focus on the drinking, although that should be paramount, but also offering options to driving drunk and riding with a drunk driver. Not unlike many schools offering/forcing bus transportation to prom activities these days.
The pre=prom events are great, but they must be part of a greater program. We can’t just go home after the event and think that our “work” is done for another year.
These tend to be quite impressive extravaganzas with a lot of work involved by many people pulling it together and making it happen. I hope they work. I hope they make an impression, really I guess my hope is that they make an impression on the teens that would drink and drive and not only on those not likely to have done it anyway. One life saved would make all of them worth doing. However, we need to remember most teen deaths related to drinking and driving don’t happen prom night. The message to not drink and drive (and not to ride with someone who is drunk and driving) has to be out there repeatedly. It can’t be an attempt to scare the teens, which rarely works. The message must be educational, as well as hinged on the consequences. It seems most prudent to me to not just focus on the drinking, although that should be paramount, but also offering options to driving drunk and riding with a drunk driver. Not unlike many schools offering/forcing bus transportation to prom activities these days.
The pre=prom events are great, but they must be part of a greater program. We can’t just go home after the event and think that our “work” is done for another year.
Monday, April 24, 2006
Why death scene memorials?
I have seen many of these memorials, but it was actually the disappearance of one that prompted this post (it was “cleaned up by the city”).
I had thought that these memorials were uniquely American (cultural conceit?), but a quick Google Search cured that misconception. They occur the world over. There are references to Ireland, Australia, South America, and they are mentioned in the Middle Ages and in “Ancient Times”. However, they do seem to be occurring with increasing frequency and the events they memorialize are getting broader (car accident to “all” deaths).
Why do we have/make these memorials and why are they increasing in numbers? The death of a loved one is a very difficult experience, particularly a sudden, unexpected death. There is sudden grief and a feeling of loss of personal control, rudderlessness or anchorlessness, (again neologisms) in the world around us. There is a desire to make some sense of the death. There is a need for closure (or as closed as we can come). There is a desire not to forget or to seem that we have forgotten. Depending on the cause of death, there is a desire to warn others so that they won’t die similarly and so that others won’t have to live through the same experience you are living through. Are we less in control of our daily lives, do these sudden deaths hit us even harder than in previous times? Do we have a greater need to express our personal spirituality separate from and/or in addition to more traditional religious practices, post-death rituals? Are we just more social/public in our displays of grief? Am I way off base and they are just happening because they are happening?
At least think about it next time you see one of the memorials and you doff your hat or send up a little prayer for the individuals so memorialized.
I had thought that these memorials were uniquely American (cultural conceit?), but a quick Google Search cured that misconception. They occur the world over. There are references to Ireland, Australia, South America, and they are mentioned in the Middle Ages and in “Ancient Times”. However, they do seem to be occurring with increasing frequency and the events they memorialize are getting broader (car accident to “all” deaths).
Why do we have/make these memorials and why are they increasing in numbers? The death of a loved one is a very difficult experience, particularly a sudden, unexpected death. There is sudden grief and a feeling of loss of personal control, rudderlessness or anchorlessness, (again neologisms) in the world around us. There is a desire to make some sense of the death. There is a need for closure (or as closed as we can come). There is a desire not to forget or to seem that we have forgotten. Depending on the cause of death, there is a desire to warn others so that they won’t die similarly and so that others won’t have to live through the same experience you are living through. Are we less in control of our daily lives, do these sudden deaths hit us even harder than in previous times? Do we have a greater need to express our personal spirituality separate from and/or in addition to more traditional religious practices, post-death rituals? Are we just more social/public in our displays of grief? Am I way off base and they are just happening because they are happening?
At least think about it next time you see one of the memorials and you doff your hat or send up a little prayer for the individuals so memorialized.
Saturday, April 22, 2006
Choking “Game” is Suffocation Roulette
It’s a “high without drugs”. In this “game” kids, and some adults, try to get a close to death as possible by shutting off oxygen to the brain for that “high”. Kids, most old enough to be considered to be young adults in many cultures, are playing this “game”, flirting with death. It kills; it has killed here in Lake County as it has elsewhere. How big a problem is it? No one knows, but I know some teens who have tried it (thank goodness/luck without fatal results).
The “high” comes from robbing the brain of its needed oxygen and then giving it back (if all goes as planned). Brain cells can’t store oxygen and survive only minutes without a continuous supply. These cells shut down/off before they die. That is something to recall with self-induced “choking”, because the brain will shut off very quickly, all too often before whatever is being used for self-strangulation can be released or undone.
With relatively minimal pressure the venous blood outflow from the brain is stopped (a point rarely mentioned in discussions on the topic). This results in back pressure into the brain. That back pressure can easily get high enough to stop blood flow into the brain (and happen very quickly), starving it of oxygen. This back flow will break small blood vessels (capillaries) scattered throughout the brain. [This is also responsible for the broken blood vessels (blood-shot, reddened) white part of the eyes that can be an outward sign that someone has been playing the choking “game”] These broken blood vessels damage and kill brain cells by blood leakage and disruption of local circulation. This back pressure also causes leakage of fluid from the blood vessels and that edema can impair circulation and kill brain cells. [Point to remember: dead brains cells do not come back, do not regrow.] Death can and does result from stopping venous outflow from the brain.
A bit more pressure on the neck shuts off Carotid arterial blood flow into the brain, cutting off the flow of oxygenated blood into the brain. Quickly, within a very few short moments, the brain shuts down and dies without the continuous flow of blood and oxygen into the brain.
The “high” someone gets from this “game” is the brain screaming for oxygen, pleading, not wanting to die. The odds really are stacked against the “player”. Some brain cells will die every time you “play”. The roulette part is the very real risk of “winning” death.
Think, make good choices, don’t take chances.
The “high” comes from robbing the brain of its needed oxygen and then giving it back (if all goes as planned). Brain cells can’t store oxygen and survive only minutes without a continuous supply. These cells shut down/off before they die. That is something to recall with self-induced “choking”, because the brain will shut off very quickly, all too often before whatever is being used for self-strangulation can be released or undone.
With relatively minimal pressure the venous blood outflow from the brain is stopped (a point rarely mentioned in discussions on the topic). This results in back pressure into the brain. That back pressure can easily get high enough to stop blood flow into the brain (and happen very quickly), starving it of oxygen. This back flow will break small blood vessels (capillaries) scattered throughout the brain. [This is also responsible for the broken blood vessels (blood-shot, reddened) white part of the eyes that can be an outward sign that someone has been playing the choking “game”] These broken blood vessels damage and kill brain cells by blood leakage and disruption of local circulation. This back pressure also causes leakage of fluid from the blood vessels and that edema can impair circulation and kill brain cells. [Point to remember: dead brains cells do not come back, do not regrow.] Death can and does result from stopping venous outflow from the brain.
A bit more pressure on the neck shuts off Carotid arterial blood flow into the brain, cutting off the flow of oxygenated blood into the brain. Quickly, within a very few short moments, the brain shuts down and dies without the continuous flow of blood and oxygen into the brain.
The “high” someone gets from this “game” is the brain screaming for oxygen, pleading, not wanting to die. The odds really are stacked against the “player”. Some brain cells will die every time you “play”. The roulette part is the very real risk of “winning” death.
Think, make good choices, don’t take chances.
Wednesday, April 19, 2006
Script Call?
Another “strange’ call came in yesterday at the end of the day. An individual identifying themselves as a writer in LA (from a phone with an LA area code) wanted to ask a few questions.
Could the “toe tag” identifiers get switched accidentally on 2 bodies in the morgue? I suppose it would be possible when moving the bodies around the tags might come untied, fall off, and get retied to the wrong decedent. That is one of the reasons we have switched to hospital-like identification wristbands in my office (the only way they come off is if you cut them off).
Could 2 individuals coming in at the same time get misidentified as the other, essentially switching “identities”? It could (and it has, but not under my watch, those stories surface in the media from time to time), but we stay vigilant and cautious to prevent such an occurrence. For example, 2 young men came into the office after their deaths in an auto accident. They looked very similar, had similar body habitus, similar haircuts, similar clothing. We took the extra step of dental record comparison to ensure we identified them correctly.
Has the wrong person been buried or cremated after misidentification? Yes, again those stories do get into the media, but with our precautions in place in our office, the chances here are so remote as to be virtually impossible.
There were a few other questions regarding burying or cremating “John Doe”(s), lack of identifiability (probably not a word) due to lack of dental records or fingerprint matches, and the like. I don’t know what this guy was writing, but at least this one didn’t ask me how to kill someone.
Could the “toe tag” identifiers get switched accidentally on 2 bodies in the morgue? I suppose it would be possible when moving the bodies around the tags might come untied, fall off, and get retied to the wrong decedent. That is one of the reasons we have switched to hospital-like identification wristbands in my office (the only way they come off is if you cut them off).
Could 2 individuals coming in at the same time get misidentified as the other, essentially switching “identities”? It could (and it has, but not under my watch, those stories surface in the media from time to time), but we stay vigilant and cautious to prevent such an occurrence. For example, 2 young men came into the office after their deaths in an auto accident. They looked very similar, had similar body habitus, similar haircuts, similar clothing. We took the extra step of dental record comparison to ensure we identified them correctly.
Has the wrong person been buried or cremated after misidentification? Yes, again those stories do get into the media, but with our precautions in place in our office, the chances here are so remote as to be virtually impossible.
There were a few other questions regarding burying or cremating “John Doe”(s), lack of identifiability (probably not a word) due to lack of dental records or fingerprint matches, and the like. I don’t know what this guy was writing, but at least this one didn’t ask me how to kill someone.
Tuesday, April 18, 2006
Blogging a "legit" forum for communication?
Not that the Lake County Suicide Prevention Task Force is a bunch of old folks (i.e. folks my age), but there seemed to be general lack of knowledge of what a “blog” is when I brought it up this morning. I know you know what one is because you are reading this.
I really dislike meetings (especially if they don’t serve coffee) so I am trying to facilitate meeting, discussion, information exchange while limiting sit-down face-to-face meting. We are at a point in our process that I think would lend itself very well to “virtual meeting”. We need to expand task force representation (deciding who is “not on board” yet, and pull in more groups and organizations involved in or interested in suicide prevention), put together a compilation of current resources (organizations, existing programs, etc.) and then decide where gaps exist in education, programs and services. I think a blog (either this one or one specifically for the task force) would be a good forum to accomplish these tasks. However, despite my enthusiasm, I think the group is more comfortable using serial, round-robin e-mailing. It will work, but I think be more time consuming and labor intensive.
I really think that blogging has potential beyond diary/journal work and could be used for “conversations” with posting and comments, collaborations, and information sharing (beyond information dispensing). We’ll see how things shake out.
I really dislike meetings (especially if they don’t serve coffee) so I am trying to facilitate meeting, discussion, information exchange while limiting sit-down face-to-face meting. We are at a point in our process that I think would lend itself very well to “virtual meeting”. We need to expand task force representation (deciding who is “not on board” yet, and pull in more groups and organizations involved in or interested in suicide prevention), put together a compilation of current resources (organizations, existing programs, etc.) and then decide where gaps exist in education, programs and services. I think a blog (either this one or one specifically for the task force) would be a good forum to accomplish these tasks. However, despite my enthusiasm, I think the group is more comfortable using serial, round-robin e-mailing. It will work, but I think be more time consuming and labor intensive.
I really think that blogging has potential beyond diary/journal work and could be used for “conversations” with posting and comments, collaborations, and information sharing (beyond information dispensing). We’ll see how things shake out.
Monday, April 17, 2006
If my Mother knew I was giving Parenting advice
Anonymous has left a new comment on your post "Youth Group Spiel": Hi Dr Keller: Just wanted to know how being the coroner can effect your family--are YOU overly strict with your teenage daughter because of what you have seen other teens do--drugs, suicide, car wrecks? Or do you think that maybe the tables are turned and because of what you see she has made it a point NOT to be involved with risky behaviors? Teens believe they are infallible, yet, in spite of talks at home, programs at schools, it seems as though drug use, car accidents, suicides continue to happen!! So give me your best advice from a father and coroner’s perspective, for dealing with teens and keeping them safe. I really like your column and end up talking about them with my teen THANKS!!
I have talked with a grown daughter of a former coroner (not local) whose father used to bring her in to view the bodies of young people killed in auto accidents. While this may have served to keep that young person out of trouble, it certainly isn’t how I handle it (not that I am an expert, just a learner). I do talk about deaths that occur both generally and, at times, specifically (those in the “public record”) regarding the choices that weren’t the best, the chances that were taken, how things went wrong.
I believe (and it is born out in studies, although I couldn’t find the source to link to) that you can’t scare a kid “straight” (re: drugs or other activities). I believe that the best you can do is to inculcate good values over time to the best of your ability, be honest and open in discussions, particularly regarding consequences of behavior and actions, and “give them their head” (sorry for the race horse analogy), keeping a hand on the reins until their majority. I think the vast majority of the time this works, but there are those times when even the best laid plans of mice and men…”
Thursday, April 13, 2006
Good, not sensational, Office Tours
I have wondered about writing about this topic for some time, but it keeps coming up, questions keep being asked, requests being made, so I decided to plunge ahead.
Tours of the Lake County Coroner’s Office have been taking place for years (although the number has increased over the last year or so). Not only have my staff told me that the tours occurred, but I also get people touring now with groups asking questions based on their previous tour experiences. While our tours now go well, get rave reviews, and generate returns and referrals for other groups to tour, we sometimes “disappoint” expectations based on tours before I took office.
So what disappoints? Some of the “things” no longer included in the tours since I took office:
What our tours now lack in sensationalism, they make up for it with education, information and discussion of the history of and role of the Coroner’s Office and the work we do. We are also certain to include in our discussions, information regarding forestalling death and how to avoid “coming into” the office prematurely.
Tours of the Lake County Coroner’s Office have been taking place for years (although the number has increased over the last year or so). Not only have my staff told me that the tours occurred, but I also get people touring now with groups asking questions based on their previous tour experiences. While our tours now go well, get rave reviews, and generate returns and referrals for other groups to tour, we sometimes “disappoint” expectations based on tours before I took office.
So what disappoints? Some of the “things” no longer included in the tours since I took office:
The body of a young woman murdered in 1999 kept in the freezer until I arranged for her burial after I took office. (Jane Doe recently identified as Mary Kate Sunderlin)
An arm, never identified, kept in the freezer and shown during some tours in the past (the freezer is now empty of all remains and contains only some toxicology specimens)
A skull with a face and scalp “reconstructed” with clay to aid in identifying the young man murdered in 1983. The clay has been removed and the skull will be buried very soon with the young man’s remains that are already buried in cemetery just north of here.
A display of fetuses confiscated from a traveling side show about 30 years ago. (All of the fetuses have been given a proper cemetery burial)
What our tours now lack in sensationalism, they make up for it with education, information and discussion of the history of and role of the Coroner’s Office and the work we do. We are also certain to include in our discussions, information regarding forestalling death and how to avoid “coming into” the office prematurely.
Wednesday, April 12, 2006
Alcohol’s Ocular Effects
Ethanol, drinking alcohol, is a poison (and it makes you stupid, too).
It worst long-term toxic effects are to liver cells (actually you can measure chemical/enzyme leakage from damaged cells after just a drink or two) and brain/nerve cells.
Some of the earliest, and lower dose, effects of alcohol are on the eyes. First affected are the papillary muscles that allow you to constrict your pupils in response to bright lights (making them tolerable). With these muscles paralyzed sudden bright lights, like oncoming headlights, cause you to look away or cover your eyes. Doing that can cause you to crash your car, possibly killing yourself or someone else.
As more alcohol is consumed and absorbed into your body the next set of eye muscles affected are the muscles that allow you to see one image with 2 eyes. Your vision then becomes double. You see 2 lines on the side of the road. Which one is the real line? Guess wrong and you are off the road, crashing your car. There are too many lines in the center of the road. Which is the right set? Guess wrong and you crash into (and/or “clip”) on-coming traffic. These crash scenarios can result in death(s).
More alcohol in your system? Realization may kick in that you are drunk (and really stupid) so you decide to follow something home, trying to get there safely. Those taillights ahead, something to follow, but if it’s a parked car you’ve got yourself a crash (yes a parked car can kill). Maybe you can follow those bright lights ahead, bad choice that is on-coming traffic. These things happen; this sort of “reasoning” can/does occur in an alcohol befuddled mind.
Don’t drink and drive. Don’t ride with someone who has been drinking. Think, make good choices, and don’t take chances.
It worst long-term toxic effects are to liver cells (actually you can measure chemical/enzyme leakage from damaged cells after just a drink or two) and brain/nerve cells.
Some of the earliest, and lower dose, effects of alcohol are on the eyes. First affected are the papillary muscles that allow you to constrict your pupils in response to bright lights (making them tolerable). With these muscles paralyzed sudden bright lights, like oncoming headlights, cause you to look away or cover your eyes. Doing that can cause you to crash your car, possibly killing yourself or someone else.
As more alcohol is consumed and absorbed into your body the next set of eye muscles affected are the muscles that allow you to see one image with 2 eyes. Your vision then becomes double. You see 2 lines on the side of the road. Which one is the real line? Guess wrong and you are off the road, crashing your car. There are too many lines in the center of the road. Which is the right set? Guess wrong and you crash into (and/or “clip”) on-coming traffic. These crash scenarios can result in death(s).
More alcohol in your system? Realization may kick in that you are drunk (and really stupid) so you decide to follow something home, trying to get there safely. Those taillights ahead, something to follow, but if it’s a parked car you’ve got yourself a crash (yes a parked car can kill). Maybe you can follow those bright lights ahead, bad choice that is on-coming traffic. These things happen; this sort of “reasoning” can/does occur in an alcohol befuddled mind.
Don’t drink and drive. Don’t ride with someone who has been drinking. Think, make good choices, and don’t take chances.
Tuesday, April 11, 2006
Youth Group Spiel
I was putting together some thoughts for a talk to a youth group I am doing tonight and I decided I might post them here as well. In addition, to general stuff about the Coroner’s Biz, I always put in information about forestalling death appropriate to the group I am talking to. I did also get a special request to say something regarding teen driving for the group’s leader.
Teen Driving:
Teens (not unlike many adults) are easily distracted and when in control of a 1 ¾ ton machine of death, this is a problem
Teens think they are invincible and get a real buzz out of risk taking, this is a problem
Teens see what they, or someone else, can do in a video game and what others do on TV and in the movies and think it would be fun/exciting to try that “trick” in real life (e.g. jumping railroad tracks), not realizing that it is all fake on TV and in the movie
Alcohol (and drugs) makes you stupid and impairs reaction time and the ability to drive
Suicide:
A very serious (and large) problem among teens, it needs to be recognized, those at risk need to be referred for help, they may need a bit of a push to get help, they need to know it is OK to get help. We can’t ignore this problem any longer.
Alcohol and Drugs:
Another big problem: they can make you high, but they can make you die.
Alcohol and drugs make you stupid (and more stupid the more you consume).
Alcohol is a poison and it temporarily paralyzes the muscles in your eyes at fairly low dose/amount consumed, leading to crashes and other accidents.
Health habits:
Teens need to develop healthy life habits, because its easier to develop them as a teen then when you get older, and they will impact you the rest of your life
Bottom line, take home sound bite: Think, make good choices, don’t take chances
Teen Driving:
Teens (not unlike many adults) are easily distracted and when in control of a 1 ¾ ton machine of death, this is a problem
Teens think they are invincible and get a real buzz out of risk taking, this is a problem
Teens see what they, or someone else, can do in a video game and what others do on TV and in the movies and think it would be fun/exciting to try that “trick” in real life (e.g. jumping railroad tracks), not realizing that it is all fake on TV and in the movie
Alcohol (and drugs) makes you stupid and impairs reaction time and the ability to drive
Suicide:
A very serious (and large) problem among teens, it needs to be recognized, those at risk need to be referred for help, they may need a bit of a push to get help, they need to know it is OK to get help. We can’t ignore this problem any longer.
Alcohol and Drugs:
Another big problem: they can make you high, but they can make you die.
Alcohol and drugs make you stupid (and more stupid the more you consume).
Alcohol is a poison and it temporarily paralyzes the muscles in your eyes at fairly low dose/amount consumed, leading to crashes and other accidents.
Health habits:
Teens need to develop healthy life habits, because its easier to develop them as a teen then when you get older, and they will impact you the rest of your life
Bottom line, take home sound bite: Think, make good choices, don’t take chances
Monday, April 10, 2006
DNA Cross-contamination
This might be of interest, but then again maybe not. An issue came up recently at the office, actually it came up a while back but we have been working on the solution for us to use so it seems more recent. This issue was brought up during some of the ongoing training my deputies go through and it really makes sense when you do think about it. That issue is the possibility of DNA contamination in evidence we collect.
For years our office has been using a “drying closet” (passive air) to dry wet “evidence”, e.g. bloodied clothing from a homicide victim. Although it wouldn’t happen often there were times when there might be items “belonging to” more than one individual in the closet at a time (including the DNA sample card we obtain and keep on our “clients”). That no longer happens. We have also improved our procedure for cleaning and sanitizing the closet after each use.
As a part of the criminal investigation of some of the cases that “go through” our office, DNA testing is done on items that we collect at the scene of death based on our responsibility for collecting all evidence on and touching the decedent’s body. The DNA testing will be looking for the perpetrator’s (or someone other than the decedent’s) DNA on the person, clothing, bed linen, etc of the decedent. The DNA evidence can be easily contaminated and one of the places that can occur is while wet items are drying. If you have someone else’s DNA (blood) drying in the same closet/cabinet, it is not a stretch to imagine some that dried blood (with its DNA) floating onto the other item that is drying and “contaminating” it. Because of the way DNA is tested for with microscopic amplification techniques, it doesn’t take much of a contaminant to raise questions and potentially change the outcome of a case.
While this issue may become the plot of a CSI episode, it is a truly important part of real-life forensic science, as well as one of the “ah ha” moments in the Coroner’s “Biz”.
For years our office has been using a “drying closet” (passive air) to dry wet “evidence”, e.g. bloodied clothing from a homicide victim. Although it wouldn’t happen often there were times when there might be items “belonging to” more than one individual in the closet at a time (including the DNA sample card we obtain and keep on our “clients”). That no longer happens. We have also improved our procedure for cleaning and sanitizing the closet after each use.
As a part of the criminal investigation of some of the cases that “go through” our office, DNA testing is done on items that we collect at the scene of death based on our responsibility for collecting all evidence on and touching the decedent’s body. The DNA testing will be looking for the perpetrator’s (or someone other than the decedent’s) DNA on the person, clothing, bed linen, etc of the decedent. The DNA evidence can be easily contaminated and one of the places that can occur is while wet items are drying. If you have someone else’s DNA (blood) drying in the same closet/cabinet, it is not a stretch to imagine some that dried blood (with its DNA) floating onto the other item that is drying and “contaminating” it. Because of the way DNA is tested for with microscopic amplification techniques, it doesn’t take much of a contaminant to raise questions and potentially change the outcome of a case.
While this issue may become the plot of a CSI episode, it is a truly important part of real-life forensic science, as well as one of the “ah ha” moments in the Coroner’s “Biz”.
Friday, April 07, 2006
Inquest Bottleneck
I was reminded about one of the “services” we do for the living (survivors of the decedent “clients” of our office) yesterday during inquests. We generate the final death certificate for all individuals dying of “unnatural” causes (as well as many dying of “natural” causes, their doctors “generate” the bulk of the death certificates for “naturals”).
A death certificate doesn’t look like much, but it is a powerful piece of paper. Without it the estate cannot be settled, you can’t apply for Social Security survivor benefits, most often life insurance cannot be paid out, bill payment plans cannot be set up, people often cannot get on with their lives. It can be an incredible hardship and stressor for surviving spouses and families (not that they aren’t already under enough stress). Bills pile up with 2nd and 3rd notices, often with no recourse until the final death certificate is issued and certified by the proper clerk/registrar.
In the Coroner System, the inquest is often the bottleneck in the process of getting the permanent death certificate done. “Unnatural” deaths must go to inquest and have the cause and manner of death decided upon by a jury of 6 individuals. For a number of reasons it can take an unfortunate amount of time to get to inquest, e.g. getting through a backlog of pending inquests, getting completed investigations and documentation from outside agencies, getting medical records.
Over the last year, we have eliminated most of the backlog of “pending” cases, but it is still taking us 6-9 weeks to get to inquest. That timeframe is really untenable for many of these families waiting for death certificates. But even with that period time to inquest we still get complaints from law enforcement agencies that their investigations are still ongoing and their reports are not completed. Nonetheless, because of the real problems encountered by spouses and family, we will drive the time to inquest to 4 weeks over the next 2 months (and keep it there, if not better). It will take close follow through in my office. It will also require educating some outside agencies that we don’t need a totally completed investigation on their part (such as they would need for a criminal charge/trial), all we need is information to determine the cause and manner of death because that is all the inquest is to determine, and not whether someone or something is to blame.
I don’t want one more spouse telling me that they risk losing their house because we don’t have the death certificate done.
A death certificate doesn’t look like much, but it is a powerful piece of paper. Without it the estate cannot be settled, you can’t apply for Social Security survivor benefits, most often life insurance cannot be paid out, bill payment plans cannot be set up, people often cannot get on with their lives. It can be an incredible hardship and stressor for surviving spouses and families (not that they aren’t already under enough stress). Bills pile up with 2nd and 3rd notices, often with no recourse until the final death certificate is issued and certified by the proper clerk/registrar.
In the Coroner System, the inquest is often the bottleneck in the process of getting the permanent death certificate done. “Unnatural” deaths must go to inquest and have the cause and manner of death decided upon by a jury of 6 individuals. For a number of reasons it can take an unfortunate amount of time to get to inquest, e.g. getting through a backlog of pending inquests, getting completed investigations and documentation from outside agencies, getting medical records.
Over the last year, we have eliminated most of the backlog of “pending” cases, but it is still taking us 6-9 weeks to get to inquest. That timeframe is really untenable for many of these families waiting for death certificates. But even with that period time to inquest we still get complaints from law enforcement agencies that their investigations are still ongoing and their reports are not completed. Nonetheless, because of the real problems encountered by spouses and family, we will drive the time to inquest to 4 weeks over the next 2 months (and keep it there, if not better). It will take close follow through in my office. It will also require educating some outside agencies that we don’t need a totally completed investigation on their part (such as they would need for a criminal charge/trial), all we need is information to determine the cause and manner of death because that is all the inquest is to determine, and not whether someone or something is to blame.
I don’t want one more spouse telling me that they risk losing their house because we don’t have the death certificate done.
Thursday, April 06, 2006
Bird Flu preparations
Bird flu is in the news and every time it is mentioned so is the fear of a pandemic (that is an epidemic that spreads “everywhere”). Do keep in mind, no one knows if a pandemic will occur or when it will occur, whether it will be as deadly as the (regular) flu pandemic of 1918, but do keep in mind that hygiene measures (hygiene in its broadest sense) and healthcare (to treat the lethal complication of the flu) have improved dramatically since 1918. No one knows when (or if) the antigen shift will occur so that “bird flu” can be transmitted from person to person or just how virulent that virus will be.
But these things are not the focus of this post. My point today is that the oseltamivir (Tamiflu) pills that are being stockpiled “everywhere” and at significant cost and the public distribution plans being written and tested (at significant cost) may not have a significant effect if an epidemic or pandemic occurs.
First, the distribution of the drug to the public to interrupt an epidemic is problematic. The drug must be taken within 48 hours of the onset of the flu for it to be effective (if it is going to be effective). One thing that has been demonstrated in testing planned distribution systems is that they take too long and that is if everything is going as planned. Throw in panic or a few sick “distributors” and/or some other glitch and the distribution fails to avert and/or interrupt the transmission of the virus. You end up with boxes of undistributed meds, at significant cost in monetary terms, as well as individual morbidity and mortality.
Second, the drug itself has not been proven effective in treating or preventing “bird flu”. Granted it hasn’t be used in a large trial in treating “bird flu” transmitted to humans (there have only been a little more than 100 cases to date), but its efficacy has not been that great. The other concern is that those taking the medication in case of an epidemic or pandemic may be less symptomatic (partially treated), although still capable of spreading the virus, and end up as Typhoid Marys spreading it.
I bring these points up for a couple of reasons. We should not complacently rely on stockpiling and distributing oseltamivir. We must take a real look at the cost/benefit ratio of the system we are putting in place. Will it be more effective than a concentration on hygiene measures and common sense? And very importantly, vaccine research and development is paramount.
But these things are not the focus of this post. My point today is that the oseltamivir (Tamiflu) pills that are being stockpiled “everywhere” and at significant cost and the public distribution plans being written and tested (at significant cost) may not have a significant effect if an epidemic or pandemic occurs.
First, the distribution of the drug to the public to interrupt an epidemic is problematic. The drug must be taken within 48 hours of the onset of the flu for it to be effective (if it is going to be effective). One thing that has been demonstrated in testing planned distribution systems is that they take too long and that is if everything is going as planned. Throw in panic or a few sick “distributors” and/or some other glitch and the distribution fails to avert and/or interrupt the transmission of the virus. You end up with boxes of undistributed meds, at significant cost in monetary terms, as well as individual morbidity and mortality.
Second, the drug itself has not been proven effective in treating or preventing “bird flu”. Granted it hasn’t be used in a large trial in treating “bird flu” transmitted to humans (there have only been a little more than 100 cases to date), but its efficacy has not been that great. The other concern is that those taking the medication in case of an epidemic or pandemic may be less symptomatic (partially treated), although still capable of spreading the virus, and end up as Typhoid Marys spreading it.
I bring these points up for a couple of reasons. We should not complacently rely on stockpiling and distributing oseltamivir. We must take a real look at the cost/benefit ratio of the system we are putting in place. Will it be more effective than a concentration on hygiene measures and common sense? And very importantly, vaccine research and development is paramount.
Wednesday, April 05, 2006
Decedent Viewing
I was asked yesterday (OK, it was more like a verbal running gun battle over the last couple of days) why we don’t allow viewing of decedents by family members in our office (building). The previous administration did. While we do (and/or have) on rare occasions allowed for that to take place, as a matter of policy we do not allow it.
Previously, the viewings were done through a window into our auxiliary autopsy room in which the decedent would be placed on a cart, covered so that only their face was visible. The family would be standing in a hallway looking in through a window (that appears to have been placed to allow autopsy viewing).
It is my opinion that the coroner’s facility is not a good place to view your deceased loved one. The viewing is seldom the peaceful experience they show on TV: opening up a morgue drawer, pulling back the sheet while saying “Is this your loved one?” Our facilities are not conducive to “nice” viewing of a loved one. Our hallway for viewing is white walls, bare concrete floor and only 4 foot wide. Other areas of the office are not available for viewing decedents (including any consideration of “face-to-face” viewing) because of biohazard concerns, evidentiary chain-of-custody concerns and the like. The viewings are emotionally charged and individuals have fainted, thrown themselves to the ground and reacted somewhat violently. These eventualities are unpredictable and bring up concerns regarding injury and liability. It is also quite possible that certain odors from other decedents present (decomposition, et al.) that would make viewing in that area problematic.
Decedents are, within a short period of time, available for transfer to a funeral home, a much better place for viewing with better “atmosphere” and designed for viewing decedents. Funeral staffs are also trained and have the wherewithal to make the decedents more “presentable’ than we can or do in the Coroner’s Office.
We can and do show family and friends digital photographs (we have them readily available) of the decedent, especially if we are in need of identification confirmation.
It is therefore the policy of my office that viewing of decedents will not take place in our facility. We have only very rarely had complaints to this policy. Will it never occur? I wouldn’t say that, there could be extenuating circumstances, but it would be rare that it would occur and only with good reason.
Previously, the viewings were done through a window into our auxiliary autopsy room in which the decedent would be placed on a cart, covered so that only their face was visible. The family would be standing in a hallway looking in through a window (that appears to have been placed to allow autopsy viewing).
It is my opinion that the coroner’s facility is not a good place to view your deceased loved one. The viewing is seldom the peaceful experience they show on TV: opening up a morgue drawer, pulling back the sheet while saying “Is this your loved one?” Our facilities are not conducive to “nice” viewing of a loved one. Our hallway for viewing is white walls, bare concrete floor and only 4 foot wide. Other areas of the office are not available for viewing decedents (including any consideration of “face-to-face” viewing) because of biohazard concerns, evidentiary chain-of-custody concerns and the like. The viewings are emotionally charged and individuals have fainted, thrown themselves to the ground and reacted somewhat violently. These eventualities are unpredictable and bring up concerns regarding injury and liability. It is also quite possible that certain odors from other decedents present (decomposition, et al.) that would make viewing in that area problematic.
Decedents are, within a short period of time, available for transfer to a funeral home, a much better place for viewing with better “atmosphere” and designed for viewing decedents. Funeral staffs are also trained and have the wherewithal to make the decedents more “presentable’ than we can or do in the Coroner’s Office.
We can and do show family and friends digital photographs (we have them readily available) of the decedent, especially if we are in need of identification confirmation.
It is therefore the policy of my office that viewing of decedents will not take place in our facility. We have only very rarely had complaints to this policy. Will it never occur? I wouldn’t say that, there could be extenuating circumstances, but it would be rare that it would occur and only with good reason.
Tuesday, April 04, 2006
Not Causing Suicide in Schools
A question (fear) came up (again) recently in discussion of bringing suicide prevention programs into schools that I want to address briefly and to, hopefully, lay to rest.
Will discussing suicide, especially with “impressionable young people” lead to an increase risk of attempted or completed suicide?
NO.
Sorry to shout, but this is another of those bits of common “knowledge” that needs to be shouted down. It is one of those “facts” that have become so familiar that it is believed to be true despite any proof that it is correct. Actually, when it is ever really studied it is shown to not be correct at all. Probably the best real study looking at this matter was published in the Journal of the American Medical Society in April 2005. The study participants were 2342 students in 6 New York State high schools in 2002-2004. The study found that asking about suicidal ideation and/or behavior did not create or increase psychic/psychological distress or increases suicidal ideation among the students generally nor among those considered high-risk already (those reporting depressive symptoms, substance use/abuse problems, and/or those with prior suicidal ideation).
This is an issue that needs to be talked about with children. This is a problem that must be addressed to prevent death. It can be discussed and it can be addressed without the fear that by so doing we will precipitate death.
Will discussing suicide, especially with “impressionable young people” lead to an increase risk of attempted or completed suicide?
NO.
Sorry to shout, but this is another of those bits of common “knowledge” that needs to be shouted down. It is one of those “facts” that have become so familiar that it is believed to be true despite any proof that it is correct. Actually, when it is ever really studied it is shown to not be correct at all. Probably the best real study looking at this matter was published in the Journal of the American Medical Society in April 2005. The study participants were 2342 students in 6 New York State high schools in 2002-2004. The study found that asking about suicidal ideation and/or behavior did not create or increase psychic/psychological distress or increases suicidal ideation among the students generally nor among those considered high-risk already (those reporting depressive symptoms, substance use/abuse problems, and/or those with prior suicidal ideation).
This is an issue that needs to be talked about with children. This is a problem that must be addressed to prevent death. It can be discussed and it can be addressed without the fear that by so doing we will precipitate death.
Monday, April 03, 2006
Bad Combo, Caffeine and Alcohol
I stumbled across a health article posted March 30, 2006 on Newsday.com. The article was based on a study done at the Federal University of Sao Paulo, Brazil concerning the effects of drinking Red Bull mixed with alcohol.
The study and other comments in the article jibe with my years of ER experience. If you give caffeine (in the “old days”, coffee) to a drunk individual you get a drunk person who is more awake.
The study in Brazil found that while individuals drinking alcohol with the caffeine beverage felt that they were less drunk, their motor skills and coordination were still very much impaired. Imagine the danger of such an individual poses to himself and others not feeling as drunk as they really are. There are a number of people who believe that taking a stimulant (like caffeine) cancels out the effects of a depressant (like alcohol), but believing doesn’t make it so.
These combo drinkers are potentially even more dangerous drivers than those not mixing caffeine with their alcohol, not having the “drunk feeling” keeping them from behind the wheel with their false sense of sobriety. In addition, these combo drinking individuals may drink more increasing their risk of alcohol overdose.
The study and other comments in the article jibe with my years of ER experience. If you give caffeine (in the “old days”, coffee) to a drunk individual you get a drunk person who is more awake.
The study in Brazil found that while individuals drinking alcohol with the caffeine beverage felt that they were less drunk, their motor skills and coordination were still very much impaired. Imagine the danger of such an individual poses to himself and others not feeling as drunk as they really are. There are a number of people who believe that taking a stimulant (like caffeine) cancels out the effects of a depressant (like alcohol), but believing doesn’t make it so.
These combo drinkers are potentially even more dangerous drivers than those not mixing caffeine with their alcohol, not having the “drunk feeling” keeping them from behind the wheel with their false sense of sobriety. In addition, these combo drinking individuals may drink more increasing their risk of alcohol overdose.
Subscribe to:
Posts (Atom)