Lack of access to quality healthcare kills

I was taking a look at some articles in the recent issue of the Journal of the National Medical Association regarding “Access to Care”. This is an issue that has been of interest to me for a number of years (prompting me to action doing an itinerant clinic for homeless individuals, founding HealthReach, and helping getting the HIV Primary Care Clinic going at the Lake County Health Dept., as examples). It is also of interest in my present business, the Coroner business.

Without proper and humane access to healthcare people die before they should.

Two themes revealed in a study published in the Journal that involved interviewing physicians regarding their thoughts about access to healthcare really struck me. They go beyond simply access, but more encompass how folks are often treated even when they get access, but aren’t treated up to standard (humanely).

Respecting the patient is key to quality care.
Understanding the patient is key in quality care.

The article has comments in these categories about not being judgemental, not making generalizations based on appearance, and the like. However consider a not unusual example, an individual presenting for care that is perceived as a drug addict with drug seeking behavior, so the exam and testing is cursory and treatment is thus “not all that great”. (one of my previous related posts) Now add a worsening co-factor: old tract marks on their arm. (Not true in the case referenced above, but may have been in others) The individual presents with pain. The severity of the pain is “discounted”, they are after all only “looking for pain medicine”.

I would caution healthcare providers that while some of these folks are indeed looking for drugs, even active drug users/abusers get sick and develop “real” medical problems that can end their lives, prematurely.

All people deserve access to proper, humane and quality healthcare.

quick blogging

Just some quick blogging today with fun links (Case conferences and State's Attorney talks consumed the day):

Watch this video of nature’s non-lethal(?)firearm (who would have thought it possible).

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Eco-friendly burials

Cremation was long considered more environmentally friendly than burials in graveyards, but its use of fossil fuels has raised concerns.

Biodegradable coffins are part of a larger trend toward "natural" burials, which require no formaldehyde embalming, cement vaults, chemical lawn treatments or laminated caskets. Advocates say such burials are less damaging to the environment.

Death this time of year...

A reporter asked me the other day if there were more suicides at this time of year. My answer was no. While we are often more acutely aware of them this time of year, they actually happen with greater frequency in the spring. We tend to be more acutely aware of all deaths this time of year. Folks and family are supposed to gather and celebrate this time of year, not die.

I also talked with the mother of a young person who died recently. We discussed how unfair it was that her “child” died. How unfair that he died so young, without fulfilling his potential. How unfair he was taken away, particularly at this time of year. His death was going to change things so much. The holidays would not be the same.

But death at anytime during the year is often “unfair”. Death at anytime during the year will change our holidays and our celebrations and our lives. Death is always sudden, even when it is anticipated. Death is part of life, but it is the part we want way off in the future, not here and now.

My condolences to all who have lost loved ones to death, particularly this time of year.

Death by Hanging

Here is some stuff that you are not likely to see most any place else (it came up in recent conversations; some of my conversations take strange turns):

Hanging, and most strangulation, deaths are a result of vascular compression in the neck (not airway compression as is commonly thought). Compressing the blood vessels in the neck lead to either blood pumping into the head but not being allowed to exit (venous compression) or no blood pumping into the head (arterial compression). The end result of either is that brain cells are not fed with oxygen and sugar (the latter is fuel for function). The starved brain cells die. (This also explains why someone doesn’t need to be suspended to die by hanging.)

Arterial compression is the most “efficient” for causing death and most often the case in hanging deaths. Based on published data and observational studies, unconsciousness occurs in 6-15 seconds, at 1-2 minutes heart rhythm problems occur because of the brain cell anoxia, and death in 3-6 minutes (with irreversible brain damage in 4 minutes). [Do remember that there are no absolutes in medicine, so these times do vary individual to individual.]

In homicidal strangulation, the arterial occlusion is not so absolute, so the times are often prolonged. It is not until the victim loses consciousness that the arterial occlusion can approach total.

[Just as an aside (should I say in a different vein), severe arterial bleeding, like the carotid arteries, results in death in more like 10-20 minutes.]


Yes, I do get in strange conversations, but there are those that would like to eavesdrop and pick up on a few of these facts.

Emotional shock/stress can kill

Apparently, you can die of a broken heart or be scared to death or similar events.

Today (or yesterday) in the National Association of Medical Examiner’s listserv someone pointed to an article on Medscape (originally from Nature Clinical Practice Cardiovascular Medicine) about Takotsubo Cardiomyopathy, also know as stress cardiomyopathy.

It seems that extremely stressful events (either emotionally or physically stressful) can stun the heart. The stunned heart doesn’t pump well, there may be chest pain, and because it is epinephrine (or adrenaline) mediated there is also the risk of dysrthymia. Death can result either from the pump problem of the rhythm problem.

So stay mellow out there.

The mystery of shipping for identification

Here is an imponderable: How do you get a body to the Center for Human Identification at the University of North Texas if none of the common carriers will handle/move body parts?

That came up recently because we were sending what turned out to be two sets of skeletalized remains there for examination and DNA identification testing. We contacted the usual companies that move packages around these United States and were told they do not allow the shipping of body parts (or most of a body for that matter). We contacted the folks in Texas and they reported that they get hundreds of shipments on a regular basis for their services.

How could that be? Well, as you can imagine, we solved our conundrum. We were able to send 2 sets of skelatalized remains to them for their services. One has returned and the family, after assurance of identification, was able to have services and burial of their loved one. The Center continues to work with the other set, but once the DNA matching is done those remains will also return to our office for release to his family for burial.

The cloaking of mystery, the remains go to Texas and return from Texas, but they can not be shipped. Sometimes it is best not to pull back the curtain.

NamUs growth will help Coroner's ID the unidentified

According to a 2004 Bureau of Justice survey there were over 13,000 unidentified human remains known to medical examiners and coroners in our country that year. Approximately 4000 unidentified human remains cases are handled each year and of those about 1000 remain unidentified after one year. We are working a one such case here in our office.

We need a better system to get these individuals identified and it seems it may finally be coming. It will be a dual database system developed by the Dept. of Justice’s Office of Justice Programs (with the cute name of NamUs), phased into existence over the next few years. One database will contain records of unidentified human remains and the other will contain missing persons reports centrally compiled. I think the best part will be that by sometime in 2009 there will be the capability for the system to compare the 2 databases automatically and put out possible matches without labor-intensive “hand” searches.

While all kids 18 years old and younger are currently entered into the FBI’s National Crime Information Center (NCIC), adult missing persons reporting into the system is much less consistent. Only some states require it be done and some agencies feel that adults have many reasons to “disappear” and so are sometimes less conscientious about entering their missing persons reports.

The Doe Network can be a help in these attempts at identification, but they are a page by page search system begging for improved searchability.

The new system will have information inputted by and will be searchable by coroners and medical examiners, law enforcement, and the public; but with different levels of information access. There are certainly times when we all can use all the help we can get in difficult identifications.

Currently unidentified human remains are entered into the database and it is searchable, but not easily and without as much automation as computer searches should allow.

This is going to be a great tool in helping with difficult identification cases.

Lots of ways to die

Well that was interesting.

I got a call today from someone with Spike TV. She was doing research for an upcoming show and had a question for me. Apparently they will be doing a series about strange ways people die (1000 of them). The death she had questions about was a hyperthermia death while skin diving.

Apparently an individual made their own wetsuit (nothing like an amateur hobbyist). The plastic he used (salvaged from a waterbed) was too impervious to the loss of his body heat and he died of hyperthermia.

What she wanted was a list of stages he and his body would have gone through prior to his death for a graphic they are making to show during the broadcast. She said the graphic would be like they show on CSI, which didn't help me, because I don't watch the show. I laid them out for her: profuse sweating, muscle cramps, weakness, headache, nausea, loss of sweating and flushing, rapid pulse, difficulty breathing, confusion, agitation, possible hallucination, seizure, coma, and then death. She wrote them down, read them back to me and thanked me. Goodbye.

Another day and another brush with fame (I doubt she will credit my contribution, but we will see; if I ever see the show). Fun none the less.

Update: Got called back. It seems the guy was not skin diving, but "jumping around" in this homemade plastic "suit" in relatively hot weather. That is not a good thing, as you can tell by this guy's outcome.

Electronic control devices and death

I have been following an ongoing discussion of electronic control device use associated death (aka Stun Gun, etc; yes, I am avoiding naming name brands).

There are folks that say the deaths don’t happen do to these devices (heavily weighted by manufacturer representatives and those whose speaking fees are at times covered by manufacturers). They contend that somewhere in the neighborhood of 600,000 law enforcement folks have been zapped in training demonstrations without a reported death, so how can you say that they kill?

But deaths have been reported related to the use of these electronic control devices and not just the weird one’s like the gentleman who was zapped after dousing himself with gasoline and was set afire or the gentleman zapped on the edge of a bridge, knocked off and drowned.

From reading available materials it seems that the cause of death is likely related to 2 causes with a third less supported possible cause.

First, is the possible of a heart dysrythmia causing death. These folks collapse and die quickly, in around 20 seconds. Likely for this to occur the prongs have to hit the individual in the chest over the heart and the individual must be relatively thin (the electric shock does not penetrate very deeply). Nobody knows if someone at greater risk for dysrythmia is more likely to develop them with zapping, not a doable study.

The second possible mechanism of death is increased physiologic “stress”. This stress results from muscle contraction of patterned tonic-clonic muscle effects superimposed on catecholamines released due to pain and fear, often with a contribution post-exertion effects on the body. These folks die with a terminal collapse within minutes (“few to many”) of the last shock they received.

I would also like to mention here that both of the above mechanisms are made more likely by the superimposition of adrenergic-like drugs, e.g. cocaine and methamphetamine.

The third proposed is asphyxia related to muscle tetany or excessive tonicity from the zap. This may be a contributor in cases of prolonged administered shock seen in some cases with certain equipment, but seems uncertain. As mentioned above the electrical current doesn’t penetrate far so it is generally unlikely that this would contribute in any but a few rare cases (there are no absolutes in medicine). I should mention here that it is thought that the generalized apparent muscle effects seen with the use of these devices is a secondary spinal nerve effect. However, again, no one is going to do a randomized, controlled study to define the effects of these devices, there is always that rare risk of death no matter what some folks say.

Thrill Rides Kill

I saw this article about the dangers of carnival and theme park rides today, and while there isn’t much riding going on around here at this time of year, it ought to be at least thought provoking.

These rides are not safe, no one is tracking their safety record, infrequently is someone working to ensure they are safe, and parents should be concerned.

…supermarket shopping carts feature a more standardized child-restraint system than do amusement rides, which can travel as fast as 100 mph and, according to federal estimates, cause an average of four deaths and thousands of injuries every year.

I have wondered about these rides for years, especially the traveling carnival ones, but after reading this article I am convinced that they ought to be policed or shut-down. I don’t mean to be a kill-joy, but why should we allow children to be put at risk needlessly.

Theme parks won their exemption in 1981, after a CPSC (Consumer Product Safety Commission) probe of ride accidents at Marriott theme parks alleged a coverup of safety hazards…The exemption was included in an omnibus agriculture bill that year, leaving oversight of theme parks to disparate state programs, including some lacking inspectors or enforcement powers. Family activists and state regulators say that as a result, efforts to find and correct safety problems have been inhibited, the number and extent of ride injuries remains uncertain, and families have been prevented from assessing the risks posed by roller coasters and Ferris wheels, wave pools and spinning rides.

Here is an issue that needs pushing to federal legislators. It ought to be a slam-dunk, saving kids lives and limbs. We must fight back against “big business” influence that limits action on this issue. Kids are dying and being injured. The time to act is now, before it happens to another kid.

Heroin deaths, not just for the young

I was talking with a reporter from Fox News (Chicago) last week, because they were going to do a story on a large drug bust here in Waukegan. It was a heroin centered bust and the police had said it was triggered at least in part due to heroin overdose deaths, so she was looking for information.

I discussed with her that so far in 2007 we had had 3 heroin-only overdose deaths and 12 others with heroin and other substances. The thing that really seemed to catch her attention was the ages of the overdose victims. The ages ranged from 18 to 53. She was amazed that folks that old died of overdose or that folks that old did illicit drugs. While it is true that most of these deaths were in young adults, 3 of them (20%) could have been (may have been) AARP members.

Heroin use and abuse is not restricted to the young, it is not restricted to poor n’er-do-wells, and it is not restricted to “bad neighborhoods”. Heroin, as is true with all drug abuse, can and does cut across socioeconomic strata. We, as a society, need to realize that and understand the ramifications of that. If we realize that it isn’t just “them”, we can more rationally work toward prevention and treatment. It is not someone else’s problem, it is ours.

Coroner supports Santa's girth

Thank goodness the acting United States Surgeon General is there to tackle the important health issues of our time. Yes, obesity (in kids and adults) is a serious problem in our country and does contribute to disease and death. Yes, we are seeing more 300+ pound folks and they are dying at younger ages from heart disease than you would really expect. But to attack Santa as a bad example and in need of slimming seems a bit weird.

“It is really important that the people who kids look up to as role models are in good shape, eating well and getting exercise. It is absolutely critical,” acting U.S. Surgeon General Rear Adm. Steven K. Galson said in an interview after a presentation on obesity at the Boston Children’s Museum…
“Santa is no different.”

I participate in a number of initiatives to promote health and forestall death, but I will not support this “hit” on Santa. Growing up I don’t recall ever thinking that I wanted to grow up fat like Santa and I don’t recall ever hearing anyone say it.

Keep Santa fat, but promote health and fitness in other ways.

Mr. Surgeon General lets come out with some real stuff to promote health in the U.S.. Thank goodness that the Ghostbusters took care of the Stay Puft Marshmallow Man.

Unnecessary ER deaths

Unnecessary ER and hospital deaths continue to occur. We ought to be confident in our health/life safety once we reach the hospital, but all too often that is a trust not well placed. Our system needs to be changed, there is a critical need for improvement, as I have previously mentioned here, here, and here (to tag only a few).

Another ER waiting room death hit the news.

Why are we still talking about stuff that we talked about years ago, stuff I worked on through my 20 years in the ER. People shouldn’t die a few feet from effective treatment because they don’t fit someone’s idea of who has heart attacks or whatever the medical problem might be. You know what they say about “assume”, it makes an "ass" out of “u” and "me", and it can lead to someone’s death.

Coroner's job is interesting

This job is always interesting.

The “pump” was primed/the tone was set this morning with an email at 7:50 am, got to love Blackberry capabilities, always connected. This led to a “running gun battle” of email and phone calls through the day to work toward resolution of an office issue.

Walking in from my parking place a 4X6 piece of insulation board blew off the roof (we are getting our leaky roof fixed, finally) and hit the ground about 5 feet in front of me. That was a surprise.

I went to the gym and found I only had a sleeveless t-shirt with me, which is OK but more summer wear than winter. Lucky for me, however, it was apparently sleeveless T day at the gym; all the other guys had them on too.

I had a very interesting conversation about homeless folks with a reporter. I have been involved in homelessness issues since about 1989, so do have some background for the discussion. They are real people, not nameless and faceless as they are often perceived. We discussed how there is a “community” that gathers at “soup kitchens”, service sites, and emergency shelters. They watch out for each other. They work odd jobs to make a little money. They shop, they live.

A sampling of interesting other stuff through the day: “Lending” autopsy specimens (i.e. histology slides and paraffin blocks, etc) to a law firm for their use in litigation; discussions on how to get a badly decomposed body (partially skeletonized) to the University of Texas and their CODIS-associated facility for DNA testing and examination; scheduling an autopsy for an individual found in Lake Michigan, likely who has been there for about a month (finally the family will be able to move ahead with their lives, which have been “on hold”). This is just a sampling, there were even a few things I can’t comment on here, always a reminder that there are no typical days in the Coroner’s Office.

Let’s see what the evening holds.

Kids shouldn’t die before their parents

I have heard a radio ad several times recently that really caught my attention.

It is simply a father calling and leaving messages for his daughter who was supposed to meet him for lunch. We aren’t told why she didn’t make the lunch date or why she isn’t answering her phone. This ad catches my attention like a beacon, like a clarion.

I have heard those types of messages on cell phones. I have heard the stories of fathers (and mothers) leaving such messages on the phones of their sons and daughters. There are many nights that I pray that I will never leave messages in such a situation.

Unspoken in all of this is that sometimes kids die before their parents (kids shouldn’t die before their parents). Kids die through no fault of their own. Kids die because they take chances. Kids die because they make bad choices. May this never happen to your kids (or mine).

Rhoni Reuter and Skylar Reuter-Gayle Double Homicide

During Case Conferences today (which now serve the function of inquests), the manners of death for Rhoni Reuter and Skylar Reuter-Gayle were declared to be Homicides by the Lake County Coroner’s Office.

Rhoni Reuter and Skylar Reuter-Gayle died as a result of multiple gunshot wounds that Ms Reuter received October 4, 2007. Ms Reuter was 6-7 months pregnant, with Skylar, when she died. Skylar could have been viable if delivered at that length of gestation, and therefore is considered a second individual death and homicide. Skylar’s death was attributed to the blood loss her mother suffered as a result of her gunshot wounds.

The precise number of gunshot wounds and their distribution are a part of the ongoing investigation by the Lake County Major Crimes Task Force, so are that information cannot be disclosed at this time.

“This is certainly a heinous crime and we hope someone is brought to justice soon. I am confident that the ongoing investigation will accomplish just that”, said Richard Keller, MD, summing up the feeling of all those involved in this case from its tragic beginning.

National Survivors of Suicide Day 2007

We, i.e. the Lake County Coroner’s Office (my executive secretary) and the Lake County Suicide Prevention Task Force, set up a local site for a group viewing of the American Foundation for Suicide Prevention (AFSP) National Survivors of Suicide Day program webcast last Saturday. One of over 130 sites that offered that service.

The bulk of the webcast consisted of a panel of individuals who were survivors of suicide (i.e. they had lost a loved one to suicide). These individual’s talked of their experiences, how they coped, and how their lives had changed. They brought various perspectives and were at “different places” with regards to working with their grief and life changes. It was a profoundly affecting experience. There was not a dry eye among the viewers at our site.

The webcast will be available for viewing on the AFSP website for the next year. I highly recommend it. I think its greatest messages were how many lives are touched by suicide (20% of families and 60% of individuals know someone who has died by suicide) and along with that, the message that you are not alone in your life experience of death by suicide and that you, like the others, can survive. One other point that comes to mind as I type this is that everyone deals with the grieving in their individual way (not in stages, but in “floods”) and that that grieving does not go away, but you cope and you survive.

Make good choices

This will be a bit different.

I ran across story a couple of days ago that I had saved after running across it a few years ago (although I do not have a citation of its origin) I thought I’d share it, not because it has much to do with the coroner biz, but because it “speaks to me” and I felt compelled to share it.

There is a story about a kind, quiet man who went each morning to the river to refresh his spirit. One day while there, he saw a poisonous spider struggling in the water and he picked it up in his cupped hands a moved it to shore. As he placed it on the ground it stung him. Thankfully, the poison did not affect him lethally as it might have.

The next day the same thing happened. On the third day, the kind man was knee deep in the river and, sure enough, there was the spider, legs frantic in the water. As the man went to lift the spider yet again, the spider said, “Why do you keep lifting me? Can’t you see that I will sting you every time, because that is what I do?” And the kind man cupped his hands around the spider lifting it back to safety, replying, “Because that is what I do.”

Let it be said that what we do is to be kind and what is “right”. Make good choices.

Coroner says NO to "flask on the fly"

Isn’t America and modern technology wonderful? Apparently because it isn’t easy enough to get enough alcohol to drink, especially alcohol in easy to carry bags, these folks have come out with “Pocket Shots”. I learned about these things at our Lake County Underage Drinking Prevention Task Force meeting this morning.

Pocket Shot is a brand new way to enjoy your favorite hard liquor. No longer will you need to carry full size bottles. Gone are the breakable glass mini bottles. Now you can have it one shot at a time, any place, anywhere.
Each Pocket Shot is sealed in a near unbreakable, flexible, squishable, pocket stuffable pouch making them perfect for active activities, outdoor adventures, and glass restricting venues

For crying out loud folks, this is a product that we really don’t need and again one that can easily contribute to underage drinking, despite their comment in the middle of their web page (although their photos show who they are targeting):

Pocket Shot condemns underage drinking and the irresponsible consumption of alcohol. Please drink responsibly. To find out more about responsible consumption, visit The Century Council.

You can voice your concern to distributors and sellers of alcohol in your area (these are available in Colorado, California, Arizona, New Mexico, and Wisconsin now). Tell them they don’t need to sell these in your area. It is plenty easy to get alcohol in bottles and we don’t need alcohol in a bag in our pocket. We aren’t that much in need of a quick shot. In Lake County the mayors are most often the liquor commissioner as well, let them know, too.

Take a stand.

Suicide among veterans

Shocking is an understatement in my opinion:

Some of America's 25 million veterans face their biggest fight when they return home from the battlefield -- when they take on mental illness.

A recent Veteran Affairs Department estimate says some 5,000 ex-servicemen and women will commit suicide this year…

The five-month CBS News probe, based upon a detailed analysis of data obtained from death records from 2004 and 2005, found that veterans were more than twice as likely to commit suicide in 2005 as non-vets.

Suicide is pervasive and preventative measures need to be very broad based. De-stigmatize, make help available, and support. A long-term, multifaceted project.

Coroner’s Daughter Takes Notes

I gave a talk the other evening, not all that unusual I do give a lot of them. I have always wondered if the stuff I say gets across to listeners, just like everyone who gives a talk, but after this talk I got some feedback. My 9-year-old daughter was along and took some notes to pass her time. I thought I’d use her notes as the basis of a post (I corrected her spelling):

“more suicide dies than homicide” I start these talks with some local information about death, this information (although I use proper syntax) often seems to catch everyone’s attention.

“my dad does tours in his office old and young” We do a number of outreach activities to help demystify the office and as a nod to the huge public interest in forensics; e.g. tours for students and adults, talks at schools and to groups, and career day activities.

“kids aren’t allowed to die before grown-ups” My statement is actually: Kids shouldn’t die before their parents. I use this to drive home death prevention information for kids and teens that boils down to getting them to think, not take chances, and make good choices.

“kids, grown-ups and teens kill depending on their personality” I’m not sure where this came from, but I did talk about violence prevention as a part of premature death prevention.

“there are people drinking and driving then they die” I think this one speaks for itself.

“my dad made a blog, he’s called the blogging coroner, its like a public diary like MySpace.com and he is the first coroner to blog” Again, it is what it is.

(after taking a phone call) “its tough being on call 24-7” I had to pause the talk to speak with one of my deputies who was responding to a car crash with a fatality and dispatching a second deputy to a simultaneous death call at a local hospital. I am always on-call and take calls.

“Tips: don’t drink and drive; don’t do anything that can hurt you or others!” I closed with several tips, my Coroner’s Health Tips, on how to forestall death. I work just as hard to keep folks out of my office (i.e. alive), as I do taking care of medicolegal death investigations.

Removal of a Dead Body

There is always stuff going on demanding and using my time, so it gets tough getting blogging done (it isn’t an integral part of my work). Ongoing union negotiations to get it ‘right”, 2 presentations last week on the updated county Questionable Death Protocol, instituting and reinstituting policies so memos have to be composed and sent, in addition to the “real” work of the office doing death investigations, are all part of the job.

Someone brought to our attention that we weren’t in compliance with statute in continuing a “common practice” (i.e. no written policy) that had been instituted and continued under previous coroners here in Lake County. There is a statute that says, in short (and in weird legalese), that a licensed funeral director must be present when they remove a decedent from our office to their facility.

“The removal of a deceased human body from its place of death, institution or other location. A licensed funeral director and embalmer trainee may remove a deceased human body from its place of death, institution, or other location without another licensee being present. The licensed funeral director and embalmer may engage others who are not licensed funeral directors and embalmers or funeral director and embalmer trainees to assist in the removal if the funeral director and embalmer directs and instructs them in handling and precautionary procedures and accompanies them on all calls.” (225 ILCS41/1-20(c))

Transport personnel, trained or not, can not do the transfer without a licensed funeral director actually present.

I found this out because the word was that that someone was going to make an issue of the practice, not that any problem had occurred from the practice, but just because they could make an issue of it. So the policy is changed and will become a written policy. I am sure that the prior practice was a help to some of the smaller funeral homes, but the law is the law and now that I know that the prior office practice violated the law we will change the practice.

National Survivors of Suicide Day

National Survivors of Suicide Day is November 17.

A survivor of suicide in this context is the family and/or friends of someone who died by suicide. I continue to be amazed at just how many of those folks there are, ranging from myself to folks in every walk of life.

National Survivors of Suicide Day is an annual event sponsored by the American Foundation for Suicide Prevention (AFSP). The event consists of a network of sites throughout the country where groups of survivors come together to watch a broadcast of speakers dealing with emotional support, available resources, and the like. It also communicates to the participants that they are not alone.

For the first time we in Lake County are setting up a site. It is a collaborative effort of my office (primarily my Executive Assistant), our Lake County Suicide Prevention Task Force and the City of Mundelein (which has helped with the actual location). We will hold ours at the Mundelein Fire Station (1000 Midlothian) on Saturday, November 17 [call Kathy, 847 377 2200, if you would like to attend; other information is available from the American Foundation for Suicide Prevention]. The other option is to watch the webcast that will be up for the ensuing year.

The AFSP promotes this event as a “healing conference” and I am sure that it is. Just knowing that you are not alone in your experience of losing someone to suicide has a great salutatory effect. Also knowing where you can get more information and support can be critical, because your feelings, grief, and questions will not go away quickly. There are those that can help and support for the long haul.

Drug-induced or Natural Death

Not everyone who partakes of a “lethal dose” of a drug dies.

The obverse of this would be: can someone die of a sub-lethal amount of a drug and still be considered to have died of the drug? I think (and others agree) that the answer is yes.

Consider this hypothetical. An individual partakes of an adrenergic-like drug that acts toxically on the vasculature. That drug causes vasospasm and/or vasoconstriction of cardiac blood vessels starving the cardiac tissue (muscle and electrical) of oxygen and “energy/food”. This in turn causes electrical instability and irritability, as well as poorly functioning musculature.

Next “stress” this individual with a fear of loss of integrity/life through fear of injury or capture. I don’t know; maybe have him chased by a wolf. This stress causes the body to churn out adrenaline as a natural reaction. In this hypothetical that adrenaline would compound the effect of the recently consumed drug on the heart. In addition to the fear stressor, add that the man runs say 100-200 yards. This compounds his heart’s problem by increasing demands for oxygen and energy supplies to the heart tissue. And on top of this he develops lung perfusion/ventilation mismatch in his lungs because he isn’t anywhere near fit and maybe gets a little bronchospasm in the mix because his lungs aren’t in great shape either.

He stops (wolf gone?) and tries to recover, but the insult to his system, his heart, is too great. A dysrhythmia develops, syncope and death result.

Did the drug kill him? It certainly set the stage. Was it a natural death? It was a dysrhythmia not necessarily directly related to the drug ingestion that actually took his life. Thank goodness we can ponder these things as hypothetical.

Medication assisted treatment for opiate addiction saves lives and more

Related to another project I am working on, I was researching medication assisted treatment for opiate addiction today and came across some interesting points. Most importantly, I think, medication assisted treatment (MAT) for opiate addiction has been demonstrated to save lives, save money and positively impact society. The efficacy and effects of MAT beyond the individual patient have been studied extensively for 30 years.

This treatment is effective for opiates like heroin as well as prescription opiates like oxycontin and hydrocodone. The major problem seems to be that there is a limited supply of quality programs and so it has not reached its full potential.

All of the society benefits of MAT seem obvious when you look at them and there are studies to back up the observations (a nod to the American Association for the Treatment of Opioid Dependence). Participation in MAT is associated with a decrease in use of all illict drugs by that individual. MAT results in a dramatic decrease in crime committed by the individual in treatment. Fewer of the individuals in treatment become infected with HIV (yes, it is still out there, although we seldom hear about it anymore). The lives of the individuals in treatment improve, to their own benefit and to the benefit of society. Their family and other social relationships improve. In addition, their rate of successful employment increases. In addition to positive effects on the social fabric, all of these things demonstrate a great return on investment in MAT, if you want to boil it down to economics.

Most importantly, individual lives are saved by MAT and their quality of life (and the quality of society) improves. I have had some questions after our investigation aided the DEA and IL Dept. of Professional Regulation in stopping the practice of a few physicians, where could folks hooked by those practices get treatment. I, sadly, had to say I don’t know. The number of programs are limited (a local one has a 1 year waiting list), even into Chicago.

ID by Pacemaker

I went to speak at a local high school this morning. I was told that it would be a couple of 10 minute presentations with 30 minutes in between and only a small number of teens would attend. Well, it was a bit different. First, each discussion was about 40 minutes long. Second, about 80 kids filed into the room I was to speak in, it was a computer resource room and really not made for presentations like this. Apparently some of the science teachers heard I was going to speak and brought their classes. There were about 20 in the second group, a better fit for the room. An energetic bunch and while they had some distractions amongst themselves, they really got into my talk and it was a lot of fun as usual. I was able to discuss what we do as Coroner and I also got a few death prevention plugs in.

One of the things I discussed was a current case we are working on. Without discussing who, I told them about some skelatalized remains that were found last evening. They were found in a field not all that far from the office. One of the interesting facts about the case, and the part that I discussed with the students, was that we identified him by means of his pacemaker. We were able to get a serial number of the pacemaker and checking with the manufacturer we got his name. Several other things about the remains were consistent and so we were able to contact his family based on that information.

So many details contribute to death investigations to get straight and to keep straight; it can be quite the challenge (in a good way). That’s why we are called medicolegal death “investigators”. (His autopsy is going on now, but likely his was a natural death, without “foul-play”.)

Lack of Sleep Peaks Emotions

I certainly have noticed it in my kids and others, lack of sleep stirs the emotions. It is indeed as Matthew Walker is quoted as saying:

"It's almost as though, without sleep, the brain had reverted back to more primitive patterns of activity, in that it was unable to put emotional experiences into context and produce controlled, appropriate responses,"

They become bears.

When you consider that this would be added to the effects of lack of sleep I talked about a few days ago, it becomes a potentially deadly combination. Add anger and poor impulse control to the drunk-like effects and it is easy to imagine that lack of sleep can have a pervasive effect, probably a bigger effect than is usually really thought about.

Take driving while drowsy and throw in a little rage and consider the consequences. It isn’t much of a stretch to conjecture that impaired impulse control mixed with the poor judgment from drowsiness could contribute to violent action and escalation, as well.

Get good nights sleep and/or take a nap. It is good for you and good for the rest of us and your interactions with us.

Personal Livestock

I ran across an interesting posting about dust mites today (I am going home and clean and vacuum tonight). Did you know that there are 42,000 of them in every ounce of dust and that in addition to dead skin cells they feed upon “hair, pollen grains, fungal spores and bacteria, as well as cigarette ash and tobacco, clothing fibers, fingernail clippings and filings, food crumbs, glue, insect parts, paint chips, salt and sugar crystals and even graphite”. Just like when someone used to come into the ER complaining about scabies, just the thought of it makes you itch.

Even more itch inducing was a quote later in the post:

What was amazing was what happened to the Archbishop’s corpse, as described in Hans Zinsser’s 1935 epic book, "Rats, Lice and History", beginning with Zinsser’s description of the dead Archbishop’s robes of office. When he was murdered Becket was wearing, "...a large brown mantle; under it, a white surplice; below that, a lamb’s wool coat; then another woolen coat; and a third woolen coat below this; under this, there was the black, ...robe of the Benedictine Order; under this, a shirt; and next to the body, a curious hair-cloth, covered with linen." As Becket’s corpse grew cold the successive layers of robes also cooled, and all the little creatures that had been living within the folds and pleats started looking for a new home. Wave after wave of various fleas, ticks, spiders, pincher bugs, and other creatures flowed out from the corpse, "...like water in a simmering cauldron" producing in the hushed mourners gathered in the dim cathedral, "...alternate weeping and laughter...’".

Bugs you got to love them, particularly the personal livestock variety. We do run into this sort of livestock from time to time, never quite this graphically.

Thoughts on Teen Suicide Prevention Program

I was putting together some materials for our Lake County Suicide Prevention Task Force meeting tomorrow and thinking about 2 articles I read yesterday, they do relate (at least somewhat).

I had posted the goals of the Task Force back in March, 2006 on my blog so it was easy to cut and paste the goals to redistribute as a “hard copy” for discussion tomorrow. Two of the comments to that post mention the importance of peer-to-peer intervention (one directly and the other infers). That is where the articles come in.

While the articles are about impacting substance abuse, I have no doubt that they similarly would be true of suicide intervention. The first was about a recent study that looked at the utility of peer-led substance abuse programs (or another article on the study) and found them more effective at changing behavior than those led by adults. The second article referenced a study that demonstrated the effectiveness of teaching “competence skills” (refusal skills and decision making skills) in preventing future substance abuse.

Taken together I think this lays out a great framework for suicide prevention program for teens. It would begin first with training a cadre of teens to be educators. The education program would begin being presented to other teens in middle school and repeated throughout the remainder of school, possibly into college. It would be a peer-to-peer experience (with adult supervision and input) focusing on competence skills as they apply to suicide and life skills in general. Also the program should work to reduce the stigma of seeking or recommending that someone get help, as well as teaching how to recognize someone in trouble and how to “intervene” effectively. A last significant part would focus on where (and how) to send someone for help and/or where to get it yourself. After a conversation I had today, those already in treatment and/or with significant symptotology would only participate in the program with supervision of their (mental) healthcare provider.

Such a program would be easier said than done.

Drowsy Driving Kills

To steal a phrase from David Letterman; “I wouldn’t give my troubles to a monkey on a rock.” Busy craziness, anyway…

I recently joined a listserv pertaining to child death review. I have gotten interesting information on several topics and so it seems like it will be a good source of stuff (unlike some others I have joined and quit). The other day I got a notice about an upcoming “Drowsy Driving Prevention Week”, November 5-11.

According to studies, being awake for 17 hours impairs your judgment, coordination, and reaction time comparable to a blood alcohol of 0.05. Having seen some crashes and death related to driving drowsy, I can easily believe that that is the case. The National Highway Safety Administration reports that there are 1550 deaths and 71,000 injuries in crashes related to driving drowsy each year.

Drowsiness-related crashes are most common in teens and young adults who have the propensity to sleep too little and drive at night. So it is particularly important to get this information to them, let your teens know. Also keep it mind for yourself. You are only human. You can only push yourself so far.

Driving drowsy kills just as surely as does driving drunk.

Johnny Doe vidi-mentary

I got this link emailed to me today and thought I'd share it. It is a "vidi-mentary" on You-Tube about an unidentified toddler found dead in DuPage County. It is a nicely done piece.

It is worth watching, although the subject matter can certainly pull at the heart.

"Johnny Doe- Little Boy Blue"

TV, Salmonella, Violent Death, oh my

Posting has been a bit light lately, but it has to compete with everything else that is going on.

Last Friday I was whisked off by a limo to Chicago to do the Nancy Grace Show (about a recent homicide here in the county). There were 2 of us in a small studio in Chicago and it seemed like 10 others in various other places feeding into the story. It is somewhat strange doing these things. You sit in a room that is black walled and ceilinged (actually everything in the room is black except the stools and the wall behind us) and stare at a camera (the camera was robotic and moved at someone’s direction). You have to stare at the camera because you never know ahead of time when they might cut to you or catch you making some sort of face you don’t want on camera. I could listen to all of the conversation and interview, but couldn’t see what anyone looked like or their facial expressions. It is a bit strange talking with someone without that normal feedback. Our segment was about 20 minutes long, I got to answer 3 or 4 questions. I think it went pretty well.

Saturday was a good day, primarily because of what I didn’t do. I went shopping with my 9 year old and we picked up some food for lunch. I had actually picked up chicken pot pies to heat up, but put them back for other selections. Good thing or I might have had a serving of Salmonella I learned on the 10 o’clock news last night.

Monday, Columbus Day (although I have to agree with several folks’ comments that I don’t know why we still celebrate Columbus Day since we know he didn’t discover America and may have been a fairly unsavory character) I sent off a book proposal to an agent who agreed to look at it and consider representing me in that endeavor. We will see what develops.

Yesterday, I went to a meeting in Chicago, the Illinois Violent Death Reporting System Advisory Committee. I got fairly creative about my route down so the trip only took 2 hours each way. They are getting some interesting data from the first 3 counties participating (I will highlight some soon) and I look forward to our being able to join in the project after our county IT department gets the software loading and working here. If you want to see at least part of the data before I put more in the blog you can check out this link.

Next Generation of Blogging

I’ve been invited to serve on a small (3) panel of presenters/discussion leaders at a conference put on by the Metropolitan Chicago Healthcare Council. The panel discussion is entitled “News Media: The Next Generation of Blogging” (got the flyer today). I am honored and look forward to participating.

Apparently they see my blog as “next generation” in that its primary purpose is informational and authoritative (i.e. factual). I do think there are several things that blogs can be used for that may be “next generation”. I do support the expanded use of blogs to give out information and allow feedback (filtered to weed out the spam that comes in and the “naughty” words), opening discussion, expanding knowledge, relationally.

The conference is in a few weeks, I’ll let you know how it goes.

Sorry this is a bit short and only a few posts this week. It has been a busy week for a number of reasons and I am off soon to do the Nancy Grace Show.

Coroner Death Investigation

Why does your office do its own investigation of an individual’s death?

There are a number of reasons. First, since we are the agency that must make a decision as to the cause and manner of death, it just seems to make sense. We certainly work in tandem with and parallel to other law enforcement agencies. We use the information they gather and they use the information we gather. It is a synergy that just plain works. But our medicolegal investigations may take a bit of a different tack or have a slightly different focus so we can arrive at the conclusions that we must to make our ultimate decisions.

In addition, if an autopsy is done the forensic pathologist needs answers to a number of questions as she proceeds through the autopsy. If we have done our own investigation we get answers to those questions and have them available as we assist with the autopsy. Such things as exactly how was the decedent lying when found, whether they were lying against something that might have left a certain mark, all can make a difference to know as the post-mortem progresses.

Another reason is that often two sets of eyes are better than one. We may pick up a detail that another investigator glossed over inadvertently. Or we might think to document something that the other investigators don’t. Recently, for example, among the agencies investigating a death, ours was the only one that took photos of the crash scene in daylight and those photos became an important element in subsequent legal proceedings.

My deputies are all trained in death investigation, evidence tech work, and all the skills needed to do a “class” investigation. The number of cases we investigate is certainly sufficient to keep up their proficiency as well. We are proud to use our skills and talents to do the job necessary to arrive at the cause and manner of death in our cases. And as I said we use the investigations of others as part of our “tool set” in these investigations. Death investigation is a cooperative effort, with each of us doing our part. As is often the case, here too the whole is often more than just the sum of the parts.

Death of an identity thief

Our electronic fingerprint submission capability, a recent addition to the office, has really proven to be a benefit. A couple of days ago we were able to submit an individual’s prints and got confirmation of his identity in about 10 minutes. Then we were able to go and inform his family, confident that he was who we thought he was. Let’s just say we were less than confident on making the identification based on visual comparison with his photograph.

Another interesting incident pertaining to our fingerprint submissions occurred recently. In reviewing the responses from the IL Bureau of Identification one day we noted that an individual was identified that we did not have in our morgue storage or case files. It was a name that was familiar to me as someone who was still alive and who worked for a local agency, certainly not someone who had been through our office. When we called the individual whose name appeared he was indeed still alive and he related that he was aware that an individual had used his identity as cover because of run-ins with the police. The identity was taken after he had helped the now deceased individual on several occasions. So not only were we able to resolve the investigation into the cause of death of one individual through our usual practices, we were able to resolve a case of identity theft as well.

Death case provoked dream?

I had a weird dream last night. As I have said I do end up taking some of the job home with me, at least in my head. I think the dream sprang from a case conference we had Monday that involved the drug-related death of an individual. In the discussion and review of the scene photos, it was revealed that the victim used a homemade aluminum foil pipe (would there be such a pipe other than a homemade?) for smoking drugs.

When I googled to check on the prevalence of using aluminum foil to make a pipe. I was surprised just how common a practice it is for crack, heroin, marijuana, the whole gamut of drugs. There was even an answer to a question posed about the safety of smoking in such a devise and the risk of the aluminum inhaled. Although it would seem to me that most folks using such a device would not be overly worried about the aluminum and most of the substances smoked would be more harmful than the aluminum.

Anyway to my dream, in it I was watching a TV show, much like Saturday Night Live in the old days, and a commercial came on for a product called “Six Pack O’ Crack” that came pre-loaded in pipes. As far as I know no such product exists and would likely be pretty lethal. I mention it to demonstrate just how strange a place the world of dreams is, particularly mine at certain times.

Killing in fiction

I cruised back to a website I visited before, one that appears to give out, shall we say, not the most accurate information pertaining to forensics mixed with some good stuff and found some more not fully accurate information and an opportunity to throw in my 2 cents worth.

The question sent in by an author:

I've got a man in his 60's who is dying (I gave him cancer, but really it could be anything convenient for the scenario I'm describing). He is being cared for at home by his wife and his niece (who is a nurse), along with help from a local hospice group. He has trouble breathing and sometimes needs a mask put over his face (oxygen, I'm guessing), to help him out. The oxygen is in a tank behind his bed.
One afternoon he needs the mask, but when they put it on him, he dies anyway. His death seems natural. It's not until autopsy that they realize he was murdered: There at the end, he wasn't breathing oxygen through the mask at all but some other substance that had been put into the tank (or that tank was switched out for another) and the substance killed him.
What deadly substance was substituted for the oxygen? Would it have a smell? How would the autopsy reveal that this is what happened?
I'd like the fatal gas to be as simple as possible, something easily attainable by any of the 5 suspects. It would also be fine if someone could've just changed the settings on the oxygen or some other gas that would be present anyway and that's what killed him. The most important part of the scene is that they have to think it was a natural death until autopsy (though a whiff of some strange odor would be fine.)

The answer posted:

There are several possibilities but three that would be very easy for your killer to employ.
1—Simply not turning on the oxygen and having him continue breathing only room air. If he were very ill with severe lung disease, and particularly if he was taking pain meds, which would suppress his respiratory drive, this alone could make him gradually slip into a coma, stop breathing, and die.
2—If he had what we call Chronic Obstructive Pulmonary Disease (COPD), which is basically emphysema and similar diseases, he would be very sensitive to high oxygen (O2) levels. The physiology here is complex but the bottom line is that people with severe COPD can slow or even stop their breathing if exposed to high levels of O2. So your killer could turn up the oxygen. Normally these tank masks combinations are set at a flow rate of 2 liters of O2 per minute. If the valve on the tank were turned up to say 10 liters/minute the victim would gradually slow his breathing and eventually stop and die from asphyxia. This could take anywhere for 15 minutes to a n hour so you have a bit of leeway here.
If the gauges were returned to normal after the victim died and before he was seen by investigators or other witnesses, then the cause of death might never be determined since there are no laboratory or autopsy findings in these situations.
3--Carbon monoxide (CO) would also work. The killer could extend a small hose—or a garden hose—from a car tail pipe in the garage or the driveway just outside the window to the mask the victim was wearing. This is a very deadly situation that comes from the unique chemistry of CO…
(the website writer goes on to actually fairly well discuss the toxicity of CO and some findings after death)

Because the questioning author listed their website I dropped her an email:

Not to be a butt-in-ski, but I ran across your question on Dr Lyle’s site and I feel there are some errors in the answer he posts.
1) Having the flow of oxygen to his mask turned off would cause him to rebreath his exhalations (and carbon dioxide) and could/would ultimately result in his death. Remember that the air hunger he would experience would get quite strong, so he would have to be pretty incapacitated to not reach for the mask.
2) Oxygen through a mask is always set at a minimum of 10 liters per minute, never at the 2 liters that a nasal cannula is set, so this one starts out wrong. High flow oxygen and the loss of hypoxic drive in severe COPD is a theoretic possibility, but is very seldom seen in real life.
3) Carbon monoxide does not normally come in tanks, but I suppose you could fill one with it. A more “natural” choice here would be nitrous oxide, used by dentists and others for anesthesia. It is lethal when used in concentrations greater than about 30% (it is normally mixed with oxygen in a “machine” for administration). Given straight it would be quite lethal and might be noticed as a sweet smell. It could be found after death when a blood gas is run found to have a very low blood oxygen content.

Maybe I should get into author consulting; I guess I have done a bit of that already. I have since corresponded with the author who sent the question above, her story has changed and I think I helped her a bit in agreeing with her new plot twist on how to kill a fictional character (kind of fun).

The Coroner biz is an amalgam...

The Coroner biz is an amalgam of many fields of the arts and sciences. It involves biology, chemistry, physics, medicine, psychology, sociology, logic, criminal and social justice, communication, writing, math, and a bit of philosophy.

Biology and chemistry gives us the ability to do toxicology testing. Physics allows us to look at the mechanics and kinetics of accidents, as well as using parts of the light spectrum and phosphorescence to look for evidence. The mercurial nature of health and illness often impact the deaths under investigation. We learn from psychology and sociology how individuals and groups of individuals act, contributing to death as well as life. Justice is our goal, not in the sense of fault finding, but ensuring the most humane conditions for society. The ability to communicate well, in all its forms, is critical to successful completion of our business. Philosophy is to help us in dealing with it all and in helping the survivors of the deceased individual.

Weekend reading with an eye to those related to death

Yesterday’s Chicago Tribune had several interesting articles:

Front page article about: “…hospital is the first in the Chicago area to disclose extensive information online about the quality of its care…” It seems to me that universal postings like this could go a long way not only in keeping patients and potential patients informed, but in pushing hospitals to ensure their quality of caring. Armed with information and with hospitals living up to quality standards, maybe we can prevent a few deaths by “medical misadventure”.

In the Q section there was a small bit on preventing hospital (medical caregiver) acquired drug-resistant bacterial infections that suggested folks:

"Politely ask hospital staff members to wash their hands before touching you if you don't see them doing so.” And
“Ask the doctor or nurse to clean the stethoscope before using it on you.”

They seem like really good points to remember and worth a mention to your healthcare provider. Although these infections cause more morbidity that mortality, they can kill and, at least some, are preventable with simple techniques.

Lastly, Mary Schmich wrote an interesting column that contained a discussion of some of the “mysteries” of death by suicide. Just because I do that sort of thing I posted a reply to her column:

You are so right when you wrote: “But another of suicide's mysteries is this: Exactly what happened is unlikely to be discovered, even if the clues add up.”

Death by suicide seldom “adds up” for those that survive individuals who choose to end their pain with suicide or choose to go on to another place where they hope that the pain is less.

Despite you column being focused on Mr. Jones, I hope that folks read your comments on death by suicide, that that reading provokes some though on their part (and maybe a little discussion), and that that awareness makes it seem a bit less of a mystery for another family member survivor of death by suicide.

Thank you for writing about death by suicide, a subject with much taboo in our society.

Life skills can prevent death

Earlier today while tidying up some stuff I came across a list that I vaguely remember copying down quite a while ago with the intent of writing about them. The list is entitled Life Skills (sorry I'm not sure who to cite, all I have is a list on a small piece of paper):

Problem solving
Conflict resolution
Understanding/Managing emotions
Empathy
Tolerance of others
Working in teams

Looking at them today I do think that they are critical life skills needed to become a mature, functioning member of our society (most societies that I know about). If we could inculcate these into all members of our communities we could go a long way to solving our problems with violence, as well as other problems that lead to preventable deaths in our community. I intentionally used the fancy word “inculcate” because it communicates the essence of how I think this “stuff” must be taught (inculcate = to impress on the mind by frequent repetition or instruction).

Problem solving without resorting to drugs, managing emotions so that they neither flare toward others or consume from within, working together to address problems and work toward solutions.

Kids need to be taught these skills at home, but they must also be taught and reinforced in the community in general by lesson and example. It must be a part of what is taught in schools, both subtly in literature selection and more obviously in things like social studies. It must be “taught” in the work place, by doing. It must be shown by example on TV, in other media, and in everyone’s day-to-day actions and interactions.

What a way to buff up society and grow community members with functional life skills. What a way to impact violence and the death and mayhem that results from it. What a great way (yes, rather grandiose, although we can start with a few) to forestall death.

Accidental Infant Asphyxial Deaths

Last Thursday and Friday I was at the 12th Annual IL Symposium for Child Death Review Teams. In addition to a couple of “business” meetings there were lectures on issues of child death.

The first lecture was about a constellation of deaths that, in the past, were often confused with SIDS. But these deaths are preventable, so it is important to look for us to look for them in investigations and based on the growing body of related information, it is incumbent on those of us involved in the investigation of these deaths to get warnings out to parents about them.

I have written some about it in the past. These tragic, accidental deaths occur while these children are in bed, most often in an “adult” bed. Broadly, they are suffocation or asphyxia deaths. They can occur with:

“Overlaying”, bed-sharing adult or child unintentionally lays upon the child either totally or partially, it only takes about 4 pounds of pressure on the neck for asphyxia to occur,

Asphyxia related a child’s face becoming trapped in soft bedding (infants are unable to move their heads out of position),

Asphyxia related to getting wedged into a space in which the chest and lungs cannot expand (often seen with trapping between mattress and wall or, as we have seen, between 2 couch cushions)

Suffocation when bedding or similar materials cover the child’s head and mouth

These deaths are way too common and are preventable. The “Back to Sleep” program to prevent SIDS has been very successful. Next we must push the information that bed-sharing is incredibly dangerous. [One point that the speaker brought up is that one of the major reasons for bed-sharing is the inability to afford a crib. A child dies because of poverty. That should not happen.] The other point that must be stressed (in part already out there, but it needs to be emphasized) is that children should only sleep on appropriate sleep surfaces, not soft surfaces, not buried in bedding, not with stuffed toys, and on a surface without the possibility that the infant might become entrapped.

We must work to prevent death and this is a great potential target for prevention.

"procured"

Hawaiian’s have a saying that “words move mana (energy)”.

This can become obvious in many ways, but most recently when a word I used was misconstrued and generated problems because of the “value” assigned to it by someone reading the report. An individual died tragically and because of the type of gentleman he was his organs were donated to save the lives of others. When asked by the media I gave what I thought was a fairly neutral and thought-out statement in response to questions regarding his organ donation, already known to at least some of the reporters, and the fact that he was pronounced dead over 24 hours after the crash. Apparently, my choice of words was not neutral. In response to their request for an apology or retraction, I have sent the following to the paper with a request that they print it soon:

My use of the phrase “organs were procured”, recently, has caused some confusion and concern and, most unfortunately, pain. The statement was used in the online version of a Daily Herald article on September 5. This is the terminology used by agencies and others involved in organ and tissue donation when organs are obtained by donation for transplantation and recipient use. This is most readily evidenced by the name of the Association of Organ Procurement Organizations, a national organization dedicated to ethical organ and tissue donation. It may be jargon, but it is the correct terminology in these instances.

I apologize that the use of this unfamiliar term created concern and pain for the family of this individual who died tragically. The word “procured” was used without any intent to denote the illegal, and unethical, action of buying or selling organs that has happened in other areas of this country and elsewhere.

I and the Lake County Coroner’s Office strongly support organ donation and celebrate the lives that organ donation is able to save.

Again my apologies to those who may have been offended.

Shielding kids with community

There was an article in last Sunday’s Chicago Tribune using the availability of bullet-proof backpacks for kids going back to school to make some good points about keeping kids safe at school.

The crux of the matter is laid out well in about the middle of the article:
So, as the new year gets under way, how do we keep our kids safe? By building caring school communities, where everyone is made to feel valued and people are vigilant about disturbing behavior.

Curriculum must push in-school community building, encouragement of diversity, and the teaching of (over and over again) the social skills necessary to value “the other” and to know what to watch for and how to report what you see so that intervention can take place earlier for individuals caught in escalating problems (violence, suicide, etc.).

We also must ensure that those kids in need of counseling and psychiatric help have access to that help. While it may make sense to some to cut the availability of these services as school budgets get tight, it is a terrible idea. There is no doubt that the need for these services in schools is growing. That is reflected in deaths by suicide, violence in our schools and outside the schools as a carry-over from school, as well as the not as obvious growing incidence of mental health issues amongst these individuals.

These are community problems that require community solutions, not “band aids” (even those as big and heavy as armored backpacks).

Fish for your brain

My mother always told me that fish was “brain food”. Of course the form that it took in my diet at the time was fish sticks. Although I do still crave them from time to time, there are lots of other forms more readily available these days.

Some recent studies bear out that fish is good for your brain (the studies looked primarily at fish oil supplements, although fish in the form of fish is better for you). A recent article summarized several of those studies. Studies in prisons demonstrated a decrease in violence coincident with supplementing with fish oil. Other studies showed improvement in depression. And still others demonstrated improvement in ADHD and autism symptomatology.

Omega-3 oils, one of the major components of fish oil, appear to facilitate the function of certain neurotransmitters improving cellular communication in the brain, which leads to the salubrious effects mentioned above.

So for your brains sake, eat fish regularly. At the very least supplement with fish oils, maybe even the cod liver oil that was used on kids routinely years ago. Of course eat a good, balanced, varied diet as well. Stay healthy and live longer. And, Lord knows, we can all use just a little something “extra” for our brains.

the blogging coroner

Chicago Tribune editorial "the blogging coroner"

Thanks for the mention.

"ask not for whom the bell tolls..."

Imagine my surprise a few days ago:

I had just finished my exercise routine at “the gym” (I don’t know that it quite rises to the level of a “work out”) and was walking out of the building. (Note: I take my lunch in the office so that I can go to the gym some days; I am getting in shape so I can serve as Coroner on into the future) As I walked into the lobby there stood one of my deputies with several local police officers. Really, that isn’t something you want to see after working up a sweat and pushing your heart rate up. Particularly since I have often “preached” that you are born with only a certain number of heart beats, use them up and it’s on to death. When you see something like this you can kind of flash on one of those movies where the character out-of-bodies at death and sees folks coming for his mortal remains.

But they had not come for me. It was part of the investigation of an individual who had been pronounced dead at a local hospital. An acute myocardial infarction, 52 years old, continued inducement for my staying in shape (although his was not related to working out at the facility, he had stopped to use the public restroom).

Shocking Autopsy

My wife pointed out a game in a catalog that we got in the mail recently. Imagine the “Operation” game jazzed with the electrical genius of Tesla and you’ve apparently got this game, “Shocking Autopsy”. Like Operation you remove things with tweezers (9 mayhem causing implements), except in this one not only is there an annoying buzz but an electric shock as well.

I’d buy one for the office but I couldn’t play:

Caution: Use at your own risk. Not recommended for children under 14 years old, adults over 50 years old or persons with ANY medical conditions

Death by Suicide happens all too often

Posted at the American for Suicide Prevention website:

Hey guys, thanks for taking the time to come check out my fundraising page. In September of 2007, I plan on participating in an '"Out of the Darkness" community walk sponsored by the AFSP. Suicide prevention and awareness is an issue that is very dear to my heart. Having suffered from major depression and anxiety disorders since I was 13 years old, I know personally the pain and suffering that comes along with these diseases and others like them, that unfortunately end in suicide all too often. I have been affected by this tragedy as well, and know that suicide is something that changes your life forever and is something that you never get over. In May of 2006, I lost a good friend named Maribel Garcia to suicide. She was a beautiful, kind-hearted girl who had everything in the world going for her. She was kind, friendly to everybody, smart, athletic, artistically talented, and had the smile of an angel. Because of her battle with depression, however, she was the only one unable to see all these things that were so amazing about herself. A lot of people didn't see it coming at all, but of course in hindsight there are always signs you think you should have caught or things you could've done to prevent it. By that time though, it's too late and a lot of people learned that the hard way that day. Losing her was the most difficult thing I've gone through in my life, and I don't want anybody else to have to lose a loved one to suicide. That's why I will be walking in Maribel's memory, and I ask that if this is a cause that you also support, please consider donating to either myself or somebody else on Team Maribel. All proceeds will go directly to the American Foundation for Suicide Prevention. It doesn't matter how much you donate, anything and everything counts and will be greatly appreciated. Also, feel free to come out and support us at Busse Woods on 9/29/07. It would mean the world and more to me, and so many other people who have dealt with similar issues. Thanks for your time! ---Megan

On the Students Overcoming Suicide MySpace site:

Most of all…be kind to other people. You don’t know what they’re dealing with in their personal lives or the kind of hardships they’ve face in the past. You don’t know who’s about to be pushed over the edge. Maybe the quiet kid who sits in the corner in one of your classes is incredibly lonely, and thinking about ending his life. Just a hello or maybe sitting next to him could be the difference between life and death for him. Something as simple as holding a door, or just offering a smile, could mean the world to somebody who’s in a lot of pain. Be compassionate and don’t judge. Do the best you can to love yourself. If we can’t love ourselves, there’s no way we can truly love others, and we’re all we really have in this world. ---Megan

Her death by suicide occured a few weeks ago.

Megan offers some things that ought to be easy to do and maybe we can help lighten someone else’s load just a bit and make a real difference in their life with a simple kind gesture. I hope and pray we will.

IL Child Death Review Teams

Illinois established multi-disciplinary and multi-agency Child Death Review Teams (CDRT) in 1995. They consist of a network of 9 regional teams with review and coordination by a statewide Executive Council. As related in their annual report, “in accordance with state statute this system reviews unexpected and unexplained deaths of children 17 years of age or younger”. Reviews target, in particular, deaths of children who are “known to the Department of Children and Family Services (DCFS)” as well as “the deaths of other children who died unexpectedly”.

As someone said, the CDRT system “serves as the voice of child death review in Illinois”. By means of case review and discussion utilizing a broad expertise brought by the team, recommendations are made regarding actions that might be taken to prevent similar deaths in the future. This will be particularly true with changes made with recent legislation. With its implementation not only will preventative recommendations be made to DCFS, but a new reporting mechanism is added to report to members of the state legislature for their review and possible action. I see this as a great addition to the effort to prevent childhood deaths; although there are a few other provisions in the legislation as passed for which I am waiting to see how the implementation goes.

I look forward to continued participation in this effort, 2 years on the regional level and now as a member of the Executive Council. I am a bit unique for them, because I bring not only my expertise as a Coroner, but also my years of Emergency Medicine experience, Primary Care experience, and years of experience doing child abuse and child sexual abuse evidentiary exams for the local Child Advocacy Center.

Help Shape the Future of Lake County’s (IL) Website

Have you ever visited Lake County’s website? We want to know what you think. You can participate in a unique opportunity to help shape the future of Lake County’s website. Our goal is to make it easier for citizens and customers to access services. Your input is extremely valuable. If you are interested in participating in a focus group, please email Lake County Communications at communications@co.lake.il.us. Participants are asked to commit no more than two hours of their time and will participate in a group question and answer session. The sessions will take place in early September and there will be day and evening sessions available. Participants will receive a thank you gift for volunteering their time. Lake County government welcomes and appreciates your input as we embark on this important project to improve access to County government through e-government services.

More deaths if flu overtaxes overcrowded ERs

I have written (in addition to my speech in Boston at the Association of Black Cardiologists meeting) before about ER care and overcrowding and its contribution to deaths. As I have said some real changes must take place or the problems will only get worse. I have, also, been in talks with a cardiologist with WomenHeart about putting together a national effort to do just that and look forward to that effort.

I came across an article today that drives home the need to address ER care issues sooner rather than later. It seems Australia is experiencing a particularly virulent flu season (theirs is opposite ours and possibly upside down). The incidence of the disease appears to be triple the previous year. This strain is making folks sicker and possibly has a higher death rate than with previous year’s strains and it is just the “usual” influenza A that occurs annually (not “bird flu” or anything exotic).

The biggest concern (not that the flu itself is not concerning) is that the illness is overwhelming their healthcare infrastructure. That sort of “pressure” will undoubtedly contribute to increases in other death categories. As we know, ERs are nearly at capacity on a good night, what with increased patient numbers, sicker people presenting, and full hospitals backlogging patients into the ER.

Will our next flu season (in a few months) be equal to Australia’s in severity? If so, we need to begin to address the problem now so that we have some plan to handle the limited resources that a serious flu epidemic will “test”. Let’s do it before we have anyone else die in a hospital ER waiting room (see also).

Prescription painkiller overuse can be a killer

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

An AP investigation found these reasons for the increase:
The population is getting older. As age increases, so does the need for pain medications.
Drugmakers have embarked on unprecedented marketing campaigns.
A major change in pain management philosophy is now in its third decade.

Consider (however):
More people are abusing prescription painkillers because the medications are more available. The vast majority of people with prescriptions use the drugs safely. But the number of emergency room visits from painkiller abuse has increased more than 160 percent since 1995, according to the government.

We have been seeing an increase in deaths related to prescription painkillers. Some of those individuals have died by suicide, but most are accidental deaths. These accidental deaths fall into several categories: partying/experimenting, self-medication gone awry, over-prescribing and misuse. The misuse can be on the part of the decedent or, miserable dictu, on the part of the prescribing physician.

I have no problem with prescribing pain meds when appropriate and in needed doses, I have in the past treated many individuals with severe acute and chronic pain, including those with severe AIDS-related neuropathy. It is critical, however, to know the meds you are prescribing: actions, interactions, side-effects, etc.

We have had a few cases lately that have revealed that some physicians prescribe this class of meds without knowing quite what they are doing. For example, fentanyl (not looked at in the AP article, but one we are seeing with increased frequency). Fentanyl delivered in a skin patch has a very long half-life causing it to build in the body, if not used properly, until toxic and potentially lethal levels occur. When we have discussed this with a few physicians we found that they were unaware of that possibility and of some other characteristics unique to this drug and delivery system.

We have seen over-prescribing by a very few physicians, cases we have reported to Professional Regulation and the DEA. We have seen individuals taking meds who apply the “rule” that if “one is good a few are even better” with disastrous results. We have seen folks not controlling the meds they bring into their homes, often not realizing just how deadly they can be if misused.

Control of painkiller misuse and abuse, as is true of several things I have brought up in this blog, will require “system” changes. Our office will continue to work to stop those few “bad apple” doctors abusing the system, harming or contributing to the deaths of individuals. Other doctors must be educated or educate themselves regarding the proper indications and use of these pain meds, as well as their possible interactions with other meds, their potential side-effects, actions, pharmacokinetics, etc. People need to be aware that these drugs have a potential for addiction and abuse just like that street drugs and should be treated with “respect”.

Pain meds are useful tools, but like any tool, when improperly used they can harm or kill.

Beware web information sources

I was reading through a website recently: “The Writer’s Medical and Forensic Lab” and found it wanting (it is amazing what you can find when you wander the web). He holds himself out as an expert in Forensic Science and Medicine, and the purpose of at least a part of his website is answering questions from writers about death and medical issues for the things they are writing.

It is wanting because while his answers aren’t wrong the answers he offers are often not quite right or complete either. For example, in his answer to a question 3-14-07 about “psychological paralysis” he fails to mention that the definitive test to rule out extremity paralysis would be an EMG (electromyography), instead he states after ruling out head injury with various tests, “A psychiatrist would be brought in and the diagnosis would be made.” While that is likely when treatment would begin, it would not likely be how the “diagnosis” would be made.

In another answer (7-27-07) he states that the trachea and the larynx “could collapse and block the passage of air” when stuck though by a sharpened drum stick. Both of those structures are essentially rigid cartilaginous structures that can be fractured, crushed or lacerated, but they will not “collapse” due to a single sharp object transversing them.

I haven’t read this guy’s books, but I’d have to wonder how “good” they are. I do however like his last caveat on his home page:

The information found on this site is not to be used for any criminal activity or to bring harm to anyone.

Media face-time

I got a “message” recently passed to me through one of my Deputies from a local law enforcement official (kind-of reminds you of grade school doesn’t it). The message was (to paraphrase): You ought to come out when there is a high profile case, the media is there, when the previous Coroner was in office (meaning the longer serving individual in office prior to the one I was elected instead of) she would have been there.

I don’t do that and I will not do that. Going someplace related to a tragedy (that is after all the basis of the work of my office) just to get “camera time” is not my way of doing things. If a case that my office is involved in gets media attention and the media seeks me out or if there is a real reason to hold a press conference to get out information to all of the media at the same time and in the same way, I will participate.

I will respond to a scene from time to time, not with the intent to be seen, but with the intent to see and learn about the case, to participate in my office’s investigation. That is the way I plan to keep it. Even when I am not physically at the scene I am talking with my Deputy running our investigation on the scene, listening, discussing and consulting on the investigation. That is my role (much like when I was in the ER and paramedics were in the field under my direction and serving as an extension of “me” into the field).

I feel it is unfortunate that others don’t share my thoughts on this. I have seen officials arrive at scenes for the face-time. There are plenty of opportunities for me to work with the media without my seeking them out or seeking out “camera time”.

Designated Drivers to Prevent Deaths

The DailyHerald has an editorial, “Message must get across to save lives”, written in response to a recent car crash in which the driver was over the legal limit of alcohol for driving in Illinois (the phrase often used: “legally drunk” is wrong in so many ways). The crash was horrific according to reports and people were killed.

They close with a fairly simple proposal that could do a lot to prevent alcohol-related crashes and deaths (although the first thought should likely be to not drink to excess/intoxication). There closing paragraph:

It brings us to a key point we want to stress at such a sad time: Several years ago, the concept of a designated driver became a popular message amongst law enforcement agencies and the alcohol industry itself. It is an easy and effective way to keep groups of partygoers safe. We encourage all people of legal drinking age to adopt such a routine when knowing ahead of time that there is a chance of consuming over the legal limit at a sports event, concert, party or festival. It is something that a true friend will do for others, and it will save lives.

To borrow from the Surgeon General’s statement regarding underage drinking (It is a truism that pertains to so many “problems”, although “problem” seems an understatement): “The solution is everyone’s responsibility”.

I hope for no more crashes

First, to the individual who left the voice mail at my office, I did get it (although it is not likely he reads my blog). It was a lovely piece of work filled with invectives and scatological references.

Second, all the results of my office investigations are public record, so releasing a blood alcohol result (I should note that the release is only in response to request of the media, not in some sort of preemptive release) is action in accordance with the law.

I rarely get vitriolic voice mail with the release of investigation results. Apparently only certain cases fall into categories which certain individuals feel should be protected from public view.

The results were not released to harm anyone or their family or to denigrate anyone’s contributions to the community. The facts are that a driver of a motorcycle had been drinking and had an elevated blood alcohol. Yes it is my opinion (in agreement with Illinois law) that he should not have been driving with that much alcohol in his system. [I knew the DuPage County Deputy State’s Attorney who recently died while driving intoxicated and feel that releasing the results in her case was also the right thing to do.]

While my caller said releasing the blood alcohol results should also be exempt because it was a single vehicle crash, it is only by the grace of God that that was the case. I drive the street on which the crash occurred, as does my family, people I know and people I do not know, and I thank God no on else was injured or involved. I say this not to demean the gentleman involved, I know he was a very good police officer and a beloved family man. I pray for him and his family.

The facts are what they are. I hope there will not be any more crashes, no more lives lost before they have reached their full potential, no more family and friends mourning the loss of a loved one. I hope…

[FYI: Officials: Alcohol Played Factor in Officer’s Crash]

Life after death

There was an interesting article in AARP The Magazine that I got the other day (yes, hard to believe, but I am over 50). It was titled "Life After Death” and was based on a survey of individuals over 50.

They found that 73% of the folks surveyed did indeed believe in a hereafter, with woman (80%) out-numbering men (64%) in that belief. Interestingly, but not surprisingly, two-thirds of the folks said that their belief in an afterlife has grown as they have aged. This seemed to be related both to exposure to others’ deaths as well as the feeling that they are getting closer to their own. Most folks’ view in the life hereafter is pretty conventional with heaven and hell being the destinations.

Interestingly, 88% of those surveyed felt they were going to heaven after death, but have a lower opinion of other folks, feeling that only 64% of others would be joining them in heaven. To me that doesn’t speak highly of how they view their fellow “man”. The other survey result that seemed to raise questions in my mind was that 23% of folks also said that they believe in reincarnation. Apparently there is an overlap of those believing in heaven and those that think they may be “coming back”. Maybe they are just keeping their options open.

The last bit that I wanted to mention was the pretty strong belief in ghosts and spirits with 60% of women and 44% of men expressing that belief. This belief was highest among 50-somethings (64%) and lowest among those 70 and older (38%). Quite interestingly, 38% of believers have their belief based on personal experience. For those who may be curious, yes I am among the believers in ghosts/spirits and, yes, based on personal experience both on the job and off (the house I lived in before my present one was particularly “visited”).

Effect of Horror Movies?

I ran across an interesting article yesterday: “Science Uncovers What Literary Critics Have Always Known”. I agree with the point:

Horror movies appeal because humans like to feel grossed out and entertained pleasurably at the same time. There's a payoff in coexperiencing two conflicting emotions.

But I think the author glosses over a point made in the study that I think needs further examination:

They suggest that people who enjoy the yuck-yay feeling of horror movies are masters at psychological framing and distancing. Horror viewers who have the most fun are also the ones who are most convinced that what they're watching isn't real.

The study circumstances were quite artificial in at least one regard (the other being not using a more recent crop of horror films). The study subjects were repeatedly reminded that the movie characters were movie characters:

The researchers proved this point by showing people horror films alongside biographies of the actors playing the main characters, constantly reminding viewers that these were just movies and the “victims” were playing roles. Even viewers who normally avoid horror movies reported that they were a lot more comfortable and had some fun when they were reminded that the action was staged.

Do movie goers separate the fantasy as well under normal viewing conditions? Could not separating it as well contribute to less empathy and more desensitization to violence rained upon others? How would that translate into future actions in “the real world”? I don’t mean necessarily making them more violent toward others, although without further study I am not sure you can say one way or the other, but does it make us less empathetic or sympathetic toward others? Does it make us “numb” toward violence, less aware and more accepting? And, if so, what is that effect on society? Does it make them less “reachable” with “shock” messages based on avoidance of violence/injury?

That is the information I would like to see. It is my gut-feeling that these increasingly violent and disgustingly graphic (but not really realistic) movies have to be “bad” as a steady diet and maybe even if just consumed episodically.