Friday, May 30, 2008

They Ask Questions

I am a writer for Bridges Transitions. I am researching an article about Coroners and Medical Examiners. The idea is to let our young readers know what this career is all about, and how they can pursue this career if it interests them.

Bridges Transitions is the leading provider of career and educational planning solutions. Our service is used for career development in thousands of North American middle and high schools, libraries, employment centers, military sites, post-secondary schools, and corporations. We provide comprehensive work-related articles to help our readers with important career choices. For more information about Bridges Transitions, please visit the corporate site

Interview Questions

1. What do you like most about your job? (What makes you feel passionate or excited about what you do?)

Certainly investigating all the different ways people die is interesting and exciting, but by the same token getting out and talking to folks (particularly youth) about our work and how they can forestall their own death is really great as well.

2. What is the hardest part of your job?

Dealing with the deaths of children and teens (it strikes close to home) and having to tell their parents of their death (kids shouldn’t die before their parents.

3. Would you encourage people to get into work like yours? Why or why not?

It is great work, but it not for everyone. It is difficult work mentally and physically. The deaths of kids, dealing with a decomposed body, or a gruesome death are all tough. Equally tough are working in the cold, rain, mud, and all the locations and conditions that can surround a death.

As Coroner you also have to deal with the politics, administrative, and personnel issues that don’t show up on CSI.

4. Could you share a story about your work? For example, when you are older, what stories will you tell about what this career has done for you and what you have done for others? What experiences have you had at work that stand our in your mind?

We had an individual who died outdoors and was found 6 weeks later. When he was found he was badly decomposed, odiferous and consumed by nature and maggots. We could only identify him because his distinctive tattoo had “survived”. To find his cause of death required deduction and reasoning among all the staff. We suspected he had died of cocaine intoxication (based on circumstances and his history), but there was no blood or other body fluid available for testing. So we used a blender on the colony of maggots that was where his brain should have been (long before the somewhat similar CSI episode). On testing the resultant mass (which looked a bit like a chocolate malt) in our toxicology laboratory, we found that he had indeed died from the use of cocaine. The maggots were positive for cocaine that they had acquired by consuming him.

5. The US Bureau of Labor Statistics does not have a category specifically for coroners. Can you estimate how many coroners work in the US? Or in your State?

There are 99 Coroners in Illinois and 1 Medical Examiner. In my office I also have 7 Deputies/Investigators, 1 Toxicology Laboratory Supervisor (Analyst) and her 1 assistant, 2 Secretarial personnel (Executive Assistant and Secretary). There are other options for jobs in this field beyond Coroner and/or Medical Examiner.

The Bureau of Justice reports 1,998 coroner and M.E. offices nationwide.

6. In your opinion, what is a fair representation of the salaries of Coroners?

Coroner salaries in Illinois range from $10,000 to $116,000 per year.

7. In your opinion, how is the employment outlook for future Coroners? Are there any trends affecting this career?

There will always be deaths and the need for investigating them. There is some trending nationwide to changing from Coroner to M.E. systems, as well as increased credential requirements.

8. What advice could you offer a young person interested in becoming a Coroner who is trying to decide on an educational pathway?

There are some good Forensic Science programs in various places, but there are also some coursework that has been thrown together to catch the wave of interest. Look for older, established programs. Otherwise most science educational backgrounds and medicine are useful. In Illinois the only requirements for Coroner (an elected position) is to be 18 and a registered voter

9. What is your educational background? What career path led you to your current position?

I am a physician who came to this targeting the public health aspects of the job (working at forestalling death)

10. What are the physical requirements for the job? Could a person with physical limitations or other special needs become a Coroner?

A Coroner, but likely not a Deputy/Investigator (see above).

11. Are Coroners ever placed in situations that require tough decision-making? What is a possible dilemma, and what are the options? (For example: can you think of a time you had to make a tough decision on the job? What did you do in the end?)

As an example, I was vilified (and praised) nationwide for this case (not that there are very many this high profile):
"Woman's Heart Attack Death Ruled a Homicide"
I got 67 emails last Thursday from all over the US after a link was placed on the WomenHeart website about a recent death here in Lake County and the inquest jury’s verdict. The death was of a 49 year old female who presented to a local ER with 10 out of 10 chest pain, shortness of breath and nausea. She died waiting in the waiting room, 10-20 feet from the care she needed to interrupt her heart attack. The jury came back with a verdict of “homicide”. It was the jury’s feeling, and certainly mine, that this case demands a change, an improvement, in the system that allowed this woman to die on a couch in a waiting room after a 2 hour wait. The emails I received reinforced that opinion.

Our country should not have a healthcare system that fails so many in our “community”. It is obviously a system problem and it must be addressed before it kills again. No one should “hang” for this death or any individual death that is a result of a system problem, but we must call attention to the problem that is killing folks. We must demand change. We must demand quality healthcare. Individual malpractice suits are not affecting the system, so we must find other ways to bring this discussion to the fore.

…The lead story for the December 2006 Emergency Medicine News (not avaialble online) is headlined: “Homicide Charges Against ED Stun EM”. It is a story based on the death of Beatrice Vance and our Coroner’s jury verdict of “homicide” (there are no “charges”).

… The homicide verdict is not an attempt to destroy a hospital or all ERs (as one emailer suggested), but the honest verdict of a jury of 6 that there was a “gross deviation from the standard of care” and that the inaction in this case was “reckless”. By our definitions of manner of death that is “homicide” (again recall that does not mean criminal homicide).

When I ran for office, I pledged to also investigate “medical misadventures”. Just as our office obviously is there to serve decedents who can no longer serve themselves, just as much we are here to protect the living residents of Lake County and to forestall death when we can.
(Material from my blog,

12. How important is communication in this field? Please explain.

Communication verbally and written is incredibly important and is one of the most important skills high school students can work to develop when thinking of this field.

13. We provide high school students with a math problem that might be used by people at work. How important is math in this career? Could you give an example of a situation or problem that requires you to use math on-the-job?

Probably the most common math problems we do are figuring out how old someone is at the time of their death (not as easy as it might first appear). We use math in the pharmacokinetics of drug overdoses, crash scene investigations and other instances esoteric and common.

Thursday, May 29, 2008

Is TV viewing addicting?

I was watching my 10 year-old last evening. I had just asked her to set the table for dinner, so she was picking up some playthings while watching the TV and, supposedly, preparing herself to set the table. Instead she stood transfixed, staring at the TV. Zombiefied. This isn’t the first time (and I’m sure it will not be the last) that I have seen this happen to her.

Stumbling through the Internet today, looking for something else, I came across a possible explanation for that behavior, as well as her seeming addiction to watching the set (or a computer monitor) and why she seems to often be a changed person after watching for a while.

…people who were watching TV …reported feeling relaxed and passive. The EEG studies similarly show less mental stimulation, as measured by alpha brain-wave production, during viewing than during reading.

What is more surprising is that the sense of relaxation ends when the set is turned off, but the feelings of passivity and lowered alertness continue. Survey participants commonly reflect that television has somehow absorbed or sucked out their energy, leaving them depleted. They say they have more difficulty concentrating after viewing than before. In contrast, they rarely indicate such difficulty after reading. After playing sports or engaging in hobbies, people report improvements in mood. After watching TV, people's moods are about the same or worse than before.

Within moments of sitting or lying down and pushing the "power" button, viewers report feeling more relaxed. Because the relaxation occurs quickly, people are conditioned to associate viewing with rest and lack of tension. The association is positively reinforced because viewers remain relaxed throughout viewing, and it is negatively reinforced via the stress and dysphoric rumination that occurs once the screen goes blank again.

Habit-forming drugs work in similar ways. A tranquilizer that leaves the body rapidly is much more likely to cause dependence than one that leaves the body slowly, precisely because the user is more aware that the drug's effects are wearing off. Similarly, viewers' vague learned sense that they will feel less relaxed if they stop viewing may be a significant factor in not turning the set off. Viewing begets more viewing.

My daughter is a TV addict, are you?

However, I must admit that an occasional mental massage by the TV does feel good.

Wednesday, May 28, 2008

Pre-Prom Death Prevention

I did my last pre-prom presentation for this season today (a school not even in my county). I never really know if I have said something that will make a difference or not. There are blank stares, groups of teens talking amongst themselves, texting, etc. There are also attentive looks, laughs at the right times in my presentation, times of hushed silence, etc.

I talked about driving drunk or on drugs, driving distracted, the possibility that they could die or hurt or kill someone else. I spoke of many things.

As I was leaving the school one of the school security people stopped me and told me she had listened to parts of my talk, she was too busy to stay the whole hour. She told me it was good and that she hoped that it had sunk in to at least some of the students. I do too.

I told the students to remember just 5 things. That the rest of the talk was just dressing for those things, stuff so that the important points might be remembered:

Don’t take chances
Make good choices
I don’t want to tell their parents that they are dead
Stay out of my office (until you are very old)

Those are my points and I will take every opportunity to communicate them to teens and kids and adults. I will always hope that they sink in and make a difference.

Friday, May 23, 2008

Letter to local folks in youth groups and schools

As the Suicide Prevention Resource Center put in their recent “Preventing Youth Suicide in Rural America: Recommendations to States”:

“Many adults and youth are likely to encounter a suicidal person at some point in their professional or personal lives, but lack the skills, comfort level, and training to recognize warning signs or respond effectively…a community-wide cadre of trained “gatekeepers” may make a difference.”

A recent attempt to help develop a “cadre of trained “gatekeepers”” in Lake County middle and high schools met with minimal success. The Lake County Suicide Prevention Task Force will continue to push for that with materials developed locally by Dr John Jochem. We will be working with the Regional Office of Education Superintendent’s Office into the next school year in another attempt to get the material to school personnel at all levels.

However, to attempt to reach a tipping point sooner and to offer it to even more individuals who regularly interact with youths who might be suicidal I am sending the links to the material for your review and consideration. These materials are available on the Lake County Coroner website.

Letter to school administrators

Project Safety NET

Feel free to use the materials for education in your organizations, communities of faith, etc and feel free to disseminate them to others who might be interested.

Richard L Keller, MD
Lake County Coroner
Lake County Suicide Prevention Task Force

Thursday, May 22, 2008

Social Skill Education to Prevent Violence

I was reading about “Dealing with the School Bully Epidemic” the other day and a followed a link to a program that has been developed to teach “Social Smarts”.

From “Dealing with the School Bully Epidemic”:
Today's children are just not coming into school -- into life -- equipped with adequate social skills and character development that helps them understand that this kind of behavior is simply not OK. They are not taught to respect and value differences among people, in opinions, in actions…
People may argue that social skills education belongs in the home, not in the schools, and I'd be the first to agree. But, our schools have become a war zone, where teachers spend more time disciplining students and trying to keep order than they do teaching! Is it any wonder our schools under-perform? If you were losing 20/30/50% of your average educational time because of behavior issues, how effective do you think you could be?

The “Social Smarts” program emphasizes:
… thinking "beyond oneself"
… kindness and consideration in all dealings with others
… behavior must not only be taught, but also must be practiced and reinforced by example in the family, in schools, and in the child's everyday world.
Rather than dismiss manners and etiquette as old-fashioned, fussy, and irrelevant… we need to return to a more civilized period of behavior, where people are responsible and accountable for their words and actions.

Although the world can be a rough place in which to live, and we cannot always change what others say and do, we can change how we act and speak, and hope that by "keeping our own houses clean" we can serve as positive examples in our homes, our communities, and in the world at large.

Those social skills are key, I believe. Couldn’t we all use a refresher in proper social skills and frequent reminders of proper manners and proper action? Teaching these skills and principles in our schools and working with parents to help them reinforce the lessons and working with society (including the media in all its forms) to highlight good examples that will likewise reinforce manners and “good” behavior can help reclaim our future and our future generations. It can improve our society, decrease violence and all its terrible consequences (yes, including death). [Although I do believe we need a non-proprietary, inexpensive program that is easy to disseminate to all, because all are in need.]

Wednesday, May 21, 2008

HIV Anniversary

I was reminded that yesterday was an anniversary (or birthday, as the writer put it). 25 years ago an article in Science described a virus (later named HIV) was found in an individual with acquired immune deficiency syndrome and was the likely cause.

I practiced HIV Primary Care from 1993 into 2003 (in a practice I helped start and grew as its lead physician). I will never forget the many experiences that practice afforded me. To say that the patients and the disease touched my heart is an understatement.

I often talked then of how “compassion fatigue” drove HIV/AIDS out of the news and most people’s minds. It is worse now. We must remember that over 25 million people have died from AIDS since 1981. The AIDS rate in Washington, DC is 5% currently.

AIDS means a mother can't work to feed her children. It means that a sister has no brother to protect her from neighborhood thugs. It means that a family, a community, and a culture is torn apart. AIDS means that teachers can't teach and students can't learn. AIDS means that the road out of poverty is slow, albeit impossible. AIDS is a societal transformation and so much more.

The treatment for HIV is much better these days, but there is no cure. We must make sure that folks have access to care (good care) and that research continues. HIV hasn’t gone away we just don’t think about it much any more. My heart is heavy with its memories.

Tuesday, May 20, 2008

Particularly Dangerous Situation

I was watching CNN the other day and there were a large number of very serious storms happening across the mid-section of the US, but CNN wasn’t talking Severe Storm Warning or the like. They were issuing several PDS warnings (Particularly Dangerous Situation).

I really like PDS (Particularly Dangerous Situation). It would seem to have a very wide range of application. Storms, earthquakes and pestilence would fall into the category.

In our line of work a body in an unsafe environment (e.g. shooter still present) could warrant a PDS alert. Folks drinking (or using drugs) and driving ought to get a PDS alert. I like the idea of a broad based warning, useful until overused. I look forward to using it.

Monday, May 19, 2008

One of three pre-prom events last week

Crash simulations and presentation to head -off drinking and driving among teens. As always we hope we made an impression and that they think, don't take chances, and make good choices.

Wednesday, May 14, 2008

Lifted from a recent email

I just want to thank all of you for your educational emails over the past year:

Thanks to you, I no longer open a public bathroom door without using a paper towel.

I can't use the remote in a hotel room because I don't know what the last person was doing while flipping through the adult movie channels.

I can't sit down on the hotel bedspread because I can only imagine what has happened on it since it was last washed.

Eating a Little Debbie sends me on a guilt trip because I can only imagine how many gallons of trans fats I have consumed over the years.

I can't touch any woman's purse for fear she has placed it on the floor of a public bathroom.

I no longer use cancer-causing deodorants even though I smell like a water buffalo on a hot day.

Because of your concern I no longer drink Coca Cola because it can remove toilet stains.

I no longer can buy gasoline without taking someone along to watch the car so a serial killer won't crawl in my back seat when I'm pumping gas.

I no longer use plastic wrap in the microwave because it causes cancer.

And thanks for letting me know I can't boil a cup of water in the microwave anymore because it will blow up in my face...disfiguring me for life.

I no longer check the coin return on pay phones because I could be pricked with a needle infected with AIDS.

I no longer go to shopping malls because someone will drug me with a perfume sample and rob me.

I no longer answer the phone because someone will ask me to dial a number for which I will get a phone bill with calls to Jamaica, Uganda , Singapore and Uzbekistan .

And thanks to your great advice, I can't ever pick up $5.00 dropped in the parking lot because it probably was placed there by a mugger waiting underneath my car to grab my leg.

I no longer buy expensive cookies from Neiman Marcus since I now have their recipe.

Tuesday, May 13, 2008

Treating depression can make you healthier

Yet another reason to ensure that depression is treated appropriately:

Natural Killers (NK) cells in your body are responsible for attacking and killing virus-infected and cancerous cells. Studies have demonstrated that NK cell function is decreased in folks with depression. Now a study has demonstrated that treatment with anti-depressants improves that NK cell function.

Treat depression and increase immune function, quite probably decreasing morbidity and mortality. Further proof that medical care is a good investment and can improve health.

Monday, May 12, 2008

Emo not a cause of death

[You may notice that the quote below is a link to MySpace. Now I don’t cruise MySpace, but do from time to time come across a link to that networking site.]

Apparently recently in the U.K. a coroner blamed emo music for the death by suicide of a 13 year-old girl. Wouldn’t it be great if it was really that simple? Merely do away with one type of music and kids will stop dying by suicide. Similarly, as discussions seem to be running in the media lately, do away with guns and kids will stop dying from violence in our streets. No problem is that simplistic. All of these types of problems are “over-determined” with multi-factorial etiologies. Their solutions must similarly be multi-pronged, addressed on many fronts. That is not to say that they can be solved, but that they will require work and not magic wands or bandaids.

As someone posts in their comments in the discussion on the girl’s death:
NME.COM user Time For Something Bibical said: "My heart goes out to her family, but you don't get 'suicidal' just solely by listening to 'emo' music, there are always deeper reasons and connections

We must work on these “deeper reasons and connections” while providing an out, access to help and folks pushing/assisting those in these sorts of spirals to access that help.

One last aside, in response to a recent question posed to me I could not find any research demonstrating a causal link with emo music and suicide (including asking some folks I know for some help in the search).

Wednesday, May 07, 2008

Illicit Drug Prices

I was looking through a document put out by the National Drug Intelligence Center (US Dept. of Justice) titled: National Illicit Drug Prices. [It was emailed to me so I don’t have a link]

It really struck me how this report discusses this stuff similarly to other commodities. It is a commodity based business after all. It includes information on the prices of various illicit drugs at the wholesale-level, midlevel and at the retail end of the business. It talks about how some sporadic shortages and their concomitant price increases may be caused “by Columbian suppliers’ shifting cocaine from U.S. drug markets to European markets…taking advantage of the stronger euro…”

Also driving the cost of the drugs is the issue of purity at the wholesale level. Increased purity at the wholesale level in turn increases the amount of midlevel and retail drug that can be derived per kilo of wholesale-level drug. “The price of a kilogram of heroin in Chicago decreased…(related to)…heroin purity recently increased…ending a nearly 10-year decline…increasing availability of the drug.”

I am not sure that we view the drug trade as much as a commodity business as it really is, with various market pressures. This isn’t a discussion of right or wrong, Lord knows we see the heavy toll of these illicit substances, but just an observation as my thoughts were provoked by the publication.

It would be interesting to see drug-related deaths and other drug-related problems and crimes plotted against these price fluctuations.

Monday, May 05, 2008

Suicide magnet?

I agree with the author of this series of articles (I & II). Signs suggesting that folks prepared to jump from a bridge should call a suicide hotline are not going to change the death toll. You can park your ambulances down stream and pluck the dead and dying from the waters or you can do all you can to prevent them from jumping. A part of that are preventative barriers. A part of it is pushing suicide prevention (making access to mental health care readily available, hotlines, working to decrease stigma attached to seeking caring, etc) before these folks get out onto the bridge.

Awareness is key. (Thanks for the links, Randy)

Friday, May 02, 2008

Medication sharing can result in death

A recent report:

…roughly 23 percent reported loaning their prescription medications to someone else, and 27 percent reported borrowing prescription medications.

The medications most frequently shared (loaned or borrowed) were allergy drugs like Allegra (25 percent), followed by pain medications like Darvocet and OxyContin (22 percent); and antibiotics like amoxicillin (21 percent).

Seven percent of those interviewed said they shared mood-altering drugs like Paxil, Zoloft, Ritalin and Valium.

This certainly seems to agree with what we see in our cases of death due to licit drug intoxication or overdose, although certainly our death cases are more heavily weighted toward pain meds and “mood-alerting drugs”. This is a huge problem. People really don’t realize the danger in sharing, trading, and taking someone else’s meds. Just because they come from a drug store doesn’t mean they are always safe.

Thursday, May 01, 2008

Lake County Coroner’s Office Investigation of a Death

Notes from a recent presentation I did to discuss how much work goes on with (and it is by no means all-inclusive):

Lake County Coroner’s Office Investigation of a Death

The Call:
The On Call Deputy receives the call of a Death
General Information about the Deceased if available (may take several calls)

The Scene:
Collection of Evidence, Photodocumentation
Collection of Personal Property and Physical Evidence (Chain of Custody)
The Body
Preliminary Drug testing (Urine draw)
Interviewing of Witnesses and Family

Types of Scenes (many are “Messy”):
Train Tracks
Highways and Byways
Burned Homes
Fields and Streams
“Scary” Homes (see above)
Nursing Home

“Bad Scenes”:
The Decomposed
Motor Vehicle Accidents
Gun Shot Wounds

Making Identification:
Wallet Content
Live Scan, fingerprinting
Forensic Odontology, Forensic Anthropologist
DNA Sampling

Find Next of Kin (can take quite a bit of work)
Notify of death
Discuss Office Procedures and Protocols affecting the Decedent
Get support for family if necessary (brochures and website references)


Procedure itself, Assisting Pathologist
Collection of Evidence
Toxicology from blood urine, vitreous, bile, liver, brain (rarely maggots)

Call Sheet, Data Sheet, Narrative, Call Log, Personal Notes
Temporary Death Certificate, Permanent Death Certificate
Police Report, EMS Report
Medical Records reviewed
Toxicology Report
Autopsy Report
Verdict Sheet
Letters to Family

Case Conferences:
Presenting Case Investigation Details
Deciding Manner of Death
Closing Case and Final Death Certificate

Community Outreach:
Pre-Prom Demonstrations
Career Fairs
Office Tours
Driver’s Ed
Science & Health Classes at High Schools and Colleges
Parents Groups
Suicide Prevention Task Force
Child Death Review Team
Nursing Home Death Repoprting Pilot Project

Key “Partners” we work with:
Law Enforcement Agencies, Fire Departments, MEG (local Durg "Enforcement" Groups)
Major Crimes Task Force and Major Crash Accident Team