Coroner--mundane and TV-like

Just to mention some of the stuff that would never get onto CSI, but stuff that is part of the Coroner biz just as much as the stuff that makes the shows and the news. It’s all glamour, don’t you know.

I got into a discussion with the Purchasing Department about whether we needed a color copier or would be “better served” by a color scanner and color printer. Of course the “better served” really boiled down to money. It is cheaper to buy a scanner and printer with a black and white copier than a color copier, so ‘if you could maybe get by with the scanner and printer we (the County) would be grateful’. I caved quickly, figuring they would want some analysis as to why it was necessary, more than just a convenience. How about that for a CSI episode suggestion, justifying a copier purchase?

How about the “case of the missing gas ‘key’”? We need a vehicle specific chip-key to get gas at the county pumps. This weekend the key for our van went missing. Nobody knew where it was. There was a bit of “it isn’t my fault” and “I didn’t lose/take it”. Then suddenly, as if by magic, it reappeared on the counter on Monday. The whole episode struck me more like an episode with my kids than trained professionals. How about that for a CSI episode suggestion, the missing gas key?

How about my asking the County Administrator if when we bring our new transport vehicle “on-line” if we could keep the old one as a spare vehicle. With reduced use its useful life could be extended. This is supported by our Department of Transportation. But it is vacation time, so we have to wait for a decision until after vacation (not mine mind you, but therein lies the rub). On the other hand the Transportation folks want a decision ASAP or it may be marked for auction. How about that for a CSI episode suggestion, vehicle decision making to be continued?

How about the recent battle in/with a committee of the County Board to get a much deserved raise for one of my employees because I have increased her work responsibilities. That might make for “must watch TV”. How about that for a CSI episode suggestion, exciting politics and business management?

Parts of my life may be like a TV show, but mostly it is mundane and likely not fit to print. I do, however, look forward to long service to the folks in my county and assure them I will be the best Coroner I can be (even with the run-of-the-mill actions, it makes the action actions even sweeter).

"System" failure kills

Whoa, the emergency medical/healthcare system needs to be fixed, everywhere.

"Woman dies in ER lobby as 911 refuses to help"

Accident?

Tissue donation oversight

“FDA Steps Up Oversight of Body Parts Companies”

Although I wouldn’t call them “body parts companies” I think improved FDA oversight of agencies that procure tissue for transplantation and research should have considerable oversight. I want to know personally and professionally that these agencies adhere to strict guidelines and ethics (particularly considering the near-bodysnatching that was going on in the New Jersey area not long ago).

I was recently on a 3-way phone call with a family member of a deceased individual and someone with our local procurement agency. I felt comfortable vouching for the agency, because of our working relationship with them, but at the same time I understood the reticence of the family.

Tissue donation after death does a lot of good, skin for burn victims, bone for fracture healing, corneas, heart valves and the like. I certainly support the practice of tissue donation, but until we have a good oversight program, nationwide, there will always be just enough doubt out there to make the process more difficult than it needs to be. The families of these deceased individuals, by necessity, are approached at an incredibly difficult time, it would be good to have some of the doubts out of the way before discussions start about the good these donations can do.

advocate for justice, too

I was doing a case review for our next regional Child Death Review Team meeting and I was struck by several aspects. These reviews are “secret” so I can not discuss names or details, but I did want (need) to vent on one point.

This was a small, young child who died. It was the opinion of the medical staff who participated in the child’s care, as well as the physician who did the autopsy and others who reviewed the case at the time that this death occurred at the hands of another, i.e. it was a homicide, as defined in our state coronial system.

The line that got me in the voluminous record that I reviewed was: “police and the State’s Attorney (Office) declined to file criminal charges”.

WHY?

I (as do all of my deputies) do every thing we can to advocate for those that can no longer advocate for themselves. All those that have died can no longer advocate for themselves, but especially those children who die and were unable to advocate for themselves before their death are particularly vulnerable. It is yet another role of the coroner to advocate for justice.

Association of Black Cardiologists' sponsored talk

I was one of 3 speakers at a meeting sponsored by the Association of Black Cardiologists in Boston last Friday. I spoke about how the system we have for access to healthcare, and particularly access to emergency medical care, needs to be changed/improved to prevent needless cardiovascular deaths. I based my talk on the Beatrice Vance case that I have talked about here before, several posts including this one. I hope that I will have other opportunities to speak on that topic and bring this issue to the attention of as many folks as I can.

One of the other speakers spoke about the critical need and impact of disease prevention in preventing morbidity and mortality from cardiovascular disease, particularly in minority populations. She discussed the “7 Steps to a Health Heart” endorsed by the Association of Black Cardiologists. I really liked them and so I thought I’d pass them along, they are a bit different than you might see elsewhere.

Be Spiritually Active
Take Charge of Your Blood Pressure
Control Your Cholesterol
Track Your Blood Sugar (if you’re Diabetic)
Eat Smart & Enjoy Regular Exercise
Don’t Smoke
Access Better Healthcare and Take Medication as Prescribed

We can all use a bit of a reminder about working, and enjoying the work, of being healthier.

Get health, stay health, and stay out of my office as long as you can.

Suicide not in the media

While I remain doubtful that suicide “contagion” exists or is a significant problem (and there are studies to back up that belief), I have pulled some of this information from the American Foundation for Suicide Prevention’s report: Reporting on Suicide: Recommendations for the Media and they strongly caution regarding the contagion. I recommend giving it a read, particularly for media folks, or pass it on to your media friends. Although, I wish it was more supportive regarding reporting about suicide.

I think reporting on an individual’s death who has died by suicide and not reporting that fact is wrong. People ought to know that individuals are dying by suicide in their community and that it is a significant problem. It doesn’t have to be a big thing in the article, seeming to “glorify” suicide, but a mention seems appropriate to me. In this case, as I am certain is often the case, the “community” knew that the manner of death was suicide, so it was not a secret.

A brief mention of suicide near the end of the article along with the facts about suicide seems like it could be useful for others. Letting the community know that suicide happens, and that it happens more frequently than they may realize, is very important in my eyes. Letting the community know that suicide most often goes hand-in-hand with mental illness (which is often undiagnosed, untreated or both) is important. And letting the community know that help is available for those that may be considering suicide or those with mental illness in need of treatment, and just as importantly where/how to get it, would be a public service.

If we refrain from talking honestly about suicide and/or mental illness the stigma will remain and some folks who need help will not get it. Some of those folks will end up in my office and I would rather that they not.

Murder-suicide a choice?

Murder-Suicide of an elderly couple, is that such a bad way to go? Should it be a choice that folks can make?

I’m not talking about a “choice” that is forced upon one of the pair in the murder-suicide, but if it is agreed upon by both of the individuals, should it be a choice that they can make? It is difficult to grow old and particularly growing old into worsening health. It is incredibly difficult to watch a loved one deteriorate into worsening health. It is difficult to watch a loved one decline mentally (from a medical or a neurologic condition) to a point that they are no longer who they used to be.

Should it be a choice?

Smoke inhalation

I was trying to explain the different varieties of smoke inhalation to a reporter the other day, actually to a few reporters in separate phone conversations over the last few days. Not all deaths from smoke inhalation have the same etiology.

Breathing in the products of combustion (smoke) can kill in several ways. Carbon monoxide is produced from burning stuff and is the most common poison in smoke that kills and the most common cause of smoke inhalation death. It is a cellular respiration toxin, for those of you inclined to detail, although it is often spoken of as a more general toxin. There can be other toxins in the smoke that are equally fatal, such as cyanide from burning plastics. Particulates in the smoke can cause airway irritation, airway swelling, airway “compromise” and death. One smoke inhalation insult that is unusual, but did cause a death in our county the other day, is breathing in the super-heated air of the fire with resultant airway damage and death from asphyxia. An even more unusual cause of smoke inhalation death is lack of oxygen in the immediate environment around the fire causing asphyxia, so I guess it really isn’t exactly a smoke inhalation death, but certainly belongs in the “same family”.

The whole mix is then complicated by underlying disease states, concomitant other substance exposure, and all the other stuff that can complicate stuff.

Not all smoke inhalation is the same and it isn’t always what it may seem at first blush. Death is seldom simple.

Forestalling elder abuse deaths

I am one of about a dozen county Coroners in Illinois participating in a nursing home death reporting task force and project. The purpose of the project is to investigate and ultimately prevent death due to abuse and neglect at long-term care facilities. This will likely translate into prevention of abuse and neglect of individuals residing in long-term care facilities, even those not causing death.

The Coroner in each county is uniquely placed to discover and report instances of abuse and neglect and the Illinois Department of Public Health has decided to seek out/enlist that help. The project will not change our office procedures, for the most part, since we already ask the nursing homes to report deaths to us and we look into any that raise any suspicion. The change for our office is that we will now have deaths reported of facility residents who die up to 10 days after hospitalization.

Elder abuse is a real problem and we look forward to participating in efforts to prevent it in long-term care facilities and, in particular, proving its value so that it becomes standard at least across the state (and maybe a model for elsewhere). We even discussed going after regulatory changes to ensure the reporting and investigation on a mandated basis, if need be. All, again, in the name of forestalling death.

Drug Induced Homicide?

Is a death from the use of illicit drugs (or the “misuse” of licit drugs) an accident or “drug-induced homicide”?

We discussed that question this morning during case conferences (our replacement for inquests). If an adult chooses to obtain drugs from another and voluntarily uses, ingests or injects them, is their death “at the hands of another”?

The State of Illinois has a dug-induced homicide statute that holds that if an individual sells to or gives to an individual drugs (illicit or licit) that result in their death the individual who “delivers” the drugs can be found guilty of homicide. I realize that this was passed into law to give law enforcement another tool to get the “bad guys” (purveyors in drugs), but does it really make sense. It certainly does make sense in cases where an individual cannot make an informed decision about participating (too young or too impaired for any of a variety of reasons) or if the offending individual actually administers the drug to the other, but does it make sense in all cases?

An individual makes a series of choices that result in their use of drugs: the decision to seek the drugs, the decision to obtain the drugs (knowing that the quality cannot be vouched for), and the decision to use the drugs, by this don’t they accept culpability?

It is certainly “wrong” to use illicit drugs and misuse licit drugs, but is it homicide at the hands of another?

Most overdoses are an accident (as opposed to intentional): using too much, using stuff that is purer than what you are used to, using after a period of abstinence, mixing what should not be mixed (the problem of synergy), using what you think is one thing and it is another, using when your health isn’t up to the use, and sometimes things just happen.

I don’t know the answers, we just take it case by case, individual by individual.

Teeth as unique as fingerprints

Ah, doing the “fun” stuff today, working on the office reorganization, budget for next year and related stuff. (I am also finding out that much that I had relied a subordinate to get done had not gotten done, so some in my staff and I are playing catch-up)

But I did have an interesting conversation (actually among several about cases in progress, it just seems I am only working on the stuff I mentioned above) with a forensic odontologist whose services we use. He was dropping off his report identifying a recent “Jane Doe” case, the skeletonized remains I discussed before. He had prepared his report identifying her (with a reasonable degree of medical certainty) based on comparing teeth present in (on?) the skeletal remains with photographs of the suspected female that included a view of some of her teeth. His opinion was that it is “a match”.

He told me that an authoritative Forensic Science Journal had just published a study on the excellent validity of such identification techniques which came out after he had completed his report. In our case the points of comparison were striking even without full dental comparison.

Your teeth are indeed as unique as your fingerprints.

[We do have DNA comparison with her mother pending as well.]

Then late in the afternoon we got a call from a dentist who had treated this young woman in the past and had seen the report of her skeletal remains being found. We will now be able to do a full dental comparison, but I (as is our forensic dentist) am confident that our “match” will only be further confirmed.

Self-restraint

I came across a quote that Walter Mosley included in an article he wrote recently that I thought was an important bit to keep in mind: “Self-restraint is what makes it possible for society to exist.”

I certainly see the opposite all too frequently in my line of work. I frequently see loss or lack of self-restraint in homicides (reckless or intentional), in crashes, with folks making bad choices and/or taking chances, in cases of abuse, on and on.

Self-restraint is a critically important “skill” to acquire, but some never do, some lose it temporarily, and some set it aside never to “bother” with it again. Self-restraint doesn’t mean you don’t have the thoughts that a few others act on, but that you are able to separate the thought from the action and not partake in the action.

I hope to impart the ability for self-restraint to my children. I’m not all together clear on exactly how to do that other than repetitive talks and modeling behavior, but so far it does seem to be working. I plan on continuing with my self-restraint, at least as is socially relevant and acceptable. I hope that others who could impact my life also maintain their self-restraint, so that their loss or lack of self-restraint doesn’t affect me or “mine”, as I have seen it affect others.

Pre-prom events

I’ve done 3 pre-prom presentations during the last 2 days. It really is fun talking to all those teens (hundreds of juniors and seniors), although I still have reservations about the effectiveness of the faked crash re-enactments.

I do take pride that I seem to have rapt attention from the teens as I speak. As I said during a brief talk I gave for a video being shot at yesterday mornings event, I think that the verbal parts of the events can have some impact. I told them many things, all factual and none of it an attempt to scare them straight. I told them that alcohol and drugs can and will affect their brains under construction. Those effects are both short-term and long-term, making it more difficult to “second guess” or reconsider their actions before they take them. I told them to stay out of my office/morgue; that I had enough business without their deaths. I told them, should they be in an accident and survive, that they will be saying “I’m sorry” for the rest of their lives.

I over-heard a couple of the teens talking yesterday afternoon about an event I had participated in 2 years ago, it is interesting that their recollection of the “crash” itself was imperfect (actually wrong), but their overall impression was more “on the money”. They understood what it was all about. Did it change or impact their behavior? I don’t know, they didn’t discuss that within my earshot.

This year I added to my presentation the statement that I get goose-bumps at these events this year. I attribute that to the fact (which I discussed in my talks) that my 16 year old went to her 1st prom this year. These crashes are just the mental pictures I had while she was out. They put a face on my fear. I hope they got that. Maybe that will make it a bit more personal for them, so that they don’t take chances and make good choices. I hope we don’t have any prom related deaths and, maybe, no more teen drunk (intoxicated/impaired) driving related deaths.

More on IDs for skeletal remains

An interesting opportunity has come to my attention. In addition to an extensive database of missing persons and “ties” to other related databases, the National Center for Missing and Exploited Children has an extensive database for DNA profiling. In addition to their own database they also have ties to the criminal justice DNA profile bank.

We plan on submitting DNA from our former skeletal remains case (the adult male found on a local golf course) for their help in profiling and comparison. DNA from our more recent skeletal remains case is being submitted to the Illinois State Crime Lab for similar profiling and comparison, but I would consider submitting it to the National Center for Missing and Exploited Children as well.

I really appreciate that someone with the National Center for Missing and Exploited Children saw one of the recent articles about our “Jane Doe” and dropped me a note about their services. They are so much more than what I thought they were, that is a clearinghouse regarding missing children (you know the people that came up with the great new use for the milk carton). I look forward to working with them on these cases and, rather unfortunately because they will happen, on cases in the future.

Not that I advertise for folks, but the availability of these and their other services sure make the National Center for Missing and Exploited Children seem like they are deserving of support, if you are looking for a national organization to support.

Ruminating on skeletal remains

We (I and some of the deputies) were talking at lunch in the office today about skeletal remains. By their recollection we have had more than our fair share of late. Granted some were partially skeletal, such as the gentleman who died and burned in his pickup on a back road here in our county. Skeletal remains they are none the less. Two cases of strictly skeletal remains within 2 months, that just doesn’t happen very often, not in the recollection of the folks in my office.

The first was a male found on a golf course shortly before it opened for the season and the second is a female found in a relatively unfrequented spot by a passer-by. The first is possibly an individual who had been living/camping in the vicinity of where he was found, the second likely brought there by a person or persons unknown. The first likely dead in the area he was found several weeks, the second more a matter of months.

Nature, with all her little helpers, has done her natural work with both of them after their deaths. Skeletalized remains. But it is important to remember they were once alive, walking around, talking, interacting, real people. I hope that they will be identified soon.

We are working on identification. The former with distinctive teeth in a front bridge-work and we are working with someone to come up with a sketch of what he looked like in life. With the latter, the Sherriff’s Department is working on “leads”, working the investigation, we are working on dental examination prepping for the possibility of comparable dental records, as well as the possible submission of DNA (bone marrow or dental pulp) if someone turns up to allow for comparison.

Skeletal remains

Statutory power of the coroner

“May you live in interesting times” ancient Chinese blessing/curse

A number of “interesting” things going on in the office, but I can’t write about most of it.

If you don’t mind I need to organize a few things (statute stuff) in my head for an upcoming meeting, so I am going to lay some of them out here to familiarize myself with them (you may be interested as well).

“Each coroner shall be conservator of the peace in his county, and, in the performance of his duties as such, shall have the same powers as the sheriff.” (interesting “power”)

“No dead body…or the personal property of such a deceased person, shall be handled, moved, disturbed, embalmed, or removed from the place of death by any person, except with the permission of the coroner unless the same shall be necessary to protect such body or property from damage or destruction, or unless necessary to protect life, safety or health. Any person knowingly violating the provisions of this Section is guilty of a Class A misdemeanor.” (pretty straight forward)

“Every law enforcement official, funeral director or administrator or person having custody of the body of a deceased person, where the death is one subject to investigation under Section 3-3013…shall notify the coroner promptly. Any such person, failing to notify the coroner promptly shall be guilty of a Class A misdemeanor…”

“Circumstances under which (an) autopsy (is) to be performed (a) Where a death has occurred and the circumstances concerning the death are suspicious, obscure, mysterious, or otherwise unexplained and in the opinion of the examining physician or the coroner the cause of death cannot be established definitely except by autopsy…”

This stuff may not make much sense to you, the reader, out of context, but it lays out the authority of my Office in cases of death and does not allow latitude for others to rule or over-rule the Coroner. I do want to work cooperatively with others, but they need to understand my position of authority in these matters and should not make demands. They need to ask for and work towards cooperation. I look forward to developments.

Spykes ™

“Girlie Drinks” or alcopops sure look like they are targeted at young girls. An introduction to alcohol perhaps more tempting that a beer in a can.

Now along come Spykes ™. They are cute little 2 ounce bottles of brightly colored (except the chocolate one) malt beverage with 12 percent alcohol content. The bottles themselves look like over-fed nail-polish bottles. They are enticing, sweet with the flavors of chocolate, mango, watermelon and lime. The manufacturers website says that they are designed to add to a beer to add flavor and, I suppose in another time, pizzazz.

But my concern is that they fit easily into a tux jacket pocket or relatively unobtrusively into a purse for prom night “fun”. I want parents to be aware of these attractive “treats”. Teens should have fun on prom night, but to have fun they don’t need to drink.

Check your teen on prom night. Help them live out their full potential, their full lives. Underage drinking is not OK. Please do all that you can to keep them out of my office.

Antidepressants benefit children and teens

Dueling articles, what a difference a few weeks can make.

First from an article on nytimes.com today:

The Food and Drug Administration ordered drug makers yesterday to add warnings to antidepressant medications, saying the drugs increase the risk of suicidal thinking or behavior in some young adults.

Then an article on nytimes.com 2 weeks ago (or a non-"walled" USAToday link):

The authors of a comprehensive new analysis say the benefits of antidepressants in children and teenagers trump a small risk that they will experience increased suicidal thoughts and behavior.

The latter is based on the “more powerful” data, i.e. a meta-analysis of more studies than the data used by the FDA, with a greater number of subjects, so I would have to support it on that basis alone. In addition, the latter information resonates more with my experience.

I certainly hope that there aren’t any children or teens that are prevented from getting needed antidepressants because of the black-box warnings or news of the black-box warnings placed by the FDA. Lack of access to needed medication and its attendant treatment causes needless suffering, self-medication with licit and illicit drugs, and death by suicide. Let’s not gamble with the minds, psyches and lives of these kids (there were no deaths by suicide in the meta-analysis study). As one of the doctors quoted in the latter article says “you can’t say, take these and call me in six weeks”, but the meds are an important part of the therapy that must be available to all in need of it.

2007 WomenHeart Wenger Award

A Press Release I sent out today:

On April 30, 2007, in Washington, DC, The National Coalition for Women with Heart Disease (WomenHeart) presented Richard Keller, MD, Coroner of Lake County, IL with their 2007 Wenger Award for Excellence in Public Policy.

“The Wenger Awards were inaugurated in 2000 to honor Dr. Nanette Kass Wenger, a world-renown cardiologist who has long championed the need for improved research and treatment of heart disease in women”. (http://www.womenheart.org/)

The award was granted based on the events surrounding the death of Beatrice Vance on July 29, 2006. Her death investigation results were taken to Inquest and the jury, based on the facts of the case, found “homicide” to be the manner of her death from an acute myocardial infarction.. Their verdict was based on their opinion that the death resulted from “a gross deviation from (the) standard of care which a reasonable person would exercise in the situation”.

The case at the time of verdict engendered considerable national media attention, including medical media outlets for the American Medical Association and American College of Emergency Physicians. Since that time, the case has been used in teaching women to advocate for themselves, in teaching at medical schools and to hospital medical staffs around the country. It continues to bring about personal change and is serving as a catalyst for system change, so that her death is not repeated elsewhere.

During his acceptance speech, Dr Keller admonished those present to “push for changes in emergency care, nationwide, so that it becomes impossible for a 49 year old woman to die of a treatable disease process 20 feet from diagnosis and treatment. The problem here is bigger than a problem at a single hospital, it is a system problem. No one should be prosecuted for her death, but it should not be disregarded, either. We must do everything we can to forestall death, to keep folks out of the Coroner’s office for as long as possible”.

Dr. Keller accepted the award “on behalf of my Office and the deputy primarily involved in the investigation of the death, the jury who found for “homicide”, and Ms Vance, that her death may contribute to system change and the prevention of future deaths under similar situations”.

So there I was getting ready to go up in front of 100 or so folks and I decided to take one more bite of the sorbet they served for dessert. The humidity in the room caused the glass that the sorbet was in to sweat. The sweat dripped onto my leg fairly high up, if you know what I mean. Thank goodness, I had on slacks that dried quickly and I was able to go up front, accept the award, and give a short talk that got a standing ovation. It was all good and I know good will come of this tragic event.

PTSD after car crash

I just moved from one office to another in my building and ran across an article that was brought to my attention a while ago, but I never got around to writing about it.

Many of us are aware of the potential for death and injury in motor vehicle crashes (we had quite the confluence of them locally last week end):

“…traffic injury remains the leading health threat to children in the United States. In 1996, 938,000 children under 21 years of age were injured as passengers in cars, 39,000 pedestrians and 33,000 bicyclists.”

What isn’t often noted, looked at or realized is the psychic trauma that accompanies being in a crash, even if you are minimally injured. The study the article referred to found that after involvement in a motor vehicular crash, even with minimal injury:

“25 percent of these children and 15 percent of their parents suffered PTSD”

The lack of recognition of this problem leads to those folks not seeking or receiving care and treatment for their symptoms and problems. Only a minority of these folks even talked their symptoms over with others, so they were getting no support through their difficulties. PTSD (post-traumatic stress disorder) can lead to long term difficulties and even suicide, so it should not be ignored. It needs to be made clear to folks that these psychic injuries are no less real than the physical ones, and no less worthy of treatment than the physical ones (both can lead to chronic problems).

Mycobacterium vaccae is your friend

Talk about natural health treatments, Earth one of the ancient "elements". I came across an article about the health benefits of dirt and Mycobacterium vaccae.

It seems that exposure to M vaccae, i.e. getting it “under your skin”, boosts your immune system and improves your brain chemistry. So now there is a scientific “reason” for feeling good after you’ve worked in your garden or out in the yard, beyond the fresh air and sunshine. These bacteria get into your system and one result of the immune cascade is that serotonin production in your brain increases. More serotonin elevates your mood and has a few other positive mental effects that I recall studying some years ago.

So if you are feeling a bit down, grieving, or otherwise in a "funk”, get down and dirty. Get your hands in some dirt (soil for those that don’t like to play in the dirt). Breathe in that great aroma of fresh, moist soil. Welcome Mycobacterium vaccae into your system, into your body’s milieu. Germs can be your friends (and often are).

I've said it before

I've said it before (but it does seem to have universal applicability):

Think

Don't take chances

Make good choices

Too many kids die

I was talking a reporter (one of many today and over the weekend) and he was asking if I thought there was any common threads among several recent incidents or if there was something in common that could be used in prevention.

He was not so much thinking of the 16 and 17 year old girls who died in a crash in the middle of the day on Saturday, but more of the 15 year old who died in a crash at 3:45 am. That 15 year old was in a car driven by a 14 year who was quite intoxicated. There have also been some other cases of death or injury in the region that occurred late at night, or early in the morning, depending on your perspective, that beg the question are “we” doing something wrong or not doing something right.

I told him that they should be at the very least wake-up calls for people to pay attention to what is happening to their kids or kids close to their kids. I told him I re-evaluated (again) curfew and other issues pertaining to my teen. I also discussed with him my feeling that at the root of at least some of this is that we parents make mistakes of commission and omission. Parents try too often to be their kids’ friend instead of their parent and are therefore too lenient and put fewer restrictions on them then they really ought.

Teens still need control and direction, even if it means you have a shouting match or 2. While they may seem pretty mature, their brains really aren’t developed to that point When stressed or when peers are around or something else happens their “second guessing” or reconsidering fails. They don’t think a second time through something to realize that it really isn’t a good choice or a good idea. They plunge ahead, often making wrong choices and taking chances to their detriment.

That’s what goes through my head when these things happen in my county or I read about them elsewhere. I hope that we can stop the next one.

Death prevetnion via pre-prom event

I have not been so affected by a pre-prom event as I was today. I may have been in a more emotional state with other stuff that is going on, but it really hit me today.

A pre-prom event (at least most of them around here) consists of a crash enactment with bashed cars and teens with make-up and mikes or a recorded dialog played for a large group of students on the football field, followed by a couple of speakers (very often including the Coroner). The point is to convince teens not to drink or use other drugs, not to drink (or use drugs) and drive, and not to ride with someone who is intoxicated, with at least the nominal focus on the upcoming prom night.

Today’s event followed that formula. The weather was great. The audience quiet and seemed to pay attention. Differences started fairly early. Through the course of the event about 5 of the seated students passed-out and had to be taken out (I think 2 to the hospital). So it was apparent at that point that there was a fair amount of emotional energy in the “air”. I spoke after the physical part of the presentation and I think I did fairly well (there were positive comments later). I spoke about possible deaths and injuries, loss of potential, the “forever” need to say you’re sorry if you are responsible in any way, and that I don’t want them dead in my office and to have to inform their folks.

What really got me however was the mother who spoke after me of her 2 teens involved in a drunk driving accident. One of her son’s died as a result, her other critically injured. She talked of the ICU and the test that showed “brain death” before his heart stopped. She talked about how they unwrapped his Christmas gift (the crash happened just before and his death just after Christmas), a leather jacket, and had him buried in it. She showed the shirts that were cut off his body when he received emergency care to no avail.

I cried as she talked and hugged that mother when she finished. When will I have to cry and hug another mother?

Food for the forest or cremation, I'd consider it

An Australian scientist called Wednesday for an end to the age-old tradition of cremation, saying the practice contributed to global warming

But to bury the hatchet with environmentalists, he suggested it would not be a bad idea to bequeath one's body as food for a forest.

Grief is about more than death

We grieve many things, not just death. Any loss generates grieving. The amount and degree of grief varies with the amount and degree of the attachment, the amount of energy we have invested or tied to the object of loss. Grief is natural and normal. It doesn’t go away; we do not get over it.

With that loss our life has changed, because our attachment, energy investment, is lost or at least for a time cast adrift. Our self concept and our world view must be altered in view of this loss we are grieving. We can change and, really, will change whether we participate actively in that change or not. Participation is the best option.

We must realize that that energy, previously invested elsewhere, is now available to us. With that realization we can change our relationship (develop a new relationship) with that lost “object” (or deceased loved one if that is the case). That lost “object” may not be the “object” we think it is. It may not be a “thing” at all. The loss may be the loss of the comfort of sameness, a change in status or relationship with another or a loss of what was considered “normal” of “normalcy”.

The change in relationship may be specifically with the person of “object” lost or it may be a new relationship with your “environment” (broadly defined), your surrounds, your community (again broadly defined), your new “you” (based on the changed and reinvested energy), or your new world view.

Grief is normal. You will not get over it, but with the development of new relationship it takes a different place in your life and a different energy investment.

Coroner biz not covered on CSI

“We can’t make everyone happy, and I guess I really don’t want to”, said the Coroner to his Administrative Assistant. [So that I don’t sound so heartless, and example of this would be proof that the perpetrator did it and there are a legion of other examples]

Busy day today: case conferences all morning (our new inquest analog) and a meeting with local DEA folks about cases and working with them on those and others. Also, an undercurrent of unresolved issues: local police department not happy with us despite the fact that they didn’t request an autopsy for nearly 48 hours and we had released the body; another police force elsewhere to whom we had pointed out “the error of their ways”; and other stuff.

There is always “other stuff”. There are no typical days. Doing the coroner's job isn’t nearly as difficult as taking care of the “other stuff”.

Can’t make everyone happy and I probably won’t.

On another note:

I am often asked about “unusual cases/deaths” when I give talks about the coroner’s biz and I ran across one today. In reviewing a case from 1999, it proved to be unusual. It was the case of a woman riding in the backseat of an auto. Another car struck a deer throwing it into the car where the woman was a passenger. The deer kicked the woman in the head, which ultimately resulted in her death.

People die from a variety of causes and there is a different story with each of them.

Tonight's forum presentation

16 y/o dies of hypothermia/exposure after a drinking party
17y/o dies in an auto crash, the driver’s blood alcohol demonstrates intoxication

Headlines, Coroner’s cases
We have to notify the parents of these kids who are dead, kids aren’t supposed to die before their parents
Lives lost, opportunities lost, potential lost

And the deaths are only a small fraction of the serious problems that result from underage drinking, horrible as they are

The adolescent brain is a work in progress; exposure of the developing brain to alcohol and drugs alters its potential
But more important to tonight’s discussion is the fact that the adolescent brain isn’t complete, it lacks the “second guess” ability (the ability to pause and reconsider an action before undertaking it, particularly in the face of "stress” and peer pressure)

I know this despite expecting more from my teen daughter (and from other teens), but always think/remember that adolescents do not have the full capacity to control themselves. We overestimate the adolescent brain's ability to process legal and social standards and to use them as a behavior guide. We adults need to do some of the controlling that they are not capable of.

Parents must help their children make the "right” choices, through “control”, repeated discussions (shouting matches, if necessary), and by example.

Don’t allow teenagers to end up in my office.

Columbia College of Missouri in Waukegan

I gave a lecture last evening (I guess it’s a lecture when you talk, and hopefully teach something, to a group of folks in a class at a college). I really enjoyed doing it. I warned them at the start that they should ask questions and keep me to a time limit (they said there wasn’t any time limit). Being both a physician and a politician, I can talk a long time once I get started. The lecture stretched to 2 hours from the scheduled 1 hour. I probably could have gone on even longer, but I had finished the coffee I brought with me, I needed to get home and these 12 or so hour days do get to me sometimes.

It is interesting talking to the various audiences that I do presentations to. The level of the talk and types/caliber of questions vary, as do the things we talk about and/or of interest to the group to a certain extent. The talk last night was to students in a criminology class, so I did try to gear it to fit with their academic interest, although they did have a fair range of questions and we ended talking about a lot of coroner-related things (worst case, this case, that case, coroner "powers", etc). It does seem that an awful lot of folks in all walks of life and of all ages have a great curiosity for the coroner biz.

The instructor did invite me back next year, though I am not sure what I would do with a second school logo coffee cup (my “stipend” for doing the lecture). Don’t get me wrong, in looks good in my office and I do like to change up my coffee cup from time to time (and I do drink a lot of coffee). I look forward to a repeat of the experience

Cocoa to forestall death and improve your blood pressure

There are reports out on the beneficial health effects of dark chocolate. This study compared the effects of tea vs dark chocolate/cocoa (vs neither) consumption. While both tea and cocoa contained favorable flavonoids, those folks consuming cocoa containing products experienced a improvement in their blood pressure (which would result in decreased risk of related disease and death) due to some additional flavonoids present in the cocoa.

Foods like dark chocolate, which contain plenty of cocoa, may potentially reduce high blood pressure by acting in a manner similar to many blood pressure-lowering drugs, according to an analysis of previous studies by German researchers.

Researchers report a two-week follow-up of these patients after which both systolic and diastolic blood pressure was lowered in the group consuming cocoa.

Researchers also warned the study was not a recommendation to consume large amounts of chocolate since they are still loaded with calories. "Rationally applied, cocoa products might be considered part of dietary approaches to lower hypertension risk," they concluded.

Certainly if you are going to eat chocolate choose the high cocoa containing dark chocolates, but don’t over eat them (all things in moderation). Obesity trumps these BP effects. Dark chocolate is better tasting anyway and certainly is better tasting than BP meds (caveat: only replace your meds with chocolate under the supervision of a physician).

A diet with a goodly amount of fruits and vegetables, exercise, and throw in a spot of tea and cocoa-containing products, that’s the ticket.

Working with the County

I (with my Chief Deputy) had a meeting with 2 folks today.

First was an individual from the County HR Department. We had noticed that our deputies/investigators were making less than investigators in the County Public Defender’s Office. In response to our questioning, the HR folks did a preliminary “study” of Coroner’s Offices in surrounding counties to gauge how our wages compared. According to their preliminary “study” our wages compared favorably. However, they neglected to compare volume of cases (they report that volume really doesn’t “figure in” when they are making those decisions, despite comparing a county with 1100 annual cases to our 3600 caseload) nor differences in job responsibilities, what the deputies/investigators really do on the job. Suffice it to say my deputies do more. Back to the “study” for them and beefing up our job description to better capture what my deputies do for us. Also, seemingly under duress they will look how the wage was calculated for the Public Defender’s Investigator. Looks like an upcoming struggle, the stage likely set by the previous administration not keeping the wages up-to-date. It is a struggle worth engaging in.

The other individual we met with was the new County Communication Director. She seems energetic, engaged and qualified (nice change). She was impressed with what we are doing with public education and related activities. We look forward to working with her to further our goals of public education, forestalling death, and making more information and resources available to the public. The potential is great, but she will be pretty much starting from scratch in a pretty provincial atmosphere. I hope she is up to the challenge, hangs in there and accomplishes what she seems set to accomplish (it will be helpful for us and what we want to accomplish). [It will be interesting to see if and when she reads my blog. She seemed interested in it when I mentioned it, but did not ask for its address.]

The Now and Future Effects of the Iraq War

From yesterday’s Washington Post:

About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.
For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don't immediately return to duty have traumatic brain injuries…
The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by the "secondary wind": a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front…

It is thought that shock waves damage the brain at a microscopic, sub-cellular level…
"When the sound wave moves through the brain, it seems to cause little gas bubbles to form," he said. "When they pop, it leaves a cavity. So you are littering people's brains with these little holes."… Indeed, soldiers walking away from IED blasts have discovered that they often suffer from memory loss, short attention spans, muddled reasoning, headaches, confusion, anxiety, depression and irritability…

Now in its fifth year, the Iraq conflict is not a war of death for U.S. troops nearly so much as it is a war of disabilities. The symbol of this battle is not the cemetery but the orthopedic ward and the neurosurgical unit. The men and women inside those units have come home alive but missing arms and legs, many unable to see or hear or remember who they were before being hit by a roadside bomb.

Martin Luther King, Jr.’s Death Anniversary

Yesterday was the anniversary of Martin Luther King, Jr.’s assassination. As pointed out in an article I came across today, let’s remember him for more than a Civil Rights leader (of which he was a consummate one), but as a Human Rights leader.

"True compassion," King declared, "is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring."

He spoke out and called the United States "the greatest purveyor of violence in the world today." (in reference to Vietnam and our other world-wide “excursions”)

In his last months, King was organizing the most militant project of his life: the Poor People's Campaign. He crisscrossed the country to assemble "a multiracial army of the poor" that would descend on Washington -- engaging in nonviolent civil disobedience at the Capitol, if need be -- until Congress enacted a poor people's bill of rights.

He was a great man and a great leader. To remember him only for his “I Had a Dream Speech” makes him 1 dimensional and does not recall all he accomplished and the great potential that was snuffed out much too soon.

"Suicide Comedy"

"We just hope they don't cause too many accidents,"

What could a partner in an indie film company that specializes in horror films be talking about?

The suicide comedy "Wristcutters: A Love Story" will be released in August, with a marketing campaign featuring cardboard cutouts of characters jumping off a bridge, electrocuting and hanging themselves. The signage will be placed on telephone poles and trees in major markets beginning next month.

What the “heck”. This “information” from Rueters raises a number of questions in my head. Suicide “comedy”? Yes, I remember Harold and Maude, but they were faux suicides. “Cardboard cutouts” “hanging” around depicting folks dying by suicide. That doesn’t seem like a real cool idea to me.

I am not big on suppressing advertising, I can usually ignore the stuff I choose to, but this is way over the top. In that spirit I pass this along:

Dear friends,
We need your help. AfterDark Films plans to release a Lionsgate Entertainment movie this summer called Wristcutters: A Love Story. The film premiered at the Sundance Film Festival last year to some acclaim. Mental Health America and its national partners have not yet been able to view the film and cannot yet share any detail on the content.
This month, however, AfterDark will launch an alarming “shock and awe” advertising campaign featuring cutouts of the movie characters in the states in which they kill themselves (e.g., jumping off bridges and electrocuting and hanging themselves). These signs will hang from telephone poles and trees in communities nationwide.
Interestingly enough, recent outrage around the advertising campaign of another one of the companies’ films, Captivity, forced AfterDark to remove billboards that showed graphic images of women, being kidnapped, confined, tortured and killed.
On March 12, Mental Health America and 13 of its national colleagues signed a joint letter to AfterDark and Lionsgate, asking the companies to drop Wristcutters’ marketing campaign. Our letters and calls have gone unanswered by AfterDark. Lionsgate claims they have nothing to do with marketing decisions.
You Can Help stop the Wristcutters suicide marketing campaign.
Send a handwritten or typed letter to Lionsgate and AfterDark demanding they pull the marketing campaign. Use the messages and contact information below.
Send a letter to your mayor alerting him of the film’s marketing campaign and asking that he or she not allow the images in your community.
Reach out to video rental stores who will receive the film and its marketing materials shortly after the movie’s theatrical release asking that they not display the film’s marketing materials.
Send this email to your colleagues, friends and family.
Suggested messages:
The planned marketing campaign for Wristcutters, which features graphic depictions of suicide, is both alarming and dangerous.
Suicide is NOT entertainment. With more than 30,000 suicides and 1.4 million suicide attempts in the United States each year, it is a national crisis and tragedy.
AfterDark must modify the planned marketing campaign for Wristcutters before rolling it out.
Scientific evidence shows that portrayals of suicide pose the very real danger of ‘suicide contagion,’ the clinical term for ‘copy cat’ suicides.
Images of suicide are cruel and offensive to people who have contemplated or attempted suicide or to those who have lost family or friends to suicide.
This is not an issue of “political correctness” this is an issue of public health.
Please direct letters to:
Mr. Jon Feltheimer
CEO & Co-Chairman
Lionsgate Entertainment Corporation
2700 Colorado Ave.
Santa Monica, CA 90404
Office: 310- 449-9200
Fax: 310- 255-3870
Email: general-inquiries@lgf.com
Mr. Courtney Solomon
Partner
AfterDark Films
2161 N. Bronson Ave.
Los Angeles, CA 90068
Office: 323-468-9888
Email: info@wristcutters.com
If your email is returned because of the companies’ mailboxes are full, please consider calling, mailing or faxing your letter. It’s important that our voice be heard! And if their mailboxes overflow, that means we are being heard loud and clear.
To read the letter Mental Health America and its national colleagues sent to Lionsgate and AfterDark, visit http://www.mentalhealthamerica.net/go/about-us/pressroom/-wristcutters-letter.
If you have any questions, contact Heather Cobb, senior director of media relations, at (703) 797-2588.
Please remember to forward this message to your friends!

Kids frequently "experience" death

Researching for another project I am working on I came across a couple of interesting facts:

“It is estimated that at any given time in the average classroom, there are at least two students who are grieving from the death of a loved one.”

“1 out of 20 American children under age 15 has lost one or both parents to death.”

While I certainly have known for a long time that death and grieving were ubiquitous experiences, these 2 bits of information really drove it home today. It tells me that schools should do more to educate kids about death. It is a natural and frequent phenomenon. We will all experience it at least once. But there remains a strong taboo around it and any honest discussion of it, particularly before it happens in one’s life.

It should be a part of school curricula from an early age, certainly as much as telling kids not to smoke.

Other questions those “bits” raise would be about school personnel’s (teachers and counselors) preparedness and ability to deal with death and grieving when it occurs in a child’s life. It is something the personnel will be exposed to on a frequent basis.

The article (which has a good general discussion of the topic) makes a good case for both curricula inclusion and training and education of school personnel. It certainly ought to be considered (very strongly).

Balance and health

I recently read: “The world works best in balance”.

Becoming more accepting of that philosophy, I went on vacation (just got back to work). While this may not sound all that interesting or “news-worthy”, if you knew me and my habits, you’d know it was. I seldom take time off and less often go on vacation. My last vacation was about two years ago.

I decided a few weeks ago to accede to my wife’s suggestion that we take a vacation for a variety of reasons, but foremost in my mind was a need for balance in my life.

Balance is important. It is important for physical and mental health. Balance in work and “play”. Balance in energy use and acquisition (and I don’t mean gas and electricity). Balance in energy investment and expenditure. The energy I speak of here is the energy that fuels our soul, our emotions, and our relationships with “all our relatives”. Those “relatives” include our families, our friends, our co-workers, all those we come in contact with and interact with (“relate” with), even those we pass on the street or buy our “venti coffee black” from.

Take a break often and recharge your batteries. Whether that break is long or short. Whether it is a brief meditation, a mindless TV show or movie, or a longer break like a vacation, it is important to re-energize. Pulling back in that energy with balance will allow you to invest in relationships that would otherwise become strained and damaged. Pulling back in that energy with balance will help your physical and mental health. You owe it to all your “relatives”.

Did St Patrick Drink?

I had been thinking about it last week but it really bubbled up this weekend, why do we have a “holiday” with pretty much the sole purpose of drinking?

I went to a local restaurant Saturday for a burger and was amazed that it wasn’t as busy as I would have expected. The waiter’s take was that because they didn’t serve green beer a lot of folks went elsewhere.

What is it about an apparently religious man’s driving the snakes from an island country that promotes public drunkenness? It seems to me that this would be a good target for “holiday repeal”. St Patrick’s Day serves no other purpose. If we really want to model “good” behavior for our children, we really need to stop glamorizing drinking, public drunkenness, and the inference that you have to drink considerable quantities of alcohol to have fun.

(Just a side note: I had a great grandfather how emigrated from Ireland, but he was an Orangeman, so I don't get into "the wearing of the green")

Parenting and the adolescent brain

I talked with a couple hundred New Trier High School students today about the effects of drugs and alcohol on the adolescent brain.

It is interesting, as I have delved into this topic I better understand why adolescents act and think the way that they do because of the “construction” going on in their brains. But, as a parent, I still often react differently than one with that understanding seemingly ought to.

“What were you thinking when…?” Despite the fact that I know that cognitive control of behavior in an adolescent relies more heavily on the developing prefrontal cortex and that that is easily overwhelmed when the adolescent is “stressed” (stressed in the broadest sense). There is no hippocampal “back-up” as there is in an adult. So, in fact, when “stressed” the adolescent really isn’t thinking it through, there is no “executive processing”.

“Why are you so moody/Why are you in a bad mood?” Despite the fact that I know that the mesocorticolimbic system is still forming causing fluctuations in emotional perception and the ability to solidify assigning emotional value to a thought, action, or attitude. Also, I know that allopregnalone (a hormone released when an individual is “stressed”) works differently in the adolescent brain than in the adult. There are different receptors in the adolescent brain that makes this more excitatory than its calming function in the adult brain (allowing you to pause and reflect on options).

No doubt this dichotomy will persist, but at least with my knowledge (and a bit of help from allopregnalone), I can pause and analyze it somewhat after the fact. I continue to work on narrowing that time, so that that “after the fact” can occur while the discussion is still going on with my teen child and I can bring it into that discussion.

It's not OK

I participated in a discussion recently in a group looking for a rubric, a slogan, a motto, if you will, to use to “push” underage drinking prevention activities in all their permutations. I liked one brought up by someone in the room (thanks Bruce), not necessarily invented by him, but something he felt would be a good choice:

“It’s not OK”

I like it. It’s simple, yet covers a lot of what we will be doing in our efforts to decrease underage drinking.

It’s not OK for parents to buy alcohol for underage kids and/or allow drinking parties for underage kids in their house. It’s not OK for older siblings or friends to provide alcohol for underage drinking. It’s not OK to drink and drive or ride with someone who is drinking and driving. It’s not OK to drink when you are underage. It’s not OK to “target” ads or products at potential underage drinkers. It’s not OK that the number 1 “date rape drug” (alcohol) is so readily available and so under-feared/under-respected.

It’s not OK.

Addiction

At a meeting of the Lake County Chiefs of Police Association Committee on Underage Drinking meeting yesterday one of the members brought up an HBO series that would begin airing soon.

The series (13 episodes long) is called Addiction. It will begin with its 1st episode next week on the 15th. Interestingly they scheduled it during a time that non-subscribers can watch as well. HBO has also put up a website to supplement the show that seems to contain (I just took a quick look around) a fair amount of good information. It has sections titled: “Understanding Addiction, Adolescent Addiction, Treatment, Aftercare, Stigma and Discrimination”, as well as more show specific information.

The basic premise of the show is:

Over 23.2 million Americans struggle with addiction, yet fewer than 10 percent are getting treatment.

And they are attempting to improve that with the show and website.

The Addiction Project is produced by HBO in partnership with the Robert Wood Johnson Foundation, the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

I wish them success in their endeavor; their success will translate into lives saved. The number of overdose deaths here in Lake County continues an upward trend that has been present for years; we can use all the help we can get.

Bad things happen to other people

Zlata Filipovic became a recognized author when her diary covering her experiences during the war in Sarajevo (1991-1993) was published. She wrote a line in another book that caught my eye: “…its human nature to always believe that “bad” things happen to other people, not us.”

I think that thought is what is really going on when we say that kids think “they are invincible”. I don’t think teens (and other folks, for that matter) really think that they are invincible. I think that they know that they can get hurt, or worse, when they do certain things, but they simply think that that “hurt” can only happen to someone else. It won’t happen to me. That pattern seems to fit most incidents and accidents that I see.

That changes the focus of the “intervention” as I see it. While it needs to be a part of the “education” that this stuff and/or action can harm or kill you, the main focus ought to be that it can harm or kill YOU. I think that the thought that bad things always happen to the other guy is why we can’t scare kids straight or into “good” behavior.

We need to figure out a way to overcome that human natural belief and somehow convince teens (and other folks) that the “bad” stuff can happen to them. I think seeing, knowing, talking to, and hearing about kids that these “bad” things have happened to makes an impact. I think presenting in a reasoned and reasonable fashion that believing “it won’t happen to me” doesn’t make it so, can have an impact. I think educating them that the basis for some of their behavior is the belief that “bad” stuff only happens to someone else, can, when repeated over time, have an impact. But I think attempting to scare them into the “knowledge” that they are not invincible, gets you nowhere. Telling them that “this” happens to teens instead of this can happen to YOU misses the mark. It may seem a small difference, but it has got to be personal to get them personally.

“everything to live for”

We are often confronted with the statement “My (loved one) could not have died by suicide, they had everything to live for”, when we discuss that manner of death with family and friends.

I came across a bit of information I thought was interesting and that speaks to that point. George Eastman (the Eastman of Eastman Kodak) died by self inflicted gun shot wound in 1932. He was a man described as “a man of power, generosity, and self-determination” and one of the richest men in America at the time. Talk about someone who had “everything to live for”.

However, on closer examination of his life and psyche at the time of his death he was a typical “case” (depression, physical illness, recent losses), but it wasn’t all that obvious at the time. Even someone with “everything to live for” can die by suicide. It does not diminish them in the least, as someone said recently: “they are leaping from their own inferno”.

You don't "get over" grieving in 6 months

Both because I saw it cited in The Chicago Tribune on the 21st and because I am doing some research for a project I am working on, I read a study recently published in JAMA, An Empirical Examination of the Stage Theory of Grief.

I have several “issues” with the study and article, e.g. their mathematically manipulating their data to get a graph that agrees with their hypothesis supporting the stage theory of grief, but more on some of those issues on a later date.

The thing I found most irritating (to say the least) and something I saw pulled from the article in several other publications was their claim that: “those individuals who experience any of the (negative) indicators beyond 6 months postloss would appear to deviate from the normal response to loss”. Never mind that they categorize some responses/emotions to loss of a loved one as “negative” that don’t seem to me to be all that “negative”, the data they present does not support that claim. Certainly, common sense and experience argue against it as well.

Their data show fairly minimal decrease in “yearning” from their 6-12 month to their 12-24 month periods (3.18 on a 1 to 5 scale to 2.64, down from 3.77 in the initial 1-6 month period) and I think one could argue their data does not seem to be a clinically significant change at all across the measurements. Depression goes from 2.29 (again 1 to 5 scale) at 1-6 month, through 2.29 at 6-12 months, to 1.80 at 12-24 months. At no time do any of their indicators go to one (generally “impact felt less than once per month”). They have no “0” in their scales, although in their manipulated data graph it appears that they do.

I just don’t see it; their “measures of grief” do not go away at 6 months. The individual’s continued to experience significant grief symptoms beyond 6 months. Now, before someone jumps on it, I am not saying the folks don’t need help working on their grieving, I am saying that to declare it not “normal” is a disservice and to communicate to “others” that folks should be over it in 6 months is an even worse disservice. People “don’t get over it” in 6 months. It is my contention that you never get over it, but more on that in the future.

Web site finally getting make-over

We are finally making some progress with County IT and our Lake County Coroner Website. It did take a bit of agitation. We now have access to 2 sections (Press Releases and Publications), so we are getting things added and up for viewing (old press releases and our quarterly newsletters, in particular so far). More changes, still under the control and action of IT, will be coming (are promised) over the next few weeks (our designing is done). I look forward to our new look and “news” availability.

Methadone overdose deaths

Just as we are seeing an increase in Methadone-related overdoses, so are many places across the country. While it is often seen as a drug used to replace heroin in addicted individuals, the overdoses we are seeing are related to its increased use as a potent pain medication (as is the case elsewhere as well).

Methadone is being used increasingly in tablet form as a pain med. Like all behavior the reason is “over-determined” or multi-factorial. It is quite effective and had been thought to be less addictive than many other pain meds (not true, but all meds are addictive in some ways and in some people). Another reason is that OxyContin has gotten such a “bad name” that a replacement was needed.

One of the main problems with Methadone is its long half-life (the time required to clear half of the med from the body). The half-life can be up to 60 hours. The problem is that the pain-relief effects diminish prior to it being cleared from the body, so that repeated dosing for pain relief in the face of that slow clearage leads to the development of toxic levels.

The other “problem” with Methadone is that it is usually an incredibly safe med when taken alone, but can quickly becomes deadly when mixed with other meds at higher than “normal” doses. That is, if your Methadone level is a bit on the high side and you take it with a benzodiazepine a bit on the high side and wash it down with a bit too much alcohol, you can wake up dead (as we say in the profession). This can occur even if none of those drugs are in the toxic range by themselves. In particular, the respiratory and cardio- depressant effects of these drugs are additive, if not somewhat geometric, in their cumulative effects.

Methadone may be a good pain med and may be useful in those addicted to heroin, but it can be lethal and we are seeing an increase in its lethal effects.

Operation STAAT doesn't look so good to me

I had to leave a local community meeting early the other day so I missed a discussion that I would have like to have listened to. In addition to several other programs to decrease underage drinking there was to be a discussion of “Operation STAAT”. Based only on an article in the Chicago Tribune, parts of it seems like a bad idea to me.

Operation STAAT (Stop Teen Alcohol Abuse Together) appears to have a few components according to the article. It encourages neighbors who suspect that there is a party at which underage drinking is taking place to report that to a “hot line”, anonymous calls are allowed. That seems reasonable. It also encourages those neighbors to record and report license plates of the vehicles of the attendees. That seems to have a potential for trouble to me, someone could get hurt if caught writing down the numbers. The program calls for community service for underage drinkers caught offending. That seems reasonable as well.

The part I have the most trouble with is that it requests parents who suspect that their teenagers have been drinking to call the police. The police come to their home and administer a “preliminary breath test” and if positive a juvenile officer meets with the teen and community service hours are set up. If the parents “say” that the teen continues to drink the teen can be charged with underage drinking. If the teen stops drinking, no arrest is made (and no record or other consequences for the teen).

While I am a very strong proponent of being your teen’s parent and not their friend/pal, I think this is wrong-headed. It destroys trust and I think it would get in the way of your (the parent’s) ability to get your teen help and/or treatment. If your teen continues to drink they have a problem probably better handled with counseling than punishment. They would not likely trust you about other problems and issues as well.

Parent; don’t get the police to solve your problems better handled in another way. As they say in the article: We can’t arrest ourselves out of the situation”. You can NOT scare a kid sober.

Working with the DEA

We work with many agencies in our death investigations. While local police and fire agencies are our most frequent “allies”, we work with a number of others. One that we have been working with more frequently, it seems, is the Drug Enforcement Agency (DEA).

We have worked on a few cases that involve people who died after use of prescription meds purchased over the Internet. Perfectly legal drugs (not tainted or of “different” quality), but purchased via the Internet with prescriptions that are also acquired over the Internet from the same provider as the seller of the med. We have seen this scenario with individuals who inadvertently overdosed while “self-medicating” and, in at least one instance, meds that turned up at a party. We continue to report these instances when they occur and know that the DEA closes down the offending sites when they gather enough evidence to do so.

Also, we have worked with the DEA (and continue to) in instances where a doctor “over-prescribes” and/or a pharmacy “over-dispenses”. Imagine the contribution of a doctor that prescribes several hundred pain pills and anxietolytics at a time, at intervals too short for safety, and in combinations that put individuals at risk of poly-substance overdose. Or imagine a pharmacy allowing and dispensing a pain med prescription with 99 refills, and at quantities and frequencies with a potential to risk patient safety. These cases are reported to the DEA and the IL Dept of Professional Regulation for their review and consideration.

Just like those cases I talked about yesterday, we see ourselves as proactive in preventing future deaths by reacting to components of individual deaths and making certain that those conditions are not repeated with other folks.

“Activist” Coroner

We are at it again. Treading where we think we ought, to best “serve” those that die in our county and their survivors.

In a recent investigation it appeared that the prior investigation was “incomplete” and so we were compelled to intervene. It involved an individual severely injured in another jurisdiction, who ultimately died in Lake County. Our ruling at “case review” will be homicide. In reviewing the police investigation done at the time of the injuries it appeared to us that the investigation was disjointed and certain facts and statements had not been given the attention that they merited. We arranged a meeting between our office, our pathologist and an official of the investigating police department. My deputy pointed out things we saw in the records of the investigation, had our pathologist discuss how the severity of the injuries went along with our interpretation of the information available and strongly recommended that they reopen their investigation. After asking if they thought they could use some help from the state police, they decided to reopen their investigation. It is now a work in progress.

Another recent investigation raised several questions for us about the care and interventions a dying person received and/or ought to have received. Because of those concerns we contacted an oversight agency in whose jurisdiction those actions fall and have prompted an investigation on their part. That investigation should result in improved care, which is our goal in reporting the incident.

We take these actions because it is the right thing to do. As our mission statement says:”…we serve those who can no longer serve themselves…” (We speak for those who can no longer speak for themselves.) And we work “…to help prevent deaths in similar circumstance.”

Note: to the media that read this blog, I cannot discuss the particulars in these cases as the investigations are ongoing and the results might be skewed by such reporting.

Note 2: Mr. King: Yes, I am “addicted” to quotation marks, particularly for emphasis. Thanks for your input; I shudder to think what my English teachers would think of my writing (of course, it was over 35 years ago that I last sat in an English class, so they might not be reading this).

IL Nursing Home Death Reporting Task Force

I got involved in a “new” state-wide task force yesterday, the (Nursing Home) Death Reporting Task Force. We will be developing, piloting, and then implementing a project to ensure better reporting and, when appropriate, investigation of the deaths of individuals in nursing homes and related facilities. While we already require reporting from the nursing homes in Lake County, I look forward to this effort in improving these “reports”.

We met yesterday in Springfield (my first meeting with the group) 5 Coroners and individuals from IL Dept. of Public Health, the Attorney General’s office and State Police. We will be working to improve reporting and follow-up across the state, ultimately. In addition to adding a few questions to what we routinely ask when the deaths are reported to us, I think it will be good for systematizing the reports, improving our ability to report “questions” to IL Dept. of Public Health (IDPH) for their investigation and encourage sharing both ways. One piece I particularly look forward to is IDPH sharing with us nursing home “complaints” and “trends” so we can look a bit more “suspiciously” at death reportings from those facilities. And hopefully head off events like the upcoming 6 exhumations in McHenry and Lake Counties to investigate deaths at a nursing home in McHenry County.

Often nursing home residents don’t have advocates and folks watching closely after them. I think it is only right that the Coroner watch out after their interests after death and perhaps gather data to prevent needless deaths in the future.

Suicide prevention programs

We (again that “royal we”) really have some things moving forward with our Suicide Prevention Task Force. We are starting a project, partnering with a local agency to bring faculty training to local high schools and middle schools to assist them with suicide prevention efforts. The training will target faculty to help them in recognizing “at risk” (of depression and suicide) students along with “how to” refer and encourage them to get help. The second “target” is school counseling staff to ensure they have the “tools’ to handle those referrals and do appropriate evaluations and referrals as needed. This program will also ensure “institutionalization” of the training, so that the schools can continue training new faculty, retrain current faculty, and that the program once started will continue on into the future.

Our second big project is a program to encourage suicide survivors (i.e. family and friends of those that die of suicide) to get help and support for themselves earlier after their loss than the 4 year national average. We are as yet uncertain how this will look finally, but we are looking at several models around the country and seeing how we might borrow the best of each and bring it here to Lake County. There are not many “first responder”, “early intervention/support” models out there, but we are confident we can get something effective working here “soon”.

Both of these efforts are exciting and I look forward to their development. As well we are continuing to bring together referral sources and find gaps in services that need to be addressed. The other “pieces” include working on other education programs (students, community) to expand knowledge about suicide and what to do when confronted by it to help prevent it, and working to decrease the stigma associated with it.

Off to the "Illinois Death Reporting Task Force" meeting tomorrow. Long drive, but certainly pertaining to our Coroner work, and I have been invited to participate.

Typical day, typical stuff?

Confluence of stuff, belying the thought of a “typical day”.

Started my day, yesterday, doing a bit of volunteer doctoring (I still do a bit). Into the office to get a bit of stuff done for some upcoming meetings this week and other “usual stuff” stuff. I paused in those endeavors and examined a sub-galeal hematoma and skull fracture as one of my deputies retrieved a “bullet” from a death by suicide, as requested by the police agency involved in the case. Then I walked across the street to watch a press conference being held by a local state senator regarding proposed legislation to make it a felony for parents to knowing allow underage drinking to occur if a serious consequence of that drinking occurs. I was asked, rather spur-of-the-moment, to speak of my thoughts on the issue and it’s utility in preventing teen deaths (my comments ended up in the local newspapers and on WGN). I then went out to participate in the “scene” investigation of a death (man severely in a burned out pickup truck, investigation still in progress). When I got back to the office, I did get a couple of “usual stuff” tasks done, not to mention taking at least half-a-dozen media calls. My meeting last evening went off without problem.

Today I began with a meeting of the Lake County Underage Drinking Prevention Committee. While there I was notified of a homicide that one of my deputies had responded to. When I got back to the office, the first autopsy of the day had begun, the homicide autopsy was “scheduled to follow”. The third autopsy (on the victim from yesterday) was ultimately postponed until tomorrow. While I was still trying to get my act together for tomorrow’s meeting of the Lake County Suicide Prevention Task Force, some guys came by to replace the broken window in my office forcing me out to the conference room for a bit. File reviews, case reviews, review of material from this morning’s meeting, review of other stuff, talked with a recent decedent’s family member about a couple of issues, media calls (about today’s homicide, yesterday’s death and a couple of other matters), this blog post and my day was done.

Although I will be leaving for the day soon, I am always on-call and I look forward to the interesting stuff to come now and into the future. (Did I get the stuff done for tomorrow’s meeting?)

Radio "Company"

Just a quick posting today, something I have been thinking about for awhile.

I’m sure none of my deputies would admit that they believe in ghosts, but I’ve noticed that they leave a radio on in back, in the intake area by the “cooler”.

Although, when you are in the building by yourself at “off hours” it is awfully quiet and then when the security folks come around shaking all the doors to make sure they are locked it can be a jolt.

Coroner Authority

I’m working on an article for our 2nd quarterly newsletter for local fire departments. At least partly because of a recent incident (ah yes, there are some of those), I’ve pulled together some quotes from IL statutes and IL Attorney General Opinions that I am attempting to write the article around. My intent with the article is to speak of our desire for a spirit of cooperation among agencies investigating deaths, while making it clear that the coroner’s office has a certain level of authority that should not be interfered with in these cases and that we have the right to assert that authority.

The “quotes” include:

“Each coroner shall be conservator of the peace in his county, and in the performance of his duties as such, shall have the same powers as the sheriff.”

“…inquire into the manner by which persons came to their death where there was any reason to suppose the death might not have been due to natural means”

“No dead body…or the personal property of such a deceased person, shall be handled, moved, disturbed, embalmed or removed…by any person, except with the permission of the coroner, unless…necessary to protect such body or property from damage or destruction, or unless necessary to protect life, safety, or health.”

“…specific grant of authority to coroners to investigate deaths would necessarily prevail over the general law enforcement powers of other police agencies”

Our office takes these responsibilities and “authorities” very seriously. We do, and will continue to do, complete and thorough medicolegal death investigations (maybe even more so than some coroners in other jurisdictions) in conjunction with and parallel to law enforcement agencies, fire agencies, and other agencies that might have interest in and jurisdiction regarding the death in question (e.g. NCIS, OSHA).

A work in progress.

Vets PSTD and suicide

I ran across an article today on a topic that I don’t think gets covered enough. It had a comment in it that really caught my attention as well.

The article is entitled: “Vets’ suicides: casualties that go uncounted and another hidden cost of war”. It talks about the terrible tragedy of war-related post-traumatic stress disorder (PTSD) and its relationship to suicide. It also mentions how PTSD is often undiagnosed and untreated, how its toll is not tracked after discharge, and how it is a growing problem even in the face of threatened cuts in veterans’ healthcare benefits.

But what really caught me was the statement: “No one knows how many Vietnam veterans killed themselves because no one ever bothered to track or count. There are many experts, Jonathan Shay for example, who have no trouble believing that there have been more suicides since the war than there are names on the Wall…”

My father died by suicide after a second tour in Viet Nam in 1972.

We can not let this tragedy continue and repeat the mistakes of the past. PSTD and suicide in active duty soldiers and in veterans must become a priority. Let’s support our troops.

Nap and live longer

In a study released recently, it appears that a daily nap decreases your risk of dying from heart disease. While, like all studies, it must be replicated in other patient populations, it certainly looks like an impressive effect. The effect may be related to stress reduction and afternoon naps may be “more natural” fitting with the normal cycling of our daily clock. Napping, researchers believe, allows people a chance to reset their heart rates and blood pressure in the middle of the day.

However, the first thing I thought of last night when I saw the report on the news was something a cardiologist told me a number of years ago. He told me we were each born with just a certain number of heartbeats and when they were used up, you checked out. So my thought is that a nap helps you save a few of those limited number heartbeats and allows you to live longer. [Disclaimer: I am not a napper]

So nap away, unless you work someplace where I need service/attention at the time of your nap (or if your one of my employees, I’m not paying for napping).

Keg Reg to lower underage drinking

“Underage drinking cannot be successfully addressed by focusing on youth alone.” You must “create and sustain a broad societal commitment to reduce underage drinking”. “The nation must collectively pursue opportunities to reduce the availability of alcohol to underage drinkers, the occasions for underage drinking, and the demand for alcohol among young people.”

We discussed keg registration (at the Illinois Coalition meeting referenced above) as a strategy to decrease underage drinking. This is a good strategy because it ties the purchaser to a keg when “trouble” arises, whether that trouble is just catching the underage drinkers or if some other incident occurs tied to the drinking (e.g. crash, sexual assault, other injury). This has been demonstrated to decrease the incidence of keggers for “kids”. It is a strategy that is very helpful for law enforcement.

Laws like this do tend to push the drinkers to bars, but it is much easier to monitor/control access there than at a kegger somewhere. Also, another “work around” is to purchase beer in cases, etc, but there is less of an impetus to finish the case of beer than the keg of beer (“it will only go bad after it is tapped”). Over-drinking is a less likely to occur with cases than a keg.

Our discussion now centers on how to implement such a plan. A state law was tried in the past and never got out of committee. Should we try it again, now that times are different and, perhaps, with a legislator with a bit more clout? Or, as is being done with “smoke-free” efforts, should we push multiple local ordinances until we reach a “critical mass” and then go for the state legislation. [Politics are in everything and politics are a “game”.]

But something has to be done. We can’t wait for another kid to die.

Bottle of Red-eye to Die for

I have been to several meetings lately (and going to another tonight) working on preventing underage drinking at several levels. Last Friday I attended a meeting of the Illinois Coalition to Stop Underage Drinking and will be a part of their Steering Committee going forward. In addition to the efforts on the local level that I am participating in, it is important to push and share efforts state-wide and have a presence for the legislature, hence the state coalition.

We plan to concentrate efforts on things like 1) keg registration (more likely growing it to state level from local efforts) so that kegs can always be tracked back to the individual who purchased it, 2) alcopops (think mike’s hard lemonade) or bottled “girlie drinks”, or at least working to impact their marketing that seems to target underage female drinkers, 3) minimum age for bar entry (particularly a problem in college towns), and 4) perhaps a tax increase on alcohol products to fund interventions and (although I doubt its effectiveness) to decrease consumption, particularly among underage kids. I look forward to these efforts and others as they become apparent.

One interesting bit of information that came up at the meeting was Senate Bill 948 that passed in the last legislative session. It seems to me that it kind of brings back the “wild west”. Picture the scene in the old westerns where the cowboy goes into the saloon and orders a bottle of red-eye (with a dirty glass if he was really tough). If (or when) the governor signs this bill into law, folks in Illinois can go into a "club” and order a full bottle of distilled sprits (sounds pretty put that way) to be shared by a table of 2 or more people. This bottle service, while it likely won’t be red-eye, will likely contribute to over drinking. Once the bottle is open you can’t take it home, so you might as well finish it there (17 drinks in a fifth, 21 in a quart, or 22 in a liter). “Over the teeth and past the gums, look out liver here it comes.”

That should be “good for business”.

Social Norms Marketing

Is “social norms marketing” what I have been looking for? It appears to be a unifying approach to addressing an array of social problems leading to death and other problems.

Instead of using “health terrorism” or attempting to “scare the health into people”, you educate them about what their peer norms are and work to promote conformity with that health norm. For example, instead of telling folks that 25% of youths binge drink, you tell them that 75% don’t, building social pressure to minimize drinking, particularly in underage drinkers.

Attempting to frighten individuals into positive change by pushing the negative consequences of certain behaviors has “not changed behavior one percent”. Using “social norms marketing”, however, has demonstrated effectiveness by correcting misperceptions (usually overestimations of use), and identifying and promoting the healthy, protective behaviors that are the actual norm in a given group of folks (teens or adults).

One study demonstrated a 21% reduction of heavy drinking in a college population using “social norm marketing” techniques. There was also a significant decrease in consequences of drinking (e.g. property damage and unprotected sex) pointing to decrease in drinking among those that continued to drink when they had a real handle on the number of drinks that were “normal” in social situations and that not “everyone drinks”.

Social norm marketing has demonstrated effectiveness in a number of issues (although it has been mostly studied in its affect on underage drinking and heavy drinking among college students). It has shown promise in seat-belt use, smoking, spousal violence and grade improvement. My mind races in considering other “targets” (e.g. convincing parents that it’s not OK to throw alcohol available parties for their kids).

Promote health to increase health. Accentuate the positive. Show folks what the real “peer pressure” (social norm) is not taking chances, not making bad choices, but making “healthy choices”.

Blog B-Day

It was pointed out to me today that I have been blogging for a year now (220 posts), wishing me “Happy Blog B-Day” (somewhat belatedly, 1st post Jan.6, 2006).

Also today, I was starting to organize a list of my accomplishments since being elected to office 2 years ago. It does sound a bit egoist to be doing that but I am also preparing to ramp up and “reapply” for this job all too soon (the Primary is a 1 year away).

These 2 things do intersect. I think one of my greatest accomplishments over the last 2 years has been making my office more open, the information it gathers in death investigations more accessible, and on a whole the experience dealing with “our office” a bit less “scary”. We have an “office tour” repeatedly showing on the local County cable access channel. Our “tours” for high school students and other groups have increased in number. I answer questions of the media as much as feasible, keeping the public informed about causes of death and contributing factors, as appropriate.

But I am most proud of this blog (thanks Steve for helping me get started). It is good for my psyche and, hopefully, interesting and useful for others.

I am able to share information we pick up locally, as well as stuff I run across that seems pertinent. I have been able to answer questions and make that information available to other folks with similar questions. I am able to discuss my thoughts about a wide range of issues. Laying it all out in the open for anyone to read, think upon, and who knows, act on and share with others.

Thanks for sharing this with me and I look forward to continuing this on into the future.

Probe post-surgical deaths

There is a proposal in South Carolina to mandate reporting of “patient deaths that happen within 24 hours of surgery to the coroner’s office”. The feeling is that an independent investigation (with the possibility of autopsy) outside the hospital would be better to track and differentiate deaths due to medical “misadventure”, those due to “error” vs. an unavoidable “accident” vs. a system problem in need of remedy. Corrective measures might be more likely to occur at the behest of an agency outside the hospital.

I like the idea.

Here in Illinois hospital deaths are reportable to the Coroner if they occur within 24 hours of admission (which include ER deaths) and if they are the result of a diagnostic or therapeutic procedure. The later categories allow for some interpretation by the hospital in reference to “as the result of”. I am not saying that hospitals “hide” things or that they are less than truthful and open in their reporting, but the perception could exist without a mandate as proposed in South Carolina.

Is it possible some cases shown not to warrant litigation could be kept out of the courts? It certainly is quite possible. Could some cases be pushed to early admission of culpability and settlement? Again, quite possibly. Could we possibly positively affect the healthcare system by pointing out errors and system problem areas, allowing for correction before others suffer a similar fate? I think this is the most important reason to consider this proposal.

MySpace, off-line community replication

I came across an article referencing MySpace that I agree with. It is an interview with a social researcher who has taken a real look at social network sites and activity. My bias: I support teens’ access to and use of social network sites.

The researcher divides the users of those sites into 2 groups. 1) (by far the larger group) those individuals who use the social network sites as an extension of their off-line lives, and 2) marginalized kids who substitute their online lives for community off-line.

Teens for the most part use the sites to talk to others they already know, building relationships not meeting “others”. These sites are just a part of their “new” social repertoire that includes cell phones, texting and the Internet. Realizing this, adults should not fear their use of these sites, as long as their child is in group 1. If their child is in group 2, they (the teen) need “help” for a variety of reasons, the least of which is their Internet usage.

We also need to keep in mind (as she states in the interview) that there has never been an abduction linked to these Internet sites. There have been “runaway situations”, but likely they would likely have occurred in some other “form” without the use of the Internet involved.

Social disapproval as a tool

The other “thing” that came up at the CeaseFire meeting yesterday was the usefulness and effectiveness of “social disapproval”. CeaseFire works to instill and reinforce social disapproval as a deterrent to violence.

Thinking about it, social disapproval used to be an important impediment to a number of behaviors when communities were communities. It is an attribute that we as a society need to recapture.

Society should disapprove of violence vocally and demonstratively. Society should be obvious in their disapproval of underage drinking. Society could use their disapproval to impact bullying in schools (“violence” in itself and a possible precursor to violent action/behavior). So many societal ills deserve disapproval. Publicly avowing that disapproval and breeding action based on that disapproval could go a long way toward solutions to many of our problems, many of those “problems” resulting in unnecessary death.

We can not continue to “accept” these things as inevitable or as unpreventable consequences of our society and/or life. These “problems” are not something we can’t do anything about. We need to disapprove and act or help others to act so that that disapproval is put into action.

I have been accused of “preaching to the choir” on these things, but it is time for the choir to sing and proclaim that it should no longer be so.