Beware web information sources

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

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

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

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

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

Media face-time

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

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

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

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

Designated Drivers to Prevent Deaths

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

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

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

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

I hope for no more crashes

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

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

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

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

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

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

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

Life after death

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

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

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

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

Effect of Horror Movies?

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

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

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

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

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

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

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

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

Marin County (CA) pushes to prevent suicide deaths.

You know about an object that has contributed to over 1300 deaths during the past 70 years and have had a number of folks say that it is “fixable” so that most of those deaths will not occur there in the future. What do you do? Obfuscate and don’t talk about it, because it would involve saying a taboo word. Don’t talk about it because it would involve talking about suicide. It would involve admitting that death by suicide occurs there and we all know that the “law of contagion” would lead to increased numbers of deaths by suicide there.

Finally, the Medical Examiner of Marin County is pushing for something to be done:

"I'm tired of the carnage," he said. "The public needs to know these needless deaths continue at an alarming rate."
He also wants officials to erect a suicide barrier to prevent future deaths (on the Golden Gate Bridge).
"I believe a higher railing would stop a lot of the suicide attempts," Holmes said. "A lot of people go to the bridge really in the moment, rather than carrying through any well-thought-out effort to end their lives. Of course, you're not going to stop all of them. I'm not that idealistic."
Along the pedestrian walkway visited by millions of tourists each year, only a 4-foot-high railing separates visitors from the turbulent bay waters below.
"If that rail was just 6 foot tall, it would delete 75% of the suicides," he said. "Because now it is just too easy to kill yourself there. You don't even have to climb. You can just lean over the rail and go."

In office for “decades”, he has now taken a stand. He released data on the suicide deaths that have occurred off of the bridge during the last 10 years and is taking a leadership role in preventing them in the future. I applaud his speaking out about suicide and his efforts to prevent them.

Suicide should not be cloaked in taboo and stigma. Suicide happens more than most folks realize (57 deaths by suicide in our county last year). Certainly not all suicides are preventable, but we owe it to folks to try to prevent as many as we can. It is not an easy road to prevention, but we most definitely should go after those things that present an “easier” remedy and remediate them. Our Suicide Prevention Task Force keeps looking for those sorts of issues locally, as well as the tougher targets and solutions. Step one is getting folks more comfortable with talking about suicide, lessening the taboo and stigma.

Death sensor

Oscar the cat seems to have an uncanny knack for predicting when nursing home patients are going to die.

It does remind me of the old “Ripley’s Believe It or Not” articles and books, although the cat has reportedly gotten it right 25 times.

Is it natural or supernatural? I have experienced things and heard credible stories about stuff that does stretch that dynamic (or narrow it?).

Anti-smoking ads have opposite effect on teens

Study: Anti-smoking ads have opposite effect on teens

The more exposure middle school students have to anti-smoking ads, the more likely they are to smoke, according to a new University of Georgia study.
…many anti-smoking ad campaigns have the opposite effect on teenagers, backfiring because they actually encourage the rebellious nature of youth.
…the data showed middle school students are more like to be influenced by the perception of what their friends are doing, and that anti-smoking campaigns should be more focused on peer relations.

Here we have the problem defined (anti-smoking ads don’t work well), the reason spelled out (authoritarian messages invoke contrarian behavior), and the solution laid out (peer messaging), we need to pay attention to that and use it.

Obviously this also holds for so many other problems/issues and it is not the first study to “discover” this triad. Underage drinking is just that sort of issue that jumps to mind (certainly in part because it has been large in the local media lately). We need to institute “social marketing” techniques to let teens know that many of their peers don’t drink and set-up peer education as a good chunk of our campaign against underage drinking (or seatbelt use or licit and illicit drug use, etc.)

1 soda=cardiac risk, how about 42 ouncer?

I just felt I had to pull these 2 articles together for your consideration (you may need to click through the ads on the links):

Study Links…Soft Drinks with Cardiac Risks
Drinking more than one soda a day -- even if it's the sugar-free diet kind -- is associated with an increased incidence of metabolic syndrome, a cluster of risk factors linked to the development of diabetes and cardiovascular disease, a study finds.

…a new McDonald’s menu item is a bit of a stunner. Remember Supersize sodas? They’re back, except this time the chain is trying a new name. Meet the “Hugo,” a 42-ounce drink now available for as little as 89 cents in some markets. A Hugo soda contains about 410 calories.

We are considering increasing the lifting ability requirements for our Deputy Coroner job descriptions.

Distracted Driving Kills

Last Sunday the Chicago Tribune ran an article that is very concerning to read, but the data isn’t all that surprising to me.

"Americans are doing just about everything in their car except focusing on driving,"

We have seen numerous crashes caused by distracted drivers and, as you can guess if you read the article, they do outnumber alcohol-related crashes. The outcry caused by these crashes doesn’t reach the level of alcohol-related crashes, probably because of all of the multi-tasking (and distracted) drivers that are out there.

More than 80 percent of the 1,200 people who responded to its survey identified themselves as "multitaskers," drivers who do at least one other thing besides mind the helm. Motorists age 18 to 27 were the least focused on driving, with 35 percent saying they always multitask.

It is however just as critical that folks realize the real dangers of driving distracted and that it doesn’t take much in the way of distraction to crash.

The National Highway Traffic Safety Administration says that in nearly 80 percent of accidents the driver was distracted three seconds or less before the crash.

We need a campaign “Don’t do the stuff you do and drive”. Not as catchy as “Don’t Drink and Drive”, but just as important to “drive home”.

You won't see this on CSI either

Have you ever had that sickening feeling as your pushing the door shut on your car that you left your keys inside? Well that feeling struck me last Friday.

I was rushing to a meeting (regional Child Death Review Team), not speeding, but otherwise rushing. The meeting is about an hour and half drive, but the traffic is often bad enough to make it much longer. Of course, I had to stop for coffee, so I stopped at Starbucks in Buffalo Grove. As I got out of the car and shut my door, it struck me that I had dropped the ignition key into a small receptacle in the center console. Well that was going to make me late to the meeting and it was an important meeting with several cases to discuss and the election of chair and vice-chair.

While I was considering my options I went ahead and bought my coffee (venti coffee black, for those of you keeping score). I did notice that my passenger window was open about and inch, so I was thinking that maybe I could use a coat hanger to get in. I asked if the coffee folks had a hanger, but they did not. There was a Jewel in the strip mall, so maybe I could buy some. But as luck would have it there was a cleaners there as well and they were nice enough to give me a hanger.

So for 10 minutes I tried to fish my key out of the console. Quite the sight to passers-by I am sure (my vehicle is prominently marked as a Coroner’s vehicle). Nearly giving up, I dialed 411 on my cell phone to get help through the non-emergency police phone number. Amazingly as the operator answered, because I was too busy to respond to the electronic voice, I hooked the key and carefully drew it out through the window. Quickly telling the operator I no longer needed assistance, I got in my car and proceeded on to Glen Ellyn. The traffic was in my favor, too, and I made it to the meeting in time.

In addition to participating in the case discussions, I was elected to Chair the team at the meeting. Luck was with me at least through that part of the day.

Just a bit to be filed in the “day in the life…” folder.

Blog Brings Death Debate

"Blog Brings Death Debate"

Options should be at the very least be discussed.

"(But) all of the options need to be there and available," he said. "Different people would seek out different options."

It takes more than law enforcement

Report: Gang Suppression Doesn’t Work

Anti-gang legislation and police crackdowns are failing so badly that they are strengthening the criminal organizations and making U.S. cities more dangerous, according to a report being released Wednesday.
Mass arrests, stiff prison sentences often served with other gang members and other strategies that focus on law enforcement rather than intervention actually strengthen gang ties and further marginalize angry young men, according to the Justice Policy Institute, a Washington, D.C., think tank that advocates alternatives to incarceration.

I had read this article this morning before I went to a meeting (Avon Township Youth Advisory Board) at which we talked about the community problems of underage drinking and the use of other drugs by youths and a similar point was made there. None of these social/societal problems can be remedied by only using a single pronged “tool”, i.e. law enforcement, even with stiffer and stiffer penalties.

All of these problems (which would include violence and some others) must be “attacked” at multiple levels and using multiple “tools”. Parents and family must participate at the level at which they can and they probably will need help knowing what to do and how to do it. The schools will have a role, as will the community more generally. Public policy must be such that it will have a real impact, necessitating changes, embellishments and additions, based on tested and proven records. The faith community will have a role and on and on.

Just as so many are working in various locales; we will continue our work and come up with some concrete actions to accomplish our goals. I look forward to the efforts and its results.

"...and decrease the excess population."?

We had another individual die recently in our county. That really isn’t news there are approximately 10 deaths a day in our county. But it came to mind while I was doing some of my daily reading, that death (and there have been certainly been others) was related to lack of access to healthcare. No doctor because they had no health insurance and no meds because they are too expensive.

There has been a bit of a surge in media coverage on this topic, what with “Sicko” being released and some presidential campaign talk about access to healthcare. It is an issue I have been involved in for years and comments like the following that I came across today go way beyond irritating:

But Dr. Reddy … has a principled reason for his piratical practices. "Patients," the Los Angeles Times reports him saying, "may simply deserve only the amount of care they can afford." He dismisses as "an entitlement mentality" the idea that everyone should be getting the same high quality health care.

People suffer because of lack of access to healthcare, which primarily translates to lack of access to healthcare coverage, and people die because of it as well. Hopefully the political will is growing around this so something more global can be done. In the meantime, support any effort that works to address this crisis in our society.

Narcissism run amuck can kill

Young adults feel so entitled and we ought to blame it on Mr. Rogers according to some online discussions and the Wall Street Journal.

Signs of narcissism among college students have been rising for 25 years, according to a recent study led by a San Diego State University psychologist. Obviously, Mr. Rogers alone can't be blamed for this. But as Prof. Chance sees it, "he's representative of a culture of excessive doting."

This same researcher quoted elsewhere is concerned because these narcissistic kids “are more likely to have romantic relationships that are short-lived, at risk for infidelity, lack emotional warmth, and exhibit game-playing, dishonesty, and over-controlling and violent behaviors.”

We see the fallout. A young man dies by suicide, at least contributed to by his ingrained thought that he would make $80,000 right after graduation. Relationships without the thought of the work involved leads to self-medication and other problems contributing to deaths (accidents, suicides and homicides).
How do we pull this generation back? How do we prevent the next from falling into the same pit?

I like the part of the Alternet article about the need for “kung fu” (spiritual discipline and cultivation of the self). Equally important is the concept that “the self is best defined in relationship to others, a person among persons”. I know that parents must act like parents. I know that kids need to realize that they are kids and a lot of growing up requires hard work. That life is not fair sometimes. That just plain life requires hard work and a lot of stuff in it requires even harder work. Reality, what a concept. Those are the goals, but how do we get there?

Autopsy drug overdose deaths

I do go to a fair number of meetings attended by other coroner’s and the occasional representative of the Cook County Medical Examiner's Office (for a while it was Dr Denton). Lately they have been in “exotic places” like Springfield, Bloomington and Glen Ellyn. Chatting most often centers on work and it is not unusual to discuss and share about issues etc, but I digress a bit.

After discussions with folks from Cook County, we (that executive “we” again) have decided to change things a bit in the way we handle certain cases in the office. It is not a huge change, but change is the one constant. Historically (as long as anyone can remember), autopsies have been done infrequently in drug overdose deaths by the Lake County Coroner’s Office. The feeling was that having toxic levels of drugs, whether licit or illicit, in an individual “gives you” the cause of death. We will be doing autopsies now on most, if not all, drug related deaths. Information based on real experience, primarily from Cook County, informed us that possible prosecutions for dug-induced homicide proceed more smoothly with an autopsy done, despite the fact that the autopsy rarely gives any truly pertinent information as to the cause of death.

It may seem unusual that this was not encouraged through any communication from the Lake County State’s Attorney Office, but this is a newer “field” of possible prosecution and likely everyone is still “feeling their way”.

In all fairness the question was raised by a local police department and our research/information seeking in response to that brought the answers/opinions from the Cook County ME Office.

"Other" Deputy job requirements

It is easier to measure performance, e.g. case paperwork done in X hours, but employees in my office (particularly my investigators) must demonstrate certain other characteristics that are “softer” to measure.

They must have integrity and an internalized “system” of ethics that sets boundaries on their behavior. This encompasses a sense of “right” from “wrong”, but also an ability to make even more nuanced choices as decisions are made in their work and in their relations with others. My investigators are often in situations that demand this and at times may even “test” them. For example (and there are too many to list), there may be a significant amount of money found in the decedent’s home. That money must be handled properly and passed on to the legal next of kin or the proper authorities. Another example is that we are often privy to certain information about folks that must be maintained confidentially and not judged. My investigators must come to their job with this ethical outlook and basis for their actions. I can’t teach that or remediate it. Lack of these traits puts the results of their investigations in doubt.

They must accept and display personal responsibility. If something doesn’t go quite “right” they must accept and admit that part that they contributed to, take “ownership” and responsibility. It is not always someone else’s fault, you, too, contributed to that action and/or outcome. If punishment is deserved it must be accepted as the “just” thing to occur. Again, this is a part of them. It is demonstrated in many ways and many interactions. I can encourage it, but it is a part of them when they come into our office. I can not give it to them.

Lastly, they must earn trust (prove to be trustworthy), primarily by demonstrating and living the above traits. Earn my trust, because they often serve as my “eyes and ears” in our investigations. Earn their fellow co-workers trust (in and out of the office), because they work closely with others and without that trust working relationships are jeopardized and handicapped. Lack of that can make for untenable working conditions for my office and our staff, as well as damaging relationships with other organizations and outcomes of investigations.

Just some passing thoughts.

activist coroner's office

Lazy posting? I wrote this for our upcoming summer newsletter to local EMS providers:

There is a line in our office Mission Statement that has been in place since I took office that we take very seriously: “serve those who can no longer serve themselves”, also that we will “help prevent deaths of similar circumstances”. These are the underpinnings to several recent actions prompted by our office, giving us a bit of an activist role.

A recent case, picked up by some of the media, was our reporting of the prescribing pattern of a local physician and participating in his having his license suspended. We felt that this physician was over-prescribing meds (particularly OxyContin) and that that had contributed to at least 3 individual’s deaths (if not more). Medical “misadventures” (read errors) do occur and we need to ensure a system is in place to address those and learn from them and prevent reoccurrences, but some times the practice is “wrong” and it needs to be stopped before it kills again.

Another case that became prominent was a post-death inquest that resulted in WomenHeart (a Washington DC based women’s heath organization) awarding me the 2007 Wenger Award for Public Policy. Information about that case (an ER waiting room death) is now used nationwide as a teaching tool for women to advocate for themselves and for healthcare providers regarding providing care to all in need. No one should die in a waiting room 20 feet from needed (and available) treatment. I spoke recently at a meeting of the Association of Black Cardiologists in Boston and I will be participating in a national effort to effect system change so that deaths like this do not occur again here or elsewhere.

We work closely with hospital risk management staff; various departments of local, state and federal government; product safety folks; OSHA; and others, all with the goal of preventing future deaths. We also cooperate with families to ensure that any correctable contributors to an individual’s death are addressed and redressed if possible. We work on issues and advocate for solutions and changes to do our utmost to forestall death.

We do feel that we are here to “serve and protect” (a bit overused in other ways), we serve the dead and their loved ones and protect those that have not died yet so they stay out of our office for as long as possible.

The Coroner relaxes

What does a coroner do to unwind/relax? In addition to enjoying my family, I do several things regularly.

I read a wide variety of stuff, it occupies my mind, some allows an “escape”, and sometimes I learn a bit. I have always enjoyed reading. So much to read, so little time.

I have begun a regular exercise program at a local gym. It is a great stress reliever and that is the reason I first dove in. Also, I was seeing quite a few folks about my age in the office (horizontal, if you know what I mean). I am sure that the exercise makes me healthier, in addition to making me feel better now it should help me live longer. I look forward to growing old in my job (although I am part way there now at 52). My other thought is that I want to look good in life and when it comes time for me (in a long time) I want to look good in death.

The other thing I have been doing is continued learning. First and foremost, keeping up on coroner stuff and keeping up on doctor stuff (there is a fair overlap). But, in addition, I am learning stuff because it is enjoyable to learn that stuff. For example, a week ago I attended a day of learning involving a mixture of neurolinguistic programming and Hawaiian traditional healing/energy work (ehoomanamaiola). It was fascinating to meet Hawaiian elders/teachers with email addresses and a website (and even better, because I didn’t have to travel to Hawaii to do it). Prior to this class I would never have thought such a thing likely. They are doing a lot with their Hakalau in the Hawaiian school system. I have also been attending classes at the Infinity Foundation. Does this make me weird? (As Willy Wonka said: “A little nonsense now and then is prized by the wisest men.”)

Work, play, exercise your body and exercise your mind (stretch it and have fun with it); live long and prosper (to steal a line).

CeaseFire makes a difference

Eric Zorn has a great post on his “Change of Subject” blog today: “Road to ending violence starts in the streets”

Quoting a Chicago Ceasefire “violence interrupter”:

"People have been preaching to these guys for years," Hardiman said. "But they don't want to hear about God. Their god is money, violence, sex, drugs or whatever else sounds good to them at the time. They're not hearing that God message right now. They're committed to their lifestyle."
What works, Hardiman said, is "straight up, face-to-face meetings with them. Building trust. Finding out what's happening, putting a stop to conflict before it gets out of hand."
You don't do this by grandstanding or picketing. "You have to go right to the belly of the beast," Hardiman said. "You've got to be out on those streets, walking every block, showing these young people that you're with them, that peace is better for everybody."

I wrote a comment:

I am a firm believer in the effectiveness of what CeaseFire does. It is effective at interrupting violence and stopping the escalation of the violence. Its community basis and community relations (not in the advertising sense but relations developed with people in the community) are the reasons for its effectiveness.

CeaseFire and similar models are spreading outside of Chicago and re-proving that violence can be impacted and “stopped”, at least until we get the political will and wherewithal to tackle the more root causes that you mention. We have seen positive effects with our program in Waukegan and North Chicago and I look forward to continuing to work with the program. We also have a strong primary prevention component to our program, former offenders talking to young kids to head this behavior off before it starts.

I look forward to CeaseFire’s continued success to keep the victims of violence out of my office (Lake County Coroner) and offices like mine, let them live out their potential.

I do applaud CeaseFire’s efforts. It can make a difference.

Preventing "accidents"

Case conferences today. I like this new system for determining manner of death, it allows for more discussion and consideration among the staff of all the cases and I think good quality decision making occurs based on that.

I am meeting with some other coroners and IDPH representatives tomorrow about the project to formalize reporting of nursing home deaths. It will be piloted in several counties (including Lake) and then go statewide.

It is interesting that one of the deaths that we discussed today was a nursing home resident (confluence) who died after a fall in the hall of his nursing home. The case presentation brought up the fact that he or his walker likely caught on a lift device that was parked in the hallway. It should not have been there for a number of reasons, so as part of our deliberations we felt strongly that the incident needed to be reported to the IDPH department that oversees nursing homes for corrective/preventative action (we don’t want to see another needless “accident”).

There were other cases today in which we discussed ensuring that proper agencies get reported to about certain deaths and the circumstances surrounding them. I think we really do all we can to prevent deaths in this manner and I look forward to this continued effort.

Coroner’s Office investigation leads to medical license suspension

A case I alluded to in my last post came to a head yesterday. To paraphrase the press release from the Illinois Department of Professional Regulation: Information supplied by the Lake County Coroner’s Office has resulted in the suspension of the medical license of a local physician.

Based on evidence developed during our death investigation of 2 individuals, we reported the physician to the DEA and the IL Department of Professional Regulation. It was obvious, based on our investigation the he was over-prescribing and most concerning was over-prescribing meds with high lethality. One of the individuals had a bottle from a prescription that had contained 270 Oxycontin tablets. This is a medication usually taken twice a day. This is the same individual who had over 100 tablets still in his stomach on autopsy.

We, as an office, feel it is our responsibility to prevent death as well as doing our best to ensure justice is done by those who die what might be considered an unjust death. We “serve those who can no longer serve themselves”. I am absolutely certain that by this action we have prevented the future death of others. It really isn’t all that often I can say that with conviction, but in this case I am convinced.

We don’t only work to catalog death, but to forestall it.

CSI-like Coroner's biz

Sure I wrote last about the mundane aspects of my job/office, but it should not be construed that that is the end-all/be-all of our Coroner’s biz.

Things like providing our investigative information to the DEA and state licensing agencies to help get doctors out of practice who have turned their offices into Rx mills resulting in significant community problems and death. Or finding unexpected results on toxicology testing and sorting out why the results came back that way (e.g. an individual with kidney failure not getting dose reductions commensurate with their reduced drug clearance).

Or “mapping out” the scatter of body parts and stuff the individual was carrying to come to the conclusion that they were likely hit by a train, as opposed to blunt trauma from another cause. Tracking down eye-witness input that the individual used the tracks as their walking path to get places. Tracking down folks who knew the individual who could provide identifying information and/or refer us to others with that information so we knew who the individual was. Finding that the individual was a resident alien and tracking down family with consular help and getting the body back “home” for burial.

The stuff I mentioned in my last post is more filler than “what we do” day in and day out (our “raison d’etre”), but it does not lessen the frustration associated with it. The “meat” of what we do would be good TV script material, but the other stuff isn’t. The adrenaline stuff makes the job interesting and fulfilling, but the mundane allows for a pause and a breath. The service for those that can no longer serve themselves brings us to work everyday. Got to have a balance of both, but, don’t get me wrong, we do do CSI stuff (albeit with a smaller budget), nonetheless folks need to realize that it’s not all like TV all the time.

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”.