Coroner’s Daughter Takes Notes

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

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

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

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

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

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

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

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

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

Removal of a Dead Body

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

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

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

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

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

National Survivors of Suicide Day

National Survivors of Suicide Day is November 17.

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

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

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

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

Drug-induced or Natural Death

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

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

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

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

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

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

Medication assisted treatment for opiate addiction saves lives and more

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

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

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

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

ID by Pacemaker

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

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

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

Lack of Sleep Peaks Emotions

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

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

They become bears.

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

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

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

Personal Livestock

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

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

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

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

Thoughts on Teen Suicide Prevention Program

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

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

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

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

Such a program would be easier said than done.

Drowsy Driving Kills

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

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

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

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

Driving drowsy kills just as surely as does driving drunk.

Johnny Doe vidi-mentary

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

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

"Johnny Doe- Little Boy Blue"

TV, Salmonella, Violent Death, oh my

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

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

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

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

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

Next Generation of Blogging

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

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

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

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

Coroner Death Investigation

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

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

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

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

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

Death of an identity thief

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

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

Death case provoked dream?

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

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

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

Killing in fiction

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

The question sent in by an author:

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

The answer posted:

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

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

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

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

The Coroner biz is an amalgam...

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

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

Weekend reading with an eye to those related to death

Yesterday’s Chicago Tribune had several interesting articles:

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

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

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

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

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

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

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

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

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

Life skills can prevent death

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

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

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

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

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

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

Accidental Infant Asphyxial Deaths

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

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

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

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

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

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

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

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

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

"procured"

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

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

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

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

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

Again my apologies to those who may have been offended.

Shielding kids with community

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

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

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

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

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

Fish for your brain

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

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

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

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

the blogging coroner

Chicago Tribune editorial "the blogging coroner"

Thanks for the mention.

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

Imagine my surprise a few days ago:

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

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

Shocking Autopsy

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

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

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

Death by Suicide happens all too often

Posted at the American for Suicide Prevention website:

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

On the Students Overcoming Suicide MySpace site:

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

Her death by suicide occured a few weeks ago.

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

IL Child Death Review Teams

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

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

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

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

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

More deaths if flu overtaxes overcrowded ERs

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

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

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

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

Prescription painkiller overuse can be a killer

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

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

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

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

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

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

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

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

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

Beware web information sources

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

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

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

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

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

Media face-time

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

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

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

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

Designated Drivers to Prevent Deaths

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

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

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

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

I hope for no more crashes

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

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

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

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

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

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

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

Life after death

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

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

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

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

Effect of Horror Movies?

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

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

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

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

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

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

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

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

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.