8:24 a.m. I walk into the office Monday afternoon and am greeted by utter chaos. Or maybe this is how it always is and I've just been spoiled having just returned from a two week vacation.
There were eight cases yesterday and four of them went to autopsy. I pick up the files and sit down in my favorite chair to read. Two of these cases are death certificate inquiries because the doctor entered an erroneous manner or cause of death. This happens a lot. I look over the first file. Manner of death (MOD) is listed as "natural". The doc reasoned that the decedent had been bed-ridden and died of pneumonia...a natural consequence of being bed-ridden for an extended period of time, since fluid will collect in the lungs when you are horizontal too long. However, the dead guy had been in a car accident three years earlier which left him a quadrapolegic...which led to his being bed-ridden...which led to the pneumonia. So, the drunk driver that hit him that night three years earlier, in a sense, killed him yesterday. It was ruled vehicular homicide. I called the MD and explained the situation to him. He agreed to change the DC to reflect a homicide. After that I called Homicide so they could open a new investigation and determine whether additional charges were to be filed against the drunk driver.
The second DC issue was a doctor that entered "cardiac arrest" as the cause of death (COD). The Chief ME gets really pissed off about this one. Soon after I'd started working here I made the mistake of asking her what was wrong with cardiac arrest. "Cardiac arrest means that your heart stops!" she says with irritation, "Everybody's heart stops when they die! We want to know what led to the heart stopping...whether it was a heart condition or a Mack truck." Fair enough.
I moved on to two other files which turned out to be inspections. Inspections are cases where the manner and cause of death are fairly sure and the ME feels there is no need to perform an autopsy. The first was a 98-year-old woman who passed away in her sleep. She hadn't been to a doctor for years, but there was no need to believe that she had died of anything other than natural causes. The second was a 55-year-old, 400 lbs man who had been diagnosed with congestive heart failure 10 years earlier. The doctor that diagnosed him refused to sign the death certificate because he hadn't seen the decedent in so long. The man's ankles were swollen and red, a result of poor circulation. That and his gross obesity are classic symptom of CHF. The circumstances surrounding his death were not unusual or suspicious. He got up in the middle of the night to go to the bathroom and collapsed in the hallway. No need for an autopsy in this case, either.
I was just starting to look over the four autopsies that had taken place this morning when a call came in from Homicide. A hanging suicide. 35-year-old female.
I get directions and grab my jacket, happy to leave the office for a while.
This case is not far from the MEO. And it is in a very nice neighborhood. I was there a few weeks ago when a housewife whose lawyer husband was cheating on her left her multi-million dollar mansion after sending the kids off to school, walked to the park across the street, sat on a bench and shot herself through the head with a handgun. It took evidence technicians two hours and three metal detectors to find the shell casing in the debris at the base of a live oak tree several feet away.