9/28/05a WARNING: GRAPHIC/DISTURBING

2:06 p.m. Well, the guy didn't die of esophogeal varices. I could tell that right away when the Chief Dpty ME let me look at the scene photos after I got to the office. There WAS blood in the toilet and sink, but it wasn't thick and dark like is typical. And there should be a LOT more of it.

The problem is choosing the cause of death. They guy was a mess at 62 years. He looked at least 10 years older. He had fleas. His toilet was full of little pin worms (which means he likely was, too). There were beer cans and spent cigarettes everywhere and the place was a disgusting pig sty.

When I got to the autopsy suite he was laid out on the table. His feet and groin were dirty and encrusted with filth. And he emitted a very strange odor. It wasn't just stink, but almost sweet or nutty. Dr. Frank frequently emitted sounds of disapproval and said things like, "Ew! Those feet! I can handle anything but nasty feet and snot!"

It was interesting watching an autopsy where they use a slightly different protocol. Instead of using the bone saw to cut through the rib cage, they used a big ol' set of tree trimmers. Ugh. (Just imagine the crunching sound when you cut dry branches off a tree and that's about what it's like listening to ribs being snipped.)

And they made me get all gussied up in a hazmat suit. Which kind of seemed like overkill to me. (harhar) When I asked why, they said they treat every case as if it's HIV or tuberculosis. Which, I guess, is smart, though I might grumble a bit. I was actually gratful for it when Dr. Frank was trying to strip the fat from around the heart and accidentally flicked a big yellow glob of it onto my face mask.

The heart was enlarged from hypertension. The lungs were black and adhered to the walls of the rib cage from years of smoking. The liver, surprisingly, looked pretty good except that the gall bladder was full of stones and the bile was nearly clear. (It should be dark greenish yellow.) When I asked Dr. Frank why the bile was such a strange color she said, "How the hell should I know? Obviously something wasn't right. Nobody's taken the time to do research on that phenomenon."

The brain was a little shrivelled. (Another typical side-effect of alcoholism.) The esophegus was beat up a bit, but not bad. And the stomach was full of small ulcers that are typical in heavy drinkers. They would have caused bleeds, but nothing so severe that it would have killed the guy. His pancreas looked okay. (Often times the pancreas will hemorrhage in alcoholics, which leads to an agonizingly painful death.)

Then we got to the kidneys, which looked like hell. Instead of a smooth, dark pink, they were pale and lumpy with cysts. Huh. Kidney disease? Dr. Frank immediately checked for a blockage in the ureters, which were dialated. Nope. Then the doc took out the bladder and when she cut it open there was a huge, cancerous mass in there... so big that there was only enough room for maybe a teaspoonful of urine. The guy's kidneys had been stopped up with urine for so long that they became necrotic. Dr. Frank was pretty excited about all this. She says, "Oh, cool! I've got to stick that in some Formalin so I can play with it later. This is great!"

From all of the many choices, kidney failure due to bladder cancer will most likely be the cause of death, though there were several contributing factors. The blood in the toilet was from his diseased bladder.

The sad thing is if he'd gone to a doctor it could have been treated pretty easily. Bladder cancers don't metastasize as readily as other types.

I personally believe he had not been a heavy drinker for too long. He didn't show signs of chronic use...the ulcers were acute. Maybe from the last couple of years. I think he was drinking to mask the pain from his cancer.

The guy had no family and no friends to take care of him. He had no insurance. And a few months back he went to a local funeral home and paid for his own burial in advance.

Very sad.