9:51 a.m. Well, today I thought I'd give you all a bit of a quiz. (Sharpen your #2 pencils, kiddies.) And no cheating by looking stuff up online! (That means you, Higgy.) Oh, and I like trick questions.
When an ME investigator gets a call, they often have to make a decision whether to bring a body in for an autopsy or not. I'm going to present you with a few different scenarios and you can tell me what the manner (natural, homicide, suicide, accidental) and cause-of-death are in each case and whether the body should be released or brought in for autopsy.
1) Deputy ME gets a call on a case from a local nursing home. They had a resident who passed away from pneumonia. Further inquiry revealed that the resident was a quadrapoligic. Seventeen years earlier a drunk driver hit him as he rode his bike down a country road. The decedent had been been wheelchair bound for years and was admitted to the nursing home two years ago when his health began to fail. He was bedridden most of his remaining life.
So what do you think? Should the ME bring him in? What other questions would you ask before making that decision? What do you think the manner and cause of death should be in this case?
2) Deputy ME gets a call from dispatch directing her to a home death scene. When she gets there, she notes that the 78-year-old man is lying on his bedroom floor near a nightstand. He has a moderate gash above his left eyebrow and a pool of blood around his head. The man was being cared for by his daughter. He had a significant medical hx of emphysema, hypertension, and diabetes that was so severe that he recently had several toes amputated off his right foot. According to the daughter, his health was failing precipitously for the past couple of months and he needed help getting out of bed to go to the bathroom because he couldn't walk without getting dizzy. The decedent was on 14 medications for his various conditions.
The investigator moved to the body and did a physical examination. The decedent was initially found face-down, but had been rolled on his back by rescue. There were EKG patches still adhered to his chest. His torso was warm and his extremities were cool. There was no evidence of lividity or rigor mortis. She noted a bandage around the foot that had recently been operated on. She noted a large yellow bruise along the midline of the torso. The investigator examined the head trauma. The blood was encrusted on the forehead and it made it difficult to determine the severity of the injury. The laceration appeared to be approximately 1/2 inch in length. The investigator examined the nightstand and noted a slight amount of blood smeared on the corner nearest the door. There was an empty water bottle lying on the floor.
Okay. What about this one? What further questions would you ask? Would you bring the body in? What manner and cause of death would you assign this case?
3) This case was called into the Deputy ME in the late afternoon from the emergency room of a local hospital. The decedent had been brought in unconsious with a brain bleed at the base of his skull. His blood pressure was skyhigh when he arrived and the ER staff was never able to bring it under control. The decedent was being treated by his primary care physician for alcoholism. He had cirrhosis of the liver, esphogeal ulcers, anemia, and alcohol-enduced anorexia. His doctor said he'd be willing to sign the death certificate if the ME refused the case.
Would you bring him in? What's the cause and manner of death in THIS circumstance?