2:06 p.m. Sorry I'm a bit late with the quiz results. I got called out at 6:25 this morning and I just got home from running three scenes. Ugh. Food would be good.
One of these cases, which looked at first like a textbook traffic, is turning into a probable suicide. I'll explain more later. Right now I have to hurry. The tissue bank is coming to harvest a guy in about an hour. Harvesting tissue is truly disgusting, though it does a lot of good and I would never discourage anybody from being a donor. I will give you a detailed summary of the process when I return.
QUIZ answers:
First, as a general rule, all manners of death that are not natural and/or unattended (i.e. the person dying had no medical history and, therefore, no doctor to sign their death certificate) come to the ME for autopsy. Suicides, homicides, accidents...they're all ME cases. With that in mind, here are the answers.
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.
I would definitely bring this guy in right after I called the local homicide unit to inform them of the death and allow them to determine whether to charge the driver of the vehicle (if he's still alive) with vehicular homicide. Pneumonia and the car accident ARE related in that pneumonia is common in people that are bedridden and already not very healthy. Lying prone for days and days encourages fluid to build up in the lungs. And since the decedent wouldn't have been bedridden if he hadn't been hit by the drunk driver, his death can be directly attributed to the accident...no matter that it was 17 years ago. There is no statute of limitations on homicide.
The ME would rule the manner a homicide and the cause pneumonia due to complications resulting from injury.
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.
I wouldn't bring this guy in. It's a bit tricky because he DOES have a head injury. Now, my job is to determine whether he died from that injury or whether that injury is secondary to his death. When I examined him, I determined that it was superficial...no skull fractures or profuse bleeding. Therefore, the head trauma was not a factor in the decedent's death.
The family doctor would sign this death certificate, ruling it a natural manner of death. Cause would be ...take your pick. Probably complications of emphesyma or diabetes.
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.
This one is a bit tricky, too. The brain bleed is directly correlated to the decedent's alcoholism. And though you might say that alcoholism is a slow form of suicide, so is obesity and smoking. Yet we wouldn't rule those conditions suicide. Neither would we call death from complications of alcohol a suicide. Normally, people are not being treated for alcoholism. Alcoholics tend to deal with their condition privately and in shame. Because of that, a lot of times when they die they are brought into the MEO because nobody is aware of the condition or the resulting degenerative effects on the body. However, THIS guy had a doctor that knew of his health issues and his condition and I was able to release the body because he was able to sign the death certificate.
Manner of death, Natural. Cause of death, brain stem aneurysm due to complications of alcoholism.
Thanks for playing! That was fun. I'll write more later about the process of harvesting tissue from a cadaver and I'll also take pictures of the scary MEO.
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