Graduate Class–#4

The Lorain County Coroner came today to speak to my class. Happily, he’s a better speaker and has better photographs of France than I do. He kept the class entranced for 2.5 hours.

Jamming

I have six quarts of raspberries, a full container of sugar, a pack of pectin, it’s dark, and I’m wearing sunglasses. [/gratuitous Blues Brothers reference]

Why Students Give Teachers Grey Hairs

I like dealing with students. They are young, full of…hope, and interested. (I’m lucky, I have a good population to work with). Sometimes you get tired of the same old, same old questions “Dr. Z, how do you know that’s a liver cell?” and the same old answers “Because that’s what a liver cell looks like.” Sometimes you get the cool, neat-o questions from out in left field, and a totally new way of looking at problems.

Graduate and professional students are also slightly older, and are paying for their education themselves. Therefore they have skin in the game. But they are still young, and youth can lead to bad decisions. I recently came across the student of a colleague of mine, a young woman, who put her telephone number on-line to get as many amusing voice mails as she could.  She wanted to post the voice mails online. This concerned me.

I usually try to act as if other adults are competent, and can take responsibility for their own actions. I suppose it is sexist on my part, though that this bothered me. I’m a big, ugly, armed, full adult male; and I consider putting my personal contact information on line…unwise. (bloody damn stupid, if you ask me).  The Shadow asked “Who knows what evil lurks in the hearts of men?”  I’ll tell you, anyone who has worked in the criminal justice system, that’s who.

Now, with licenses and other stuff, five minutes work will come up with my contact information, but you don’t need to borrow trouble. For a young (and naive) woman to do that? That seemed even more unwise.  The Internet is forever, and people must be careful about bad judgement. Not only for the trouble that it can get you into now, but also in the future. “Well, it seemed a good idea at the time,” sounds kind of lame. Particularly as a response to the question “What were you thinking?”
UPDATE.  I spoke with my colleague, who spoke to the student.  The phone number was that of a pre-paid single-purpose cell phone, thank goodness.

Graduate School–third class

Having covered cause and manner of death, today we spoke of the fun topics, time of death and decomposition. The students learned the algorithm for determining time of death most accurately, the difference between putrefaction and autolysis, the anatomic basis for decomposition, rigor, algor, and livor mortis, the effect of environment on decomposition, and who eats you baby?

Hard-Core Body Modification

Staff Sgt. Brent Homan lost his right eye in June of 2007 in Balad while deployed with 3rd Battalion, 8th Cavalry Regiment, 3rd Brigade Combat Team, 1st Cavalry Division. He had it replaced with the Combat Infantry Badge

From HERE

Urge for Going

I awoke today and found the frost perched on the town
It hovered in a frozen sky, then it gobbled summer down
When the sun turns traitor cold
And shivering trees are standing in a naked row
I get the urge for going but I never seem to go

I get the urge for going
When the meadow grass is turning brown
Summertime is falling down and winter is closing in

I had me a man in summertime
He had summer-colored skin
And not another girl in town
My darling’s heart could win
But when the leaves fell trembling down
Bully winds did rub their faces in the snow
He got the urge for going And I had to let him go

He got the urge for going
When the meadow grass was turning brown
Summertime was falling down and winter was closing in

The warriors of winter they gave a cold triumphant shout
And all that stays is dying and all that lives is getting out
See the geese in chevron flight flapping and racing on before the snow
They’ve got the urge for going, they’ve got the wings to go

They get the urge for going
When the meadow grass is turning brown
Summertime is falling down and winter is closing in

I’ll ply the fire with kindling and pull the blankets to my chin
And I’ll lock the vagrant winter out and bolt my wandering in
I’d like to call back summertime and have her stay jut another month or so
She’s got the urge for going and I guess she’ll have to go

And she get the urge for going when meadow grass is turning brown
All her empires are falling down
Winter’s closing in

Joni Mitchell

Sappy Cat Blogging

I still think my life would be improved with better costumes, lighting, and back-up dancers.

Black Crowned Night Heron

So there I was, driving by Green Lake, where I usually can expect to see at least one great blue heron stalking around in the shallows. Today, I saw a heron, but it wasn’t a great blue, it was shorter, with a black cap and brighter colouring. I think it was one of these, a black-crowned night heron. It is the migratory season for them, and a new one for the life list.

Graduate Class–lecture 2

Today, we went over cause, manner, and mechanism of death. I then tried to use cases to draw out the students into giving their opinions on cause, manner, and mechanism.

Cause of death is that injury or illness that is incompatible with life.
Manner of death is one of the big five, natural, accident, suicide, homicide, or undetermined. Natural has no violent component, accident is due to the unintentional actions of oneself or others, suicide is death due to the intentional action of oneself, homicide is due to the intentional action of another. We went over the difference between the forensic medical diagnosis of homicide and the legal variants thereof.

We also discussed causation, and the but-for causation that is used in forensic pathology. If one can construct a causal chain, that can link events that but for the previous event, would not have occurred, you’ve got a causal chain.

Medical decision making has been defined, by lawyers, as 51% certainty. I love having a lawyer tell me how certain I am. Frankly, I want someone to be more certain than 51%, or “more likely than not” if they tell me I need a heart transplant, but that’s beside the point. Some folks in the field claim you need a higher standard of proof for suicide, because you’re accusing someone of self-murder. Nonetheless, the statutory definition of reasonable degree of medical certainty is 51%.

Homicide–Manner of Death

Michael Jackson’s death has been ruled a homicide by the Los Angeles Coroner’s office. His personal physician used propofol, a sedative agent used for surgical procedures and procedures like colonoscopies to help Mr. Jackson sleep. This is an off-label use of the drug, it was not designed as a sleep aid. It was also not designed to be taken anywhere else but a monitored room with crash carts and help close at hand.

Propofol is abused, usually by CRNAs or AAs or anesthesiologists. All of these gas passers are at risk due to the nature of their job. I have had a patient who hung his bottle on a floor lamp, and infused it in himself. Propofol deaths also seem to decompose very quickly, as my patient did. (I snarkily wonder how much Mr Jackson will decompose, considering he was mostly plastic, but that is by the bye).

Mr. Jackson was deliberately injected by his physician with a pharmacologic agent that caused his death. This is what makes the death a homicide, a death due to the deliberate actions of another human being. Now, there was no intent to cause death. If anything, the doc had a vested interest in keeping his cash cow patient alive. One can make a case for accident, as the doctor wasn’t trying to kill his patient.

The accidental manner, though, does imply a lack of intent, or at least an element of bad luck. Falling off a ladder is an accident. Getting hit by a bus is an accident. Taking an overdose of heroin is an accident. But the doctor is supposed to know what he is doing. Many medications are used in an off-label way, that is other than what they were designed for. Tri-cyclic antidepressants, for example, treat nerve pain quite well.

But in the Jackson case there is more than an element of bad luck. His doctor should have known better, and took tremendous risks that were not justified by the situation. If you need your gall bladder out, I could remove it. If we were stuck on a desert island, I’d be your only hope. In any normal situation, you’d be wise to get a real surgeon, I don’t sew my patients up again afterwards. Propofol is not a sleep aid. This went beyond off-label use, and I believe crossed the line into criminal negligence. Other docs have written about the dangers of giving bad outcomes criminal penalties (hey, WhiteCoat), but I (and most of my forensic colleagues) would rule the same way.