July 24, 2013

“We have to remind them that we held the heart in our hands.”

In Nautilus  Why Autopsy Gandolfini? Death Is Certain; Its Cause Is Not

The sad fact is that despite medicine’s many modern wonders—the tests, the drugs, the scans that show fibers the size of a hair—the cause of death that American doctors provide for death certificates are dead wrong about a fifth of the time.

How do we know they’re wrong? Because of so-called autopsy studies. In an autopsy study, researchers perform or collect data from post-mortem dissections of large numbers of dead people; determine definitively why they died; and then compare those findings to the causes of death listed on those people’s medical or death records. These studies reliably find something rather shocking: about 15 to 30 percent of the time, the diagnoses at time of death are wrong—and 5 to 10 percent of the time, that diagnostic error probably helped kill the patient.

This is why Italy required Gandolfini’s autopsy: So the doctors and family would know with certainty why and how he died. As it happens, heart attacks and pulmonary embolisms—clots in a lung—present very similarly: Both cause chest pain, shortness of breath, panic, and can kill you within an hour. Doctors thus often think someone died of a heart attack when they actually died of a pulmonary embolism—so often, in fact, that most pulmonary embolisms are not diagnosed unless an autopsy is done. (We know this, of course, only because autopsy studies showed us it was so.

This isn’t just arbitrary hindsight information. The discovery of an embolism on the autopsy table can provide vital health-risk information for the rest of the family. A victim’s brother, for instance, might have a chest angiography done to look for fluid in his lungs, and if it’s there, start heparin therapy that could save his life.
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Alas, we’re missing most such learning opportunities these days, because the routine autopsy has pretty much died. Fifty years ago, American hospitals autopsied almost half of all deaths. Every doctor had done them, learned from them, and took their presence for granted. It’s hard to overstate how much we learned from making autopsies routine back then. The list of ailments they discovered runs long, from sudden infant death syndrome to Alzheimer’s, Legionnaire’s disease to toxic-shock syndrome.

In the summer of 1999, for instance, four New York City residents died of a lung ailment that the treating doctors diagnosed as St. Louis encephalitis. The New York City medical examiner’s office, an ardent autopsy advocate, insisted on autopsying them anyway—and identified the first known U.S. victims of West Nile virus.
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We now autopsy fewer than 1 in 50 deaths in the U.S, missing 49 out of 50 chances to learn something new. The rates have dropped for a number of reasons, but primarily because the government stopped requiring them for hospital accreditation in 1970.

This will almost certainly remain the case. Congress could change this quickly if it made Medicare payments or hospital accreditation depend on autopsy rates of, say, 25 percent. But no one seems to take interest in such regulation. Thus when doctors make diagnostic mistakes in a dying patient, we usually get no chance to learn from it. Instead, we bury it.

But what about the fancy scans? Can’t they tell?

Not really; not always; and sometimes not even with causes of death you’d think would show up easily in a good scan. Doctors take far too much confidence in scan results, feeling they see everything with certainty. They don’t. As a Florida coroner told me a few years ago, “We get this all the time. The doctors get our report and call and say, ‘But there can’t be a lacerated aorta. We did a whole set of scans.’

“We have to remind them that we held the heart in our hands.”
Posted by Jill Fallon at 1:42 PM | Permalink

June 19, 2013

Clearly a suicide

Tulsa police say a woman came home to find her husband dead in the garage.

Police said the man was found with his hands and feet bound and he had been decapitated. Police surrounded the home near 45th & Sheridan during the investigation. 

They told FOX23 they think the death was suicide.
Posted by Jill Fallon at 1:59 AM | Permalink

April 17, 2013

"My grasp of the English language doesn't really allow me to fully describe how horrific this clinic was"

I am following the Kermit Gosnell trial in Philly and every day it gets more horrifying.

He kept baby feet in jars!  Like trophies.  He considered himself "a good person".

Former employees testified last week that Gosnell gave different explanations for why he kept up to 30 specimen jars containing fetal feet. He told some the feet were for DNA testing and others they were for medical research

Yesterday, the medical examiner testified how he had to thaw the fetal remains to analyze how they died.

The remains of aborted fetuses were stored in water jugs, pet food containers and a freezer at a West Philadelphia abortion clinic, the city's chief medical examiner testified in the murder trial of the doctor who ran the facility.

Medical Examiner Sam Gulino told jurors Monday he had to examine the remains of 47 aborted fetuses, some of which were frozen, as part of the investigation into the charges against Dr. Kermit Gosnell.

Authorities accuse Gosnell, 72, of using scissors to sever the spinal cords of fetuses who emerged from their mothers still alive.
"There was no guidance on how to proceed," Gulino said, adding that the lacerated fetuses had to be thawed slowly so the tissue would not be destroyed. "I was never asked to do that (before)."
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When authorities searched Gosnell's office, they found bags and bottles holding aborted fetuses scattered throughout the building. Jars containing the severed feet of babies lined a shelf. Furniture and equipment was blood-stained, dusty and broken.

"My grasp of the English language doesn't really allow me to fully describe how horrific this clinic was -- rotting bodies, fetal remains, the smell of urine throughout, blood-stained," Williams said.
 Gosnell's--Freezer
Gosnell's freezer was full of  aborted babies

Today, a former janitor testified that toilets were backed up with body parts from abortions.

Johnson worked as a janitor, maintenance man and plumber of sorts and he was the common-law husband of 51-year-old Elizabeth Hampton, who is herself Gosnell’s wife’s sister. He told jurors some of the morbid details that appear in the grand jury report — including how he threatened to quit working at the abortion clinic because he refused to pull any more flesh from aborted babies out of the plumbing.
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His job was to collect abortion remains and take them to basement — but he eventually refused to participate and bags began piling up.

He told the jury toilets backed up one-two times a week and said he opened the outside clean out pipe and fetal parts such as babies’ arms came spilling out.

Such horrors were the result of how Gosnell's  practice of inducing labor in the pregnant women then severing the spinal cords of the live babies.

Posted by Jill Fallon at 12:31 AM | Permalink

April 11, 2013

Molly in the morgue

The eccentric memoir of the woman who worked on 8,000 autopsies alongside the legendary pathologist Keith Simpson and the hangman Albert Pierrepoint

Molly Lefebure was the only young female working in the morgues of London. Before she died in March, aged 93, she published a memoir recalling some of her most tantalising cases.
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How could I expect him to understand that corpses all had fascinating stories — of hopes unfulfilled, joys that ended in sorrow, love, sacrifice, broken hearts, stupidity, depravity and crime of every description?

And my goodness, how they talked!  Everything about them talked. The way they looked, the way they died, where they died, why they died.

They were all there on the post-mortem (p.m.) table: the tart who picked up a killer; the baby left to starve; the soldier who came home to find his wife in bed with another man and gassed himself; the sailor who came home to find his wife in bed with another man and shot her.
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In the case of a peppery old Lambeth stall-holder who’d had a punch-up with his adult son, there seemed little doubt that he’d killed his boy: they’d been arguing over who was responsible for not screening the windows properly during the blackout.

The body was found to have the large imprint of a sizzling iron on its chest. So by the time we started work at Southwark mortuary, the father had already been arrested and his prospects looked grim.

I stared at the hot iron mark on the corpse’s chest, which looked just like a tablecloth on which a careless housewife had set down her iron. The mortuary assistant, however, had seen it all before.

‘Old way of reviving people, a hot iron,’ he said, ‘guaranteed to make anyone unconscious sit up, with a jerk — so long as he isn’t dead.’

It was, as Dr Simpson said, a ‘beautiful specimen of post- mortem burning.’

As he worked on the man’s brain, he suddenly made a startling discovery: it was not the blow from the father’s fist that had killed the son, but the rupturing of a cerebral aneurism. This meant that he could have dropped down dead at any time — and his remorseful father, who had obviously tried to revive him, was off the hook.
Posted by Jill Fallon at 3:41 PM | Permalink

January 15, 2013

Forensic research links blood of beheaded king to his ancestor who died 7 generations earlier

Dipped in the blood of beheaded French king: Scientists use DNA to confirm gourd was a VERY gruesome memento from the execution of Louis XVI

Two centuries after handkerchiefs were dipped in the blood of the beheaded French king Louis XVI, scientists believe they have proved one such rag kept as a revolutionary souvenir contains his bloodstains.

For years researchers have been trying to verify the claim that an ornately decorated calabash contained a blood sample of the king, who was guillotined in Paris on January 21, 1793.

On that day Parisian Maximilien Bourdaloue joined the crowds as dipped a handkerchief into the blood left at the scene of the decapitation.

He is then believed to have placed the fabric in the gourd, which has been in the hands of an Italian family for more than a century, and had it embellished.

Two years ago, analysis of DNA taken from traces of blood found inside the gourd revealed a likely match for someone of Louis' description, including his blue eyes.

But it was never able to be proved beyond doubt as at the time the team did not have DNA of any royal relation.

But a team of experts from France and Spain, which has published its findings in the journal Forensic Science International, have conducted further research using genetic material from another gruesome artefact - a mummified head believed to belong to Louis' 16th century predecessor, Henri IV.

Their research has uncovered a rare genetic signature shared by two men separated by seven generations, and managed to provide evidence for the authenticity of both sets of remains in the process.

 2 Kings 7 Generations Apart

Posted by Jill Fallon at 3:51 AM | Permalink

August 31, 2011

The Blessing of Cadavers

Deacon Greg in Life amid death points to "a  remarkable glimpse into a world few of us see", courtesy the Chicago Tribune:

On Monday, 150 students at Loyola University Chicago's Stritch School of Medicine approached their task with reverence, reciting prayers and bowing their heads as a Roman Catholic priest offered a blessing over the 18 shrouded cadavers — silent teachers who would guide the aspiring physicians' careers.

"The cadaver keeps speaking to you even in death," said Michael Dauzvardis, director of the anatomy course. "You've got to listen to it. There are volumes of knowledge you can still learn from that person who made that ultimate gift."

During the ceremony, Salvation Army Maj. Debbie Sjogren, of Lombard, stepped up and addressed the students. Her late husband, Salvation Army Maj. Randall Sjogren, was likely under one of those sheets, she said, because he wanted to be one of the next generation's first patients.

"My husband's prayer was: 'I've always wanted my life to bring glory to God. Now I want my death to,'" Debbie Sjogren recounted. "He prayed for every medical student that learns from his body and every patient of theirs that heals from the knowledge they receive."
Posted by Jill Fallon at 12:27 PM | Permalink

July 28, 2011

Autopsy reveals he died of the flue

"Autopsy reveals he died of the flue" wrote James Taranto in the Wall St Journal linking to this piece, Remains of Man Missing for 27 Years Discovered in Bank Chimney.

Joseph Schexnider, who was 22, disappeared from the town of Abbeville in January 1984, after missing a court hearing over charges of possessing a stolen vehicle.

It is thought his family did not report him missing because police officers had arrived at their home searching for him following the missed court appearance.

Mr Schexnider’s mother said at the time that he had been known to leave abruptly – including once to work on a circus – and was this time thought to be on a “rendezvous”.

However, human remains were discovered with a pair of gloves, a cigarette lighter, a watch and a wallet in a chimney during renovations carried out to Abbeville National Bank in May.

This week DNA tests by a Louisiana State University laboratory confirmed that the remains in the chimney, which was sealed off later in the 1980s, were those of Mr Schexnider.

Mary Manheim, the head of the lab, said Mr Schexnider “died within a few days maximum of when he went into that chimney”

It has been speculated that Mr Schexnider died of dehydration or starvation. However, Ms Manheim told ABC News, “Nobody will ever know” precisely how he died.

He had no bag with him so is not suspected of trying to rob the bank, police have said.

Lt. David Hardy, a local detective, said: “Hopefully this will give the family some closure. There's no signs of foul play in this investigation, so as of now it's going to be a closed case.”

“His mother is upset that she lost a son, of course, but she is at ease that she now knows where her son is”.
Posted by Jill Fallon at 4:48 PM | Permalink

July 21, 2011

Salvador Allende's death a suicide

His remains were exhumed and a forensic analysis made by a team of Chilean and international experts who concluded that the Death of Chile's Ex-President Allende was a Suicide.

SÃO PAULO, Brazil — A new autopsy has determined that President Salvador Allende of Chile killed himself with an assault rifle, Chilean officials said Tuesday, dispelling doubts that have persisted for 37 years about the exact circumstances of his death, including whether troops storming the presidential palace had murdered him.
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Even as leftist supporters like Fidel Castro declared that Mr. Allende died in a gun battle on Sept. 11, 1973, the day of the coup, his family members had long found credible the original autopsy and accounts of witnesses, including palace detectives and doctors, who said he had taken his own life before the military entered the palace.  But doubts had lingered
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“We are in a position to assure that this was a violent death that was suicidal in nature,” said Dr. Francisco Etxeberría, a forensic expert appointed by the Allende family. “Of that we have absolutely no doubt.”
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For the Allende family, the team’s findings brought relief, confirming Mr. Allende’s suicide, which had come to be a source of family pride. He “made the decision to end his life before being humiliated or having to go through some other situation,” Senator Isabel Allende, his daughter, said Tuesday.
Posted by Jill Fallon at 10:44 AM | Permalink

March 31, 2011

By now you are almost qualified to perform an autopsy

Last night Dana Delany's new show, Generic Medical Examiner Hour-long Drama, debuted. Okay, I don't know what the real title is -- Body of Proof or Body of Evidence or Cases of Bodies or Hey, Dana Delany Still Looks Really Good Twenty Years after China Beach or something like that. But I would conclude that after all of the CSI shows, all of the Law and Orders, NCIS, Bones, Crossing Jordan, Tru Calling, and every other cop show that requires one grisly scene of a dissected body on a slab per week, your average prime-time-television watcher is now almost qualified to perform an autopsy.

Jim Geraghty in the Morning Jolt

Posted by Jill Fallon at 5:49 PM | Permalink

Morgue workers seize body ten minutes before wake was to start

Morgue workers sent to seize body of dead policeman to prove he didn't die of 9/11 related illness

The funeral of 9/11 first responder George Wong, 48, was due to go ahead yesterday, but had to be postponed after New York City Medical Examiners told relatives they were taking the body away ten minutes before his wake was due to be held on Monday.

Overzealous officials were objecting to his death certificate, which said Mr Wong had died of gastric cancer caused by dust he inhaled while guarding ground zero in the days after the September 11 attacks.

Mr Wong died of gastric cancer on Thursday at the age of 48 after a two year battle with the disease - and he always believed his tumour was caused by his two weeks serving at ground zero.

His death certificate said he died of an illness caused by 9/11 toxins, but the link between dust inhaled after the towers came down and long term health issues is not yet recognised by city health officials.

Mr Wong's death certificate has been scrubbed by officials at the Office of Chief Medical Examiner or OCME, with the cause of death now listed as 'pending'.

Mr Wong's family refused to allow city authorities to conduct an autopsy, but the OCME changed the cause of death to 'pending' after conducting an external examination and photographing the body.
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Mr Wong retired from the NYPD on a disability pension in 2006, after 20 years as an officer.

A police source told the Post: 'It's reprehensible. You don't give the body back to the morgue. Even perps don't deserve this. It's about being a human being. Everyone is livid over this.'

Condolences to his family on their loss.

In this case, I side with the officials.  I don't know who signed the original death certificate and I question how anyone could come to a medical and legal conclusion that Mr Wong died from inhaling dust at ground zero without evidence from an autopsy which the family did not allow.    The fact that such a death certificate was issued is suspicious in and of itself.  It could have been used as evidence in a civil suit against the city.  The Office of the Medical Examiner is correct in listing the cause of death as 'pending'.    We won't know what the cause of death was  until an autopsy is performed.

Posted by Jill Fallon at 5:39 PM | Permalink

May 21, 2010

The Death Mask of Abraham Lincoln

 Deathmask Abraham Lincoln

Taken at the time of his autopsy and currently on display at the National Museum of Health and Medicine, Washington DC. In 2007, Dr. John Sotos studied his face and medical records and concluded that he suffered from a disease called Multiple Mucosal  Neuroma Syndrome and had he not been assassinated, he would have died soon anyway.

From 20 Death Masks of Famous People

Posted by Jill Fallon at 1:19 PM | Permalink

June 10, 2009

Scanning the Dead

From Kevin MD, the Benefits of Scanning War Corpses.

In the past five years, every soldier who was killed in Iraq and Afghanistan has been given a CT scan. Why? In the hopes of creating a database of war injuries, which can be used to better equip and treat future soldiers.

The effort has already paid dividends. While examining the data, it was noticed that chest tubes used to treat pneumothoraces in the field were too short. The standard tubing would have been appropriate for 50 percent of soldiers, versus longer tubing that would fit 99 percent.

Also, it was because of these “autopsy scans” where it was noticed that many of the troops died from wounds in the upper torso, which could have been prevented with the appropriate body armor. On the basis of these findings, the military rushed more armor plates to Iraq.

It’s an interesting piece, and goes on to discuss the sensitive implications of the findings to family members:

The possibility that a relative burned to death is a particular source of anguish for families, and one area in which CT can outperform an autopsy. In a body damaged by flames, CT can help pathologists figure out whether the burns occurred before or after death. The scans can also tell whether a person found in water

It’s truly remarkable to see how much that can be learned after death.

Posted by Jill Fallon at 11:11 AM | Permalink