External Examinations

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An external examination is similar to a (live) physical but obviously a bit more thorough. The remains are looked at from head to foot – literally! We look at the scalp through the hair, we feel the head for lumps and bumps, we check the eyes for petechia, and the mouth for trauma such as a damaged frenulum can be very telling – especially in children and infants when someone has held a hand over the child’s mouth and it struggles against the hand causing the frenulum (that little piece of skin between your front teeth and your gums) to tear.  The neck is checked for enlarged glands, thyroid abnormalities, and visible contusions. The torso is checked for palpable rib fractures, lumps, extreme and unusual firmness or large amounts of free fluid. Free fluid in the abdomen can mean an internal injury with internal bleeding or it can be a sign of infection such as ascites or sepsis which can mean a liver or kidney problem or a perforated intestine. We look for signs of sexual assault as well.  We look for scars – which can reveal laparoscopic surgery, bypass, hernia, cesarean sections, etc. We look at the lower legs and feet which can reveal peripheral vascular disease and diabetes. We are also looking for scars or fresh needle marks that can reveal a history of drug abuse or in an assault case the use of forced injections. We look for signs of restraint.

The external examination can tell us many things, which we then compare when we do an autopsy to see if the underlying tissues are consistent which what the external showed.

next time what we doing during an autopsy!

Suspicious death!!! … or IS IT???

body outline

Is it natural? Does the scene look right, or staged? Many scene investigations start basically the same as far as qualifiers go… Is there blood, weapons, what is the story, etc. From there we separate what the facts are and what they reveal.  I have had several cases start out as suspicious because the person “reportedly” died alone and there is a lot of blood – either around them, on them or through the house.

For example: In a locked residence, I had a case where the downstairs was very clean with a few empty alcohol containers here and there. The upstairs was same except for the master bedroom which had a large area of blood on the bed, some on the pillows, as well as on the floor and some pillows on the floor laid out as if someone was sleeping on the floor. There was some blood in the bathroom and some bloody clothes on the floor. There were alcohol containers upstairs as well as a bowl of ice-cream by the bed and the empty ice-cream container in the bathroom… both had spoons in them. As for the decedent, she had been located on a landing in the middle of the staircase, in a sitting position, leaning against the wall. She had some blood in her short hair, but barely any elsewhere, including on her tied/laced shoes – AND NO OBVIOUS INJURIES!!! So what happened?

Well, there were no splatters and few smears. An interesting finding was a strange pattern on the pillows on the bed which was sort of a feathered pattern, which I determine to be consistent with the decedent moving her head back and forth in a way that her hair, which had blood on it, had made the pattern.  I also noticed mucous in the coagulated blood.  I examined each area of blood separately, noted all of the alcohol containers and what I had been told about the decedent as well as the lack of injuries and her un-bloodied clothes and laced and tied shoes.  My initial findings were that it appeared she had suffered several episodes of vomiting blood due to presumed ruptured esophageal varices, cleaned herself up, moved from the bed to the floor and vomited more blood.  And again cleaned herself up. Then attempting to go downstairs, apparently collapsed on the staircase landing and expired.   The autopsy supported my findings. She had lost too much blood for her heart to function and it stopped. All of that blood and it was a natural death because CHRONIC alcoholism and the damage it does to the body is considered natural.

In another case a man was found in a chair, slumped over with a head laceration that was dripping onto the floor, bloody pants, bloody hands, a large area of blood on the floor, bloody handprints on the nearby glass kitchen table, and again a locked residence with no one else having been with him.  My first noted odd finding was that it was obvious he had laid on the floor, in the blood, long enough time for it to start to dry. I say this because on the back of his head, where the laceration was, there was a flattened area of dried blood, as if he had laid there long enough for it to dry and flatten his hair on the back of his head, at yet he was in the chair! My first step was to follow the blood.  It wasn’t anywhere else in the house and there weren’t any signs of physical altercation or forced entry.  I noted he had a walker nearby. I also noted his dark pants were down low enough that his feet were covered by them.  I noted the bottoms were bloody. He also had an alcohol problem (which thins the blood and makes you bleed more).

I looked and his hands and the bloody hand prints on the glass table and their location. Through determining each step in what appeared to have happened, I determined he had fallen, probably because of his droopy pants and because he had left his walker on the other side of the room. He hit his head on the floor causing the big laceration on his head and probably knocking him out for a little bit. He came to, pulled himself up by gripping the table with his bloody hands and plopped into the nearest chair. He then fell into unconsciousness again and died – from a combination of the blood he lost, the bleeding inside his head under where the laceration occurred and the alcohol in his system. This case was mannered as an accident – mechanical fall. Again it looked a bit suspicious at first glance, but after careful investigation I was able to get an idea of what had really occurred. It’s very important to go into a scene with an open mind and not be too quick to draw conclusions!!

Another issue is medication, alcohol and /or illicit drug overdoses. I had a case of an elderly female, who lived with a relative, had a meticulously clean room (the residence itself was clean as well), was active and worked outside the home cleaning house for other folks. She was found in her bed, in pajamas, and it appeared to be a natural death. She was reported to not have a regular doctor or prescribed medications, but she was known to smoke. I must admit I was shocked when toxicology came back with methamphetamine overdose. I had not seen anything to indicate she was a user. I discussed it with the pathologist who was just as surprised, so much so that we requested another sample be tested – and sure enough it came back positive again!!  I called family, not sure how they would take the news – only to have them confess they knew she “used” from time to time… OHHHHH NOW YOU TELL ME!! I would have never guessed that would be the cause of death in this case!!! And it is not unusual for family to not reveal such information because they think they are protecting the decedent – but in reality they are interfering with my investigation!! Unfortunately, in a case without suspicious circumstances, we do not go through every drawer, the closet and under the bed, etc.  We look in the obvious places – the bathroom, the area near where they were found, and of course we didn’t go through the other family member’s room because we had no reason to… it’s a hard call sometimes!

Gunshot wounds: Suspicious, Suicide or Accidental??

handguns

What about gunshot deaths? What type of gun was used? Is it still there? If it’s not, then it probably wasn’t a suicide! Or did a family member think hiding it would save the family the embarrassment of a suicide? – which it doesn’t – it only creates suspicion – usually toward the person covering it up… So many little factors to consider.  What does the blood say? Does it make sense with the story provided, is it where you would expect it to be? Is it smeared when it shouldn’t be? Are there any footprints or fingerprints in the blood? What type of wound is it? Is it one that the victim could have lived a few minutes? If they used a long gun, it is possible or impossible they could reach the trigger? What do the measurements say? We measure the from the end of the barrel to the trigger, and the end of the arm to the wound. Did they use something to reach the trigger? I had one fella that used a large bar-b-que brush to push the trigger because his arm wasn’t long enough – but the blood was where it belonged.  And of course the brush was right there next to him and under part of the shot gun. Is there a note or a video of their intent to kill themselves? Have they made any recent threats or comments about suicide? Were they familiar with guns?  Were they AFRAID of guns? If someone suggests it was an accident during “cleaning” the gun, then I want to know have they ever cleaned a gun before? Where was the gun usually kept? Did that person know the gun was there if it was not theirs? Many questions to consider when a gun has been used.

Something that really confuses family is they often say the person had been depressed but recently had been in a better mood, so they are shocked that they might have killed themselves after being so “happy” lately! The reason this happens is that the person has made up their mind to kill themselves and they begin to feel less stressed and relieved that their pain (emotional and/or physical) will soon be over. They tend to give things away, get their affairs in order, spend time with people they care about, etc… Sometimes we will find literature at the scene indicating suicide planning. There are people who have basically written the “how to’s” of suicide – which I won’t list the sources or titles here for obvious reasons.

I will cover the guilt and grief of those left behind after a suicide in a later post – and unfortunately I will partly be speaking from personal experience.

Hanging deaths: Suspicious, Suicide or Accidental?

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What makes a death suspicious? Besides the obvious, like a knife in the back – some deaths can be quite questionable and not what they seem! Suicides for instance… Is there more than one mark on the neck in a hanging – what is the angle of the mark, does it match the ligature – how was the ligature tied or fastened? Does lividity and rigor mortis match the found position of the remains? When was the person last seen alive? Was there a recent altercation – physical or verbal? Are there scratch marks on the neck showing hesitation or resistance? Any defensive wounds? Any notes or recent verbal threats of suicide?

Did you know it takes much less pressure than suspected to “hang” or “suspend” in the terms of a ligature death. It can be as simple as tying a scarf or belt from a bathrobe to a door knob something similar, then put your head in the loop and lean forward so that your neck is on the loop.  The weight of your head and torso leaning forward can create enough pressure to suppress your ability to breath, causing asphyxiation. Often accidental hanging deaths happen during experimentation with autoerotic asphyxia.

How does a death investigation begin??

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Each case starts with a phone call to my office of someone reporting a death. The call starts with basic questions, where is the body, were they on hospice care, any recent surgeries, falls, injuries, suspicious circumstances, unusual amounts of body fluid – vomit, diarrhea, blood and is it near the body or through-out the scene? Is family present? Any drugs, alcohol, open or empty prescription pill bottles? Was anybody home? Was their death witnessed? Did paramedics respond to the scene? Did they do any treatment? If no one was home, was the residence locked? Why did police/fire respond if no one else was home – who called and why?

These are just SOME of the questions we ask when we receive the initial phone call in order to determine what else needs to be done and where to take the investigation next. If the person has a significant medical history, no recent injuries, is at least 65 years old, has been seen by a doctor on a regular basis, no signs of medication abuse, no blood, no contacts for APS (adult protective services), no recent falls, etc… that it appears to be a natural death and the primary care physician is willing to sign the death certificate, then in those cases the person can go to the mortuary and we do NOT need to go out there. Usually in these cases I will send an email or fax to the primary care physician and advise them of the circumstances of the death and why we did not respond. Sometimes they need a little direction in how to word the death certificate so I assist with that too.

If someone is on hospice care it pretty much goes the same. However even a hospice case can warrant further investigation if there are signs of abuse or neglect such as bedsores that are not being cleaned and bandaged, unusual bruises or cuts, dirty bedding, lack of food, apparent dehydration, clogged feeding tube, missing medications, and odd incriminating spontaneous statements by family or caregivers. Then it goes from a medical-natural to something else.

As for the “something else” types of cases, I will get into those on a more individual format.  Stay tuned!!!!

My job…. what did I do???

I have come to realize that many people have no idea what I really do – even the folks (patrol officers, nurses, etc.) I worked cases with. I had an ER nurse ask me why I have a gun, because he thought I just went to hospitals and picked up the body. Many times dispatchers call and say they have an officer who needs us to come pick up the body… An investigator for the ME or Coroner does SO MUCH MORE than pick up the body…. In fact we usually have a contracted transport company do that for US!!

I am going to take the opportunity to try and clarify a bit – and while I certainly can’t cover every type of situation or investigation I will do my best to cover the general concepts and such. I will do so in increments so that each post in itself is not overwhelming with information.

First of all, although I am a trained crime scene investigator – I did not do what is considered to be typical CSI work.  I did NOT take latent prints (prints left on surfaces like doors, glass, etc) or work non death cases. I DID assist the CSI’s in collecting evidence from the body at the scene when evidence was likely to get lost or contaminated during movement of the body – such as loose hairs, fibers, GSR (gunshot residue), liquid or body fluids on the clothing or on the outside of the body itself.  Sometimes I performed fingernail clippings or scrapings at the scene sometimes or I place paper bags over the hands to protect them for processing during post (autopsy).

In my department we are sworn peace officers, but fall under a different code than regular officers. Our “powers” are limited.  We are armed in order to protect ourselves, our scene and evidence. I will get into more of the why that would be necessary when I cover notifications and working a scene.

Here are some examples of what I plan to cover over the next several posts.  The listed order is random and some topics may be combined. I may think of other things not listed….

Autopsy

Training

Body fluids

Medications

Terminology

Talking with doctors

Grief and notifications to family

Why do we have guns?

How are we different from “cops”?

COD and manner

The mortis brothers

“Unattended” deaths

Disease investigations

What are we exposed to?

How do we handle child deaths (emotionally)?

Decomposing bodies

Insects and what they can tell us

How do we determine identification?

Reviewing medical records

Hospice cases

Welfare checks

Indigent / abandoned bodies

What happens when we can’t identify someone?

How do we work a case?

Is TV for real or way off?

Suggested books and links of interest

Have I ever seen a body move suddenly or sit up?    (I can’t count how many times I get asked that!!!!)

If you have any questions regarding a post or have a question you want explained in regards to the what(s) and why(s) of my job, please post it in the comment or “contact” form which goes straight to my email!