Great thread, GSW, thanks. As the other Howard said, you were one of the few consistently solid RGPers as well.

Can someone put a no-brainier tutorial on, instructing me how to compartmentalize the questions into a number of different quotes, I've never had to do that.

I can say that there is no way to figure out who was holding a gun if it's in someone's mouth. It all looks the same. Same with the side of the head. Everything else to prove/disprove it is pseudo-science. So I assume the prosecution had to build their case on other evidence, and the defense forensic experts were "riding for the brand".

One brother is a vascular surgeon, one is a Family practice doc, with a large ER practice as well. My dad was an oncologist. Congratulations on having the acumen to understand the business of medicine, because in my opinion, most docs, including those three couldn't run a lemonade stand. I learned what kind of mistakes can be made from my Dad, and tried to warn those two. It didn't work. But my house cost less than my yearly salary, my credit card debt is zero, 15% of my salary goes into an IRA, I have a halfway decent state pension. If it weren't for two ex-wives, I'd be sitting pretty. Those two I worry about, and they make about 3 times more than me.

And, before BF, I won literally hundreds of dollars playing online poker over about 8 years.

Not having to deal with the present bureaucracy of medicine was a factor for me. Between my Dads era, and mine, everything changed. MDs lost control of their own profession, and it will never get better. Too bad for the patient.

In a well run death investigation system, where the ME has the authority and jurisdiction over all unattended deaths, sudden deaths, suspicious or violent deaths, or deaths that occur within 24 hours of hospital admission, most deaths will be from natural disease. Accidents follow, than suicide and homicides.

We don't have that here. We are a referral system and many deaths are handled at the local level, by lay coroners and police agencies. In my Fellowship we posted every MVA, here it is rare. Many naturals are signed out by people with no training to do such. Its too bad, because you can answer a lot of questions with the autopsy, that is our job. But if every MVA was sent in in our state, we would need 5 more doctors (our highways in America are a slaughter ground). Not having the true answers to all those questions is a shame, but just represents the current state of death investigation in America. As I've mentioned above, there are very good systems out there, San Antonio and Alaska are two places I have worked where forward thinkers have managed to let the ME do the job they are supposed to.

My job is "what done it" not "who done it". I don't solve murders, cops do, but every now and then when I get a good case, whether natural or homicide, and figure things out, I'll give my best Inspector Clouseau imitation and say " Ze case is sol-ved"

No I don't watch those shows, I need separation from my own reality to enjoy the escape from reality of TV.

Serial killers are a very interesting topic and I have been interested in it for a long time. But it is mainly the field of forensic psychology/psychiatry and behavioral experts. The FBI has had several extraordinary individuals doing work in the field. At one of our meetings in Seattle they presented the Green River Killings from the perspective of every one involved in the case, cop to ME, and it was fascinating. Son of Sam left notes, a notorious case in Kansas/Missouri I believe, left notes baiting the police. I can't remember if the Boston Strangler did or not.

I have had only one case, an ordinary serial road killer/predator. Raped and stabbed a young women travelling through the state at an interstate rest stop. She let her guard down and was walking her dog out of site of the parking lot. Two hours later he was out of the state. Her family put a billboard up near the incident asking for help, it was there for years. Her face was on it, asking "Do you know who killed me?". I had to see it all the time. Pretty sad. Years later his DNA hit, he was in prison in California on another murder. So score one for our national DNA data base, and I'm glad the family finally got to take that billboard down.

Excited Delirium is nothing like that. A lion suffocates, cutting off the blood to the head so the animal goes unconscious, then dies.

Excited Delirium deaths are controversial and difficult cases, primarily because many times they involve restraint, struggle and exertion during law enforcement interaction.

First you have to get oriented to how close any one of us is to death from exertion alone. Unless you are a trained athlete, its probably closer than you think. Think about if you could run around a football track twice (880 yds), or even once, at full sprint. Now what if your child was in a car just going underwater at the end of the run. In one case you would give up after running a hundred or so yards, your body tells you you have put it in danger. In the other you have a massive amount of adrenaline being thrust into your system and are able to easily overcome, and don't even feel those things your body was able to sense before.

Several drugs, and even inherent psychosis (an acute manic break is a good example) without drugs, can mimic adrenaline very well. Meth, coke, and pcp all being examples. When you are in that dissociated state, raging, combative, violent (ie delirium), that's when you are going to attract law enforcement. The combination of that exertion, which places your physiology in a place you have not conditioned your body to be in, combined with many minutes of active struggle, then restraint, including taser shocks, behind the back cuffing, or any positional change which compromises your ability to move air in any way. And not just cut off, these people will be yelling "I can't breathe!". Well if they are yelling, they are breathing, they just can't breathe enough to satisfy the air hunger brought about by their exertion.

Inside the body, carbon dioxide is building, lactic acid is building, you need to breathe as hard as you can to get those out, as well as oxygen in. Undefined electrolyte disturbances are occurring, all impinging on a heart massively stimulated beyond its capability by drugs and adrenaline. Someone is gonna die. And in police custody, usually after everything is over, and the guy has stopped fighting and is lying on the ground. Someone will look over and notice he is not breathing. At that point it is very difficult for emergency aid to reverse the process.

That's Excited Delirium, and it happens all the time.

It depends, because so much of America has an inadequate death investigation system, there are many cases which because of political or family pressure, the bodies are not autopsied. In my state, if the elected lay county coroner does not want to send it, he does not have to. Law enforcement also has the right to send a case, so they can overrule the coroner. I don't know the system up there, or if any pressure was brought to bear in that specific case, but it happens a lot, in non-homicide cases all over the country.

You wear rubber boots and scrubs, and extra barrier aprons and gloves. Then shower right after. The oils and fats of decomposition are pretty resilient but soap and water do just fine, if not, then a little diluted bleach. I give it the dog test when I get home, if they are not extra interested in me, thinking I've been going out and rolling on road kill without them, than I'm fine. And mostly they just want to eat and go for a walk.


Necrosis is broad areas of tissue death, like the bowel, while the person is still living, and yes it is very unpleasant, even I think so. It just smells really really bad.

I'm glad you got answers as far as your father. I tell families I know the fact that their loved one is getting an autopsy is causing them more anguish, but in 6 months when the pain has begun to dull a little, the answers I give them are going to help. And for the most part that has been true.

I already talked about the grisly death, the Grizzly Man and his girl friend.
But really though, instead of Johnny Cash's I've Been Everywhere Man, my song would be I've Seen Everything Man. I've been doing this for 20 years.

I think that Is Dr. Judy Melinek you must be talking about, she has been getting a lot of publicity for her new book, Working Stiff.

I was going to write a book called, It's Okay to Fart in the Morgue, but then I got old and a little tired and forgot all my good stories.

A bullet embolism is simply when a bullet happens to stop in a major blood tube, and goes on a little trip away from the wound track. We say never bury a bullet, and when you are doing a case and there is no exit wound, and no bullet shows up on limited X-ray I get a little worried. Maybe they were using one of those infamous ice bullets. No, I will have the techs do a more comprehensive set of X-rays and its usually taken a little trip, rare, but happens.

Thanks for the comments. I really appreciate my techs, and they have saved my butt more than a few times. But occasionally I will have to look at them and say: Me Doctor, You Tech.


Back in the day, way before med-school, my buddies and I used to sit on the porch, beer and bud, watching Quincy, it doesn't get much better.

The funniest thing I ever saw with JK, was during a televised horse race. They were doing a shot of the crowd and the camera man moved to a guy in the corner working on his form. The announcers fell all over themselves saying, why there is JK enjoying the festivities, just as he looks straight into the camera and says (you couldn't hear it, but you could definitely tell what he was saying), get that thing the **** out of my face.

You heard the tape of the bear killing Grizzly Man and his GF that the director (Herzog) deemed too violent to include in the documentary? If so, could you describe what the tape revealed? Maybe put it in spoiler tags if you think it's needed

Either you mean how to multi-quote several posts: There's a button next to the quote button. If you hover over it, it says "Multi Quote This Message." You click that for every post you want, but for the last post click the regular quote button. You can use this to string together responses to post across multiple pages or even multiple threads if you want.

Or you mean how to break down each post into multiple quote boxes
Just surround the text you want in quote tags (the following without spaces): [ QUOTE]quoted text goes here[ /QUOTE] (there is a button to add these tags in, or surround any text you have highlighted with these tags. Just hover over the buttons above to see what they all do)
If you wanna get fancy you can play with the quote tag like so: [ QUOTE=name to appear in bold as the one being quoted;post # to create link back to post].
eg [ QUOTE=ContactGSW;44476763]

edit: Here, I explained that end part slightly better once: http://forumserver.twoplustwo.com/sh...2&postcount=10

I have heard it and it is pretty disturbing, I don't think it would have helped the movie. The bear is making these deep grumbling growls. He is pretty much just screaming unintelligibly, the girl friend is screaming at him to play dead or hit the bear with a pan. This goes on for a while.

I understand what a bad situation it was, but really don't understand why she didn't run and hit the water. The Alaskan bush is pretty hairy, all these thick alders, you can't see 5 yards through them, so the bear got right on them.

Alaska is a rough tough place, I can understand why there was not a lot of sympathy from some Alaskans for a guy that put himself in the midst of those animals as a hobby.

I worked with the pathologist who did the case, Dr. Fallico. He was a character, really into the publicity part of the field, even had an SAG card. Quite the opposite from me, with a couple exceptions I regret, I have spent a lot of energy keeping my face and name out of the news. He has since died, but I really liked him.

By the way, I heard the tape after one of the investigators came to us saying she found a copy on the internet, played it for both of us, and Dr. Fallico confirmed it was real. So it's probably still floating around out there. I'd rather see nekid celeb.

Lol, thanks. Your next examination should be The Fappening then.

Edit: I think I might pass on looking for that tape, I enjoy my sleep at night

Thank you for your response about Excited Delirium. I always explained it as reflexive rather than metabolic, thank you for the correction, I hope I have it right now.

Do you think that things like when insects start/complete cycles of their life are accurate when determining time of death? Could body size, coverage with litter, being submerged or exposure to sunlight introduce a lot of error in your calculations?

When you dream do you dream of the "Body Farm"? Sorry I just had to get that in there.

We do cases in the morning, on a rare day there will be no cases. Most days four out of five doctors will be working to clear the cases with a lead doctor on a rotating basis doing the hard cases, the others doing routine cases. The lead doctor the previous week is off cases. You then have to dictate the cases, follow up with investigating agencies, do microscopics, proof your typed cases and see them to final form, confer about ancillary studies with that section of the lab, primarily toxicolgy, answer multiple phone calls from interested parties, have staff meetings, review for trials, go to trials (usually involving a long car trip as we cover the whole state), and finally each report gets peer reviewed by two other doctors, which means I am involved in 2/5 cases besides my own as far as my time.

So, when you see me typing answers into2plus2 during working hours it means the Attention Deficit Gift part of me has won for the moment, and I'm going to have to pay for it later. I wish I could do cases, find the answers and go on with my life, but the paperwork and follow up stuff takes much more time.

You are talking about forensic entomology, a separate field of study than pathology. Its been studied quite a lot, and the entomologists, for some reason are the funnest people to party with at meetings, besides the forensic anthropologists (the Body Farm people). While we do occasionally need the help of the anthropologists, we rarely ever need the entomologists. I can find my basic way around bones, but don't do entomology at all, and have almost never felt the need for one. Only collecting insects where I see the possibility of the defense raising issues as to time of death.

The primary goal of the entomologist is to study the different waves of insects that feed off carrion, to see if that can help with a post-mortem interval. In my experience they just confuse the issue, mainly because of all the variables you mention above, time of year, climate, environment, and geographical locations all causing a lot of variation.

Time of death is an investigational determination. When you hear and read about people assigning time of death based on examination of the body to any specific range its just made up, or pseudo-science. The best determinate of time of death is a good cop. Tell me when they were last seen alive, and when they were found dead, then I will use what ever I can, the conditions of the body (rigor, livor, temperature, state of decomposition), clothing, even the stomach contents, to try and narrow that range down for you. But it will always be a broad range. People have been trying for years in all sorts of ways to scientifically get that range to a more narrow level of accurate determination, but presently I have seen nothing that has been accepted or that I would trust and stake my reputation on.

I have normal dreams. Its hard to fathom, but I see myself as just a country doctor, rather than someone involved in all the mystique that death seems to hold for everybody else.

What are the demographics for your jurisdiction? Big city/small town? Affluent/poor? Or is it a mix? I assume you're only doing trials for the whole state, not working cases for it. 2-5 cases seems like alot for someone who calls himself a "country doctor," but maybe when that's spread out over trial and peer review it's not as much as it seems.

I'm guessing with trial that departments in places like New Orleans are pretty busy, even if the causes of death themselves are often pretty self-explanatory.

Love this thread. I don't suppose you have any links to cool death scenes/autopsy pics? Yes, I'm sick.

Thanks again!

We cover the whole state. The local agencies investigate the deaths, these include over 70 county coroner and sheriffs offices, and hundreds of town or city police agencies, and the state police. There are 24 prosecutorial districts, all with the head prosecutor, and multiple deputies. Rarely I will have to do a federal case. So we have to get used to working with a lot of local conventions, different styles of death investigation, and different personalities. The state provides a central service for crime lab work and the medical examiner, which all these agencies can use. It is a primarily rural and poor southern state with a population of over 2 million, with a single big metropolitan area, the rest, a few moderate sized towns and a lot of small towns.

If I were a little more organized and obsessive, the paper work would not be hard, but I'm not, and I hate it, and there is a lot of it. But the details are important so its got to be done.

The ME is often considered a high profile witness and seems to give the prosecutor's case credibility, so even in cases where the defense would stipulate to the cause of death and accept the autopsy report findings, they still want us to come testify. Its pretty routine, even in high profile cases. When the defense has had a pretrial meeting with me, they will be prepared with questions that he already knows the answer to, so it makes it seem like he is on top of things. When they don't, unless they are very good, they can have a hard time, asking awkward questions that may even hurt their case.

So even in busy offices, with a lot of court cases, the testimony is usually routine. But it is a major disruption of your day, I've had cases where I have driven well over 2 hours, testified 15 minutes, then drive back.

I grew up looking at mildewed Playboys, today you don't have to do that anymore, the same is true for Man's Inhumanity to Man. Ogrish went down a long time ago, liveleak is pretty tame now days, but there are still multiple sites that show those things.

I have to keep up with sites like erowid, because I see those drugs in my job. And I used to monitor those graphic video sites, because I am asked questions, like how hard is it to cut someones head off. How am I supposed to know, I mean wtf, so I learned. But I found it affected me in ways that were detrimental to my real life outside of my job, so don't do it anymore.

I go to youtube and look at car wreck videos to get an idea of the dynamics and energy that produce the kind of injuries I see. Youtube also lets me have a pretty good idea about what an upright individual does when he is knocked unconscious in a street fight, and what other injuries may be incurred.

Anyways, you don't need my help to find those sites, 5 minutes on google with the right search terms and they are all there. Just have good virus detection software.

I will say this, even though my knowledge base is broader after seeing those videos as far as my profession, I feel less of a Human Being for having seen that stuff.

I get what you're saying. I've just always been intrigued by death, serial killers, anatomy, etc and wanted to get a job similar to yours.

I've hunted down almost all the grisly videos online. The only one that really affected me(physically and emotionally) was the Ukrainian maniacs hammer vid. No one should see that.

Thanks again for your time.

This thread is fascinating. I'm surprised it fizzled out so quickly.

Yeah, not sure why it died.

natural causes. possibly accidental.