Real-life stories from a pathologist

Once, I had occasion to autopsy a 5-year-old boy who had dropped dead on the playground at school where his mother was a teacher’s aide acting as recess monitor and witnessed it. The coroner told me that the parents wanted to talk to me before I did the autopsy, and I obliged. The mother was angry about how long it had taken the ambulance to get there, and wanted to know if her boy would have survived if they’d gotten there sooner and given oxygen. The father could hardly talk at all through his sobs. I found the difference between the parents’ reactions striking. Daddy was grieving, Mommy was pissed.

At autopsy, I found his airways clogged with a thick brown substance. Other than that, everything looked normal. When I called the parents back and told them that, the mother told me he’d eaten a brownie just before going out on the playground.

The parents sued the school, the county, the ambulance company, and the paramedics. The lawyer for the defense, who interviewed me in my office, told me that the boy had vomited and aspirated in the ambulance while the paramedics were doing CPR, which left me without a cause of death. He asked about laryngospasm, and I told him that wouldn’t show up at autopsy because one has to be alive to have any kind of spasm. At his request, I sent the case to the county hospital pathologists for a second opinion. Their report said the child died of a cardiomyopathy.

I called them to ask what it was that I had missed, and they said it was because the weight of the heart indicated that it was much too large for a 5 year-old. Cardiomyopathies generally result in an enlarged heart.  I pointed out that this child was big for his age, and that his height and the weight of his heart were both in the normal range for the average 9 year-old. That left us, again, without a cause of death.

I didn’t have to testify in court, but I did give a deposition. The bottom line was that there was no way to know if giving oxygen sooner would have made any difference. The parents lost their case and ended up having to pay $37,000 in court costs.

Another time, I had occasion once to be involved in a murder case. I didn’t know it was a murder case when I did the autopsy, though. The young lady had died at home. Coworkers said she had complained of a headache, stiff neck, nausea, and a fever the day before. I was thinking meningitis, and took extra precautions not to expose myself in any way. I took spinal fluid and blood for culture. I took blood and urine for toxicology, just in case.

Toxicology was negative. Nothing grew on culture. There were no specific findings at autopsy. Later it was found that she had been killed with insulin by her boyfriend’s ex-wife. I had to testify before a grand jury, where I explained that since insulin is a naturally occurring substance in the body, testing for it wouldn’t prove anything.

At a grand jury, one is interrogated by the prosecuting attorney and the members of the jury, none of whom had any medical background. I know that, because I’ve been called for jury duty umpteen times and never picked because nobody wants a doctor or even a nurse on a jury, let alone a pathologist!

My muse for “Murder Under the Microscope”

The basis for my first book, Murder Under the Microscope, was a female locum tenens who was hired, back in the eighties, to help with weekend call. Everyone on the medical staff thought she was wonderful. My techs couldn’t stand her, and I heard about it on a daily basis. Her method of drawing blood consisted of starting an IV and letting the blood drip into the tube. Her method of collecting a culture for gonorrhea was to smash the tip of the penis into the chocolate agar plate. When my techs tried to explain why she shouldn’t do it that way, she would tell them when they had gone to medical school, then they could tell her what to do and not before.

Eventually she started working during the week too, and that’s when I tried to talk to her about these things, but she attacked me. She gave me an earful about how incompetent she thought the lab was, and why. Nothing I said made any difference. Then she wrote a letter to Administration and the medical staff, all about how bad our lab was compared to labs at all the other hospitals she’d worked in, and how incompetent the pathologist was. When I found my copy on my desk in the morning, I went straight to the administrator, only to find that several of the doctors had beaten me to it. They assured me that the lab was okay, and so was I, but they were unsympathetic when I complained about how she was affecting the morale in my lab.

Nobody killed her. She was let go after three weeks, because that was when the patients she’d seen came back for their follow-up appointments and the other doctors found out about all the mistakes she had made, and what their patients thought of her. I also found out that she’d been as nasty to Radiology as she had to the lab, and that one of the surgeons had received a letter from her too.

When Murder Under the Microscope was published in 2011, that surgeon came charging into Histology where I was grossing surgicals, waving my book and laughing his head off, and said, “I remember that lady!”