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!

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