Day 17

2.23.10

Case 1

FW 53
Hx renal failure, chronic nephritis
Pacemaker
Called 911 with CC stomach pain, walked into ambulance, died on way to ED
Extremely granular kidneys
COD renal failure

Case 2

MB 25-30
Homicide GSW to head
Entrance on R cheek, no exit
Bullet graze on nose
No suspects
COD GSW to head

Case 3

MW 77
Suicide GSW to chest
Hx coronary bypass, hip surgery, multiple cardiac issues, pulmonary fibrosis

Case 4

MW 54
Hit by tree
COD massive blunt force trauma to head

Case 5

MW 45
Fall
Decedent had not been heard from in several days, friend checked on him when he did not show for work. Decedent was found lying w/ legs on sofa bed, upper body on floor. Blood all over, head lac.
Decedent apparently fell down stairs, got up, washed face in kitchen, and lay down on bed. Should not technically have been able to, due to extent of hemorrhage in brain.
COD massive basilar bleed

At one point, a case came in with the scene report giving an emphatic statement by the mother that her 19 YO daughter had recently had “the Smilin’ Mighty Jesus.” She was very sure that this was exactly what it was…”Oh no, she was real sick with that Smilin’ Mighty Jesus, officer.”

Opened her up, turned out she had spinal meningitis.

Day 16

2.22.10

Case 1

MW 22
Poss. OD
Hx. Etoh, marijuana

Case 2

S/O
MW 56
Fall, app. Nat.
Hx. Etoh
Family objects

Case 3

S/O
MW 58
App. Nat.
VA pt.

Case 4

FB 29
Homicide GSW to head

Case 5

MW 67
Fall from roof
Hx. CA/HTN
Family strongly objects
Laceration on crown of skull

Case 6

MW 86
Suicide GSW to chest

Case 7

MW 41
Poss. OD
Hx. Recent depression, per girlfriend
Needle tracks on R arm, axilla
Drug paraphernalia found at scene

Case 8

MW 54
S/O
App. nat
Hx cocaine abuse

Case 9

Processed only today
MB 25-30
Homicide GSW to head

Today, I learned that when you are a diabetic cocaine addict (Great combination there, sir! How’s that workin’ out for ya?), you should not dissolve a large amount of coke in tap water, mix it with meth, and inject it into your eyeball with the needle you use to skin-pop your insulin. Turns out this will kill you.

Day 15

2.19.10

Case 1

MB 42
GSW suicide (head)

Case 2.

FW 38
GSW homicide (chest)

Husband locked bedroom door (after children (9 and 3 YO) were in bed. Wife was asleep next to him in bed, found on floor next to bed. Husband shot her twice in chest w/ .45 Glock. Husband then called 911 for EMS, immediately afterward shot self under jaw w/ same weapon. Found in bed, holding gun and Bible. EMS/police were greeted at scene by 9 YO running out onto porch crying about “the bangs.”
Sealed envelopes, addressed to different family members, found throughout house.

Case 3

FW 58
Natural vs. OD
Deceased had friend over for dinner. Friends left for “20 minutes” or “one hour” (depending on story) to go to the store. Decedent set the table for them when they got back, seemed unwell, short-of-breath, later collapsed.
Hx obesity, prior strokes, MI, walker, was on oxygen, heavy smoker, diabetes, HTN, COPD.
310 lb.
Syringe/spoon W/ heroin residue found in house.
Decedent’s boyfriend is a heroin addict, said she was “high,” but son said that decedent had never used, would do anything to help BF get clean.
COD poss. nat/cardiac

Case 4

MW 73
Poss. nat.
No medical hx, refused to see doctors.
COD advanced pharyngeal cancer

Case 5

WM 59
Fall
Hx. HBP, recent surgeries, nausea, back pain.
300 lb.
Decedent fell from roof while clearing ice.
Found unresponsive, wedged between bed and heater.
Lg. 10 in x 2.5 ft burn from R shoulder to L hip.

The murder/suicide was terribly sad, but I fear we handled it with our usual sort of gallows humor. Saw my first breast implants today, floppy bags of saline, clean and shiny, in smooth little pockets of fascia over the ribs. I would not initially have suspected their presence, except for the little semi-circular scar in the top part of the navel. The areolas were grossly stretched for the size of the breasts, despite the otherwise apparently skillful work that had been done.

Day 14

2/18/10

Case 1

60 YO WM
Nat. vs. accidental
Homeless
Reported Hx of ethanol abuse
Hx unspecified heart valve problem (untreated)
Recent “brain infection”
Found in basement of vacant building.
Poss. hypothermia
Cod unknown, probable natural

Case 2

Out of county
23 YO WM
MVA
Deceased worked on a garbage truck crew, reportedly felt ill all morning, had vomited.
Deceased left truck, apparently fainted out of sight, driver pulled forward, heard “crushing sound” under L front tire.
Deceased was still breathing when EMS arrived at scene, but died very shortly afterwards.
Ecchymosis on upper chest
Lungs were bloody, crushed.
COD massive crush injuries to the head.

Case 3

OOC
56 YO WM
Poss. OD
Hospital pt (BIBA)
Hx cocaine/marijuana use, multiple myocardial infarctions
Found unresponsive on bathroom floor during party at own house.
Was witnessed flushing lg. amt of cocaine down toilet.
Lg. amt emesis all over bathroom
Died at ED
COD MI

Case 4

Processed: murder/suicide

There were almost no signs of injury of the body of garbage-truck guy. His right earlobe had been slightly torn from the head, and there was very faint bruising on the upper chest. Blood ran from his ears and nose, but washed easily away, though from the ears, the flow renewed when the clotted blood was cleaned from them. Apparently, he had still been breathing when EMS arrived on the scene, and when we opened his up, this seemed inconceivable. The lungs were pulp, crushed and dripping and red.

The head bore no signs at all of injury, though fx were palpable under the scalp. When Greg cut, shattered pieces of bone fell from the brain, which was, remarkably, in one piece. We did not need a saw to remove the skullcap, which had been crushed into multiple pieces for us, easily sliding from beneath the scalp or popped off over the brain.

Day 13

2/17/10

Case 1

38 YO WM
Poss. suicide
Looked much older
Hx depression, schizophrenia
Reported to live in an apartment complex for the mentally ill/those just out of acute care facilities. Little surveillance.
Neighbors reported that deceased seemed depressed, had not been seen for a few days.
Found in bathtub full of water, w/ approx 1 in. over face.
Smashed glass by sink, blood pool nearby.
Deceased has an open sharp-force trauma on R knee.
COD drowning (?)

Case 2

29 YO WM
Hx of epilepsy
Found unresponsive on floor of apt near bed, friend called 911.
Deceased had not been seen for several days.
No signs of drugs or foul play.
Body in early decomp
5.5x3 in. area of skin slippage on inner R wrist, discoloration on lower abd.
Lips bitten, pale; peeled skin from inner lips stuck to teeth.
Eyes pale, clouded.
COD epilepsy (?)

Case 3

Sign Out
56 YO WM
Poss. nat
Insulin dept diabetes
Had not been seen recently, friends called for welfare check
Hep C +

Case 4

Sign Out (?)
68 YO WM
Poss. nat
Collapsed at home in front of daughter, who called 911
Found in asystole by EMS
Very recent multiple surgeries
PCP “does not sign death certificates, will not sign this one”.

The water in the tub on case 1 was pinky with blood, apparently from the incised wound on his knee, said the report. Everything glass or ceramic in the apartment had been smashed, but there was no sign of any intruder. The body was lying in the tub with the head toward the spigot, shoved against the tub’s margin and about an inch under water, the back arched, shoving the torso up and out of the water, and the legs curled back underneath the body. The spigot leaked slowly into the tub. There was a pool of blood on the floor in front of the tub, with streaks of clotted, dripped blood leading down to it from the rim, where the man had apparently sat down for a while.

Bizarrely, underneath the body in the tub, lay the shattered and sharp-edged remains of a large number of coffee mugs. During the external, there were no visible wounds from these on the body.

Everything in the apartment was in tens. There were ten $10 bills in the wallet (on the counter). There were ten containers of cleaning solution in the closet. Ten rows of ten items each in the fridge. The clothes in the closet were separated into ten groups of ten with collections of ten hangers in between each. Previously in the cupboards (now on the floor), the remains of ten plates, ten glasses, ten bowls. Ten forks, ten knives, ten spoons in the silverware drawer. Ten coffee mugs, shivered into soggy pieces, at the bottom of the tub.

Day 12

February 11th, 2010

Case 1
Black M, approx 55 YO
Homicide GSW
Deceased was shoveling sidewalk in front of house when he collapsed. EMTs thought at first that it was a cardiac event, found wound over L nipple.
ED doctor diagnosed as “puncture wound”, opined that it was not very deep.
Morgue staff immediately recognized as GSW upon receipt of body.
Organ donor; eyes, skin, long bones, and short bones taken.
Multiple lacerations of organs, lg amt blood in R and L chest.
Bullet recovered.
COD homicide GSW to the chest

Case 2
Caucasian M, approx 18 YO
Homicide GSW to the head
Deceased suspected to be a “drug mule”, had just returned from a trip “down south”, per mother.
Man attempted to enter house through back door, shot decedent in head, may have been shot by decedent.
Deceased spent 3 days in hospital.
Organ donor
Projectile recovered from skull
COD massive avulsed injuries to brain, skull.

Case 3
Caucasian F, approx 80 YO
Suicide
Deceased found in bathtub, believed to have cancer.
Cut on L wrist, two GSWs to head, poss. OD
COD multiple (suicide)

Case 4
Caucasian M, approx 10 YO
Suspicious fire
Deceased recently informed an adult friend that father was physically abusing him.
Father was witnessed leaving the house 10-15 min before fire
When mother woke up to smoke, she attempted to wake the decedent, but could not. There was no fire in the room at that time.
Body was recovered by firefighters some time later.
Massive fire damage to body.
Soot found in airways.
COD smoke inhalation, burns

When Greg flipped open the body bag (black, unfamiliar—this was an out-of-county case), little black flakes and chunks of something, clothes, skin, flesh, hair, unrecognizable, gently pattered onto the wet floor. This was both my first child case and my first fire victim, and I had somehow expected to be more horrified. I had seen photos of fire vics before, I knew pretty much what to expect, and it was bad. It was bad, but I was, again, as in every other time I had been worried, I found myself impassive. We joked with the Fire Marshall who had come to view the autopsy, laughed and sang as we waited for Dr. O., gloved and gowned and masked over the little, skinny body.

There were fragments of carbon, unidentifiable, blackened debris, a wet sludge of ash surrounding the body in the bag, and Greg lifted the whole body one armed as Matt dragged the dirty bag from underneath it and folded it to contain the sludge and ashes, lifted it one-armed, and he could because it was a skinny little boy, because burn victims bake into one very set position and don’t flop about like traumas or naturals. The Marshall held open a Mylar bag for the remains of the clothes, and they had to be peeled from the body, sometimes indistinguishable from the black and flaking skin. All that was left was the collar and a little bit of shoulder from a T-shirt of unidentifiable color, black and soggy, and a little of the back and waistband, adhered to the body, of a pair of SpongeBob Squarepants pajama pants.

The skin was partially spared on areas that had at some time been covered by clothing, brown and spotted with flaky, burnt flecks of flesh instead of black and crunchy and charred. Where the body was not black or brown, it had split from the heat, the skin bursting open to reveal yellow, cooked seams of fat. Lifted, it was light and stiff, cooked into pugilistic position. The tongue was pressed against the teeth, protruding slightly, and where it did, it was yellowed and blistered and speckled with charcoal. The teeth themselves were similar, burned unevenly, yellowly spotted and whitely mottled, the lips pulled tightly back around their margins. There was no hair left, the head and face had been subjected to too fierce a fire for anything but black, crusty, thin skin to be left, but the face and ears, though the same color and texture as the scalp, was surprisingly intact, though the eyes had sunken when their boiling vitreous steamed away. They were tightly closed, and I had to use tweezers to move the cooked-hard lids so that Greg could try to get some vitreous. The eyes were still round, but there was no way to discern their color. The pupils were opaque white, the iris nearly the same shade, and the surface of the eyeball thinned and stiffened. The white eyes in that black-burned face were shocking and hideous, ugly because they were unexpected, flecked with charred flesh that fell from the lids and tweezers.

The child’s arms were almost devoid of skin, bumpy, burned, yellowish fat and stringy, dried, red muscle taking its place. The flesh of the hands, particularly the fingers, which were clenched before the sternum, almost touching, had apparently melted away, hanging from the undersides of the stiff fingers in hard, black curves. The bones of the fingers were black, the nails sloughing with the degloved skin at the finger’s tips. When cut, the skin was hard and leathery, stiff, hard to keep back from the incision. The muscle beneath looked like nothing so much as rare-cooked meat. The organs were mainly unharmed, but awfully small. The tongue and trachea were badly burned, covered in soot. At least the child had not been murdered before the fire started. He had probably died of smoke inhalation, would have had no idea that his body was burning. There was no trauma to be found at all. There was also no smell when the body was opened—it was overpowered by the scent of the burned body itself, and, god help us, it smelled, just as burn victims always do, exactly like hot dogs.

Day 11

February 10th, 2010

Case 1
Caucasian M, approx 75 YO
Suicide GSW to the head
Deceased shot self intraorally, during the night. Wife slept downstairs that evening, reported hearing no sounds.
COD suicide GSW

Case 2
Black M, approx 17 YO
Homicide GSW to the head
Deceased had close-range entrance wound in R cheek, no exit
Multiple skull fractures
Bullet recovered in L parietal lobe of brain
COD homicide GSW

Case 3
Caucasian F, approx 45 YO
Unknown
Hx depression, bipolar disorder, paranoia
Found on couch by teenage children, thought to be asleep, but children called 911 when mother was unresponsive.
COD unknown. Samples sent to Tox.

Case 4
Black M, approx 25 YO
Adrenal insufficiency (?)
Brother died several years before of same.
Massive amts blood in pericardium, R and L chest
Could not grossly identify adrenals
COD unknown, samples sent to tox.

The H GSW was shot through the right cheek, at very close range (muzzle impression/powder blackening around wound). It was a small projectile though, or his head would have been unrecognizable as that crucial appendage. As it was, the face and skull were swollen and shiny, unblemished except for the purplish entrance wound from the bullet. He hadn’t been alive long enough for much ecchymosis to surface, though the head and face had suffered multiple fx in the impact, easy enough to feel through the hard, cold, swollen skin. The enlarged head with its thick, fluffy mat of hair seemed unnatural, unstable, on the skinny, little-boy body it belonged to.

The right eye had not withstood the impact. It had not avulsed, but rather, had apparently popped, leaving a black, glutinous-looking, bulging and shiny line of discharge under the stuck lashes of the eye. When the lid was pulled back for withdrawal of vitreous, the globby-looking but surprisingly hard lump of bloody vitreous had to be pulled up with the upper eyelid that it had stuck to, and underneath the lump, where it attached redly to the white of the eyeball, the iris was semi-intact, cloudy and streaked. It was a fish-eye, burst, the white dyed red with broken vessels, the same as the intact left eyeball. It was a fishy, cloudy, passive, dead eye, and as Charity ran the hose over the face and neck, the black discharge glued it shut and ran in snotty lines down the cheekbone and into the ear.

An open casket funeral was definitely not an option.