question for pathology students

[BeeBee]

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This is a "time of death" question.

What happens to the lividity process when a body is placed in a morgue?

Background: A woman is murdered (blunt force head trauma) and is found lying on her right side. She is taken to the morgue and an autopsy is done aprx 36 hours later.

Medical examiner notes dorsal lividity, unfixed.

Does that tell you anything about time of death?

 

[djmd]

This is a "time of death" question.

What happens to the lividity process when a body is placed in a morgue?

Background: A woman is murdered (blunt force head trauma) and is found lying on her right side. She is taken to the morgue and an autopsy is done aprx 36 hours later.

Medical examiner notes dorsal lividity, unfixed.

Does that tell you anything about time of death?

Yes and no.
Do your own homework / murder investigation.


Liver motris is time dependant, it is not temp dependant.


No help from livor mortis. It tells you the death occured more that 30 mintues before the medical examiner, examined her.
Nothing happened to livor mortis when the body was placed in the morgue. (nothing that wouldn't happen outside of the morgue)

 

[Gut Shot]

This is a "time of death" question.

What happens to the lividity process when a body is placed in a morgue?

Background: A woman is murdered (blunt force head trauma) and is found lying on her right side. She is taken to the morgue and an autopsy is done aprx 36 hours later.

Medical examiner notes dorsal lividity, unfixed.

Does that tell you anything about time of death?

Do the crime scene photos show lividity on her right side when she was in that position?

 

[BeeBee]

Thanks for the responses.

The deputy coroner that went to the scene did not take a body temp or note lividity. I have not seen the crime scene photos, but the autopsy report does not note any other lividity or staining (lateral).

From what I've read, lividity should be fixed in about 12 hours.

What could explain unfixed dorsal lividity more than 36 hours after discovery?

By the way at autopsy rigor was full in the extremities, but easily overcome.

 

[Mindy]

Hi:

The mild rigor is not inconsistent with a 36 hr postmortem interval, although rigor will be nearing the end of its existence at this point. Since the decedent had rigor, it is safe to assume she was not decomposed.

The "unfixed" (i.e. non-blanching) livor at 36 hrs is unusual. Was the blanching present at a "light touch"? or did you have to press for quite a while? Ever hear that "all patients have pre-tibial edema if you press long enough?" Some think the same is true of postmortem lividity.

The "fixing" of lividity has to do with the postmortem loss of integrity of blood vessels, so that now you have red blood cells / pigments settling within the tissue. Presumably you can "squeeze" the rbc's back through the capillaries in early lividity. But there is no reason really to believe that you cannot redistribute variably intact red cells in the tissue and residual capillaries a little bit (causing attenuated, but documentable blanching) at a PMI of 36 hours. As mentioned, lividity is more of a reflection of time than temperature, etc.

The last point was eluded to: lividity will shift if a body was moved within the first few hours of being found (maybe up to 12?) I would think that due to the fact that the lividity did shift to a posterior position (assuming that it is not more "right-sided" to be consistent with how she was allegedly found), than I think you have to assume that the decedent was discovered within 30 minutes to 24 hours (to be conservative, though probably 12 hours is more realistic for an upper end) of being found based on lividity. Rigor also supports this. Any information on the decedent's temperature at the scene?

The point that death occured at least 30 minutes before being found is correct, but incomplete. Most likely death also occured no more than 12 hours before being found (24 hours for the conservative crowd).

Of course, the best "time of death interval" is between the decedent last being seen alive, and being found dead.

Mindy

 

[Mindy]

One other thought...

are you sure that the decedent's autopsy occurred 36 hours after being found? Your description easily could be an autopsy being performed within 12 hours of dying.

Mindy

 

[BeeBee]

Hi Mindy,

Thanks for the response. If lividity can shift 12-24 hours after death what about the staining that (supposidly) occurs if a body is moved prior to lividity becoming fixed? Shouldn't that have been noted? The DA's theory is that the body was found aprx 8 hours after the vicitm was killed. Why no lateral lividity?
By the way, this was a high profile homicide that resulted in what I consider a wrongful conviction, that's why I have questions.... and I appreciate all the help here.
Amazingly, no temps were taken at the scene. The body was discovered at the victim's residence at aprx 6pm on a Saturday. The autopsy was done the following Monday morning.

Actually if you want, you can read the autopsy here:

http://www.courttv.com/news/horowitz/docs/autopsy.html

 

[yaah]

This is not the place for getting legal advice. If you have a personal involvement in this case, I would suggest not trying to back up your theories on an internet posting board. If you are merely curious, then fine.

For those who have not seen it, oftentimes people will post on internet posting boards trying to seek medical or legal advice, or someone to support their theories. While it is unlikely that harm will come to you in this case, oftentimes it is better to let things lie. When someone registers for the sole purpose of posting a single question and having it answered, this is often the circumstance.

 

[BeeBee]

Did you see my post in the intro section?

I work in health care. I have been a nurse for MANY years. I have often found that younger doctors and residents are eager to kick around what they know. Maybe not here???

Sure I have an interest in the case I posted about. So? Are there no pathologists here that eventually want to be medical examiners?

I'm not looking for legal advice... or medical advice (the person in question is dead)... just interesting conversation.

If that is not welcome... just let me know.

 

[Mindy]

I do feel a need to put a disclaimer on my discussion---I have zero! credibility in discussing anything in connection to the case posted above, and my answers are just my opinions--not necessarily scientific fact or contributory in any sort of legal form.

BeeBee- I definitely love talking forensics / medicine, but on this forum, only in the theoretical.

Mindy

 

[yaah]

Did you see my post in the intro section?

I work in health care. I have been a nurse for MANY years. I have often found that younger doctors and residents are eager to kick around what they know. Maybe not here???

Sure I have an interest in the case I posted about. So? Are there no pathologists here that eventually want to be medical examiners?

I'm not looking for legal advice... or medical advice (the person in question is dead)... just interesting conversation.

If that is not welcome... just let me know.

As I said, if it is merely for curiosity, no problem. Just because someone says they are a student/nurse/doctor (whatever) doesn't mean they are. People come on these forums and pretend to be all kinds of things. People have posted things ("theoretical" they say) about a medical issue and asked if it was done appropriately or whatever, and it turns out they are not being theoretical at all. Your post just raised red flags, that's all, because you were referring to things like why the DA made this conclusion or that the person is wrongly convicted, etc etc.

It's important to remember that making conclusions based on a case in which you don't have all the information is often difficult - sure the autopsy report is there, but is that the sum total of all information? And it is also important to remember that in forensics, like in the rest of medicine, things are rarely absolute or as defined as we would like them to be.

 

[b&ierstiefel]

I think this whole discussion of legal advice on such a forum as this is quite laughable. I mean, seriously, so let's say that a legal case is discussed on the forum. OK...and some of us chime in with opinions, advice, or what not...is any of this going to be admissable in court. "Your honor, but some guy on some internet chat board said this and that..." The judge would just laugh at you! What's the worst that can happen...so some guy comes asking for legal advice and gets some...that person then has a basis for seeking experts who can help take the case to court. No harm no foul. We never hear about it. None of us get subpoena'd because there can be no absolute way to establish who is who on this board beyond any reasonable doubt.

Yes, people who ask questions can claim to be whoever they want to be...but that goes for anyone that posts here. One could always ask, "Is yaah really a pathology resident?", "Is Mindy really affiliated with MGH?", "Is LADoc00 even a pathologist or some angry 18 year old kid whos father is a pathologist and that's how he knows how much he knows?" But these are all silly questions 🙂 We know that yaah is a path resident. We know that Mindy is at MGH. And we know that LADoc00 is not 18 years old (he's really 16?).

 

[1Path]

The DA's theory is that the body was found aprx 8 hours after the vicitm was killed. Why no lateral lividity

I remember this case (I'm originally from San Fran) and all the "questions" surrounding it. I'm also reminded when I think of this case and the autopsy of Marylin Monroe why Forensics is not appealing to me.

 

[BeeBee]

So does anybody here want to eventually work as a medical examiner? I think it would be an exciting field. Science can tell us so much.
If I were younger, lol, I would have geared my nursing towards forensics from the beginning.

Anyhow- discussing murder cases isn't what I would call getting legal advice. We aren't defendents or lawyers.... and as citizens, we should be encouraged to discuss trials-- they are public.

In the case I originally posted about, the victim was supposidly laying on her right side for 8-9 hours, yet at autopsy only dorsal unfixed lividity was noted.

Mindy mentioned that lividity can shift 12-24 hours after death if the body is moved... so I'm wondering about staining?

 

[BeeBee]

I remember this case (I'm originally from San Fran) and all the "questions" surrounding it. I'm also reminded when I think of this case and the autopsy of Marylin Monroe why Forensics is not appealing to me.

wow- why is it not appealing to you? Just curious. 🙂

 

[1Path]

wow- why is it not appealing to you? Just curious. 🙂

I grew up a Quincy fan and thought for sure I would become an ME especially after shadowing one. I even said that in my high school yearbook my Senior year. After living a little however, I realized that I'm not interested in ANY field that has a high level of involvement with the Law as the lines between truth and fiction get blurred too often for my taste.

 

[pheebelv]

As a new member of this forum .
I browse the website daily.and enjoy funs in learning different kinds of information. Most replies may not be professional.But i do see the the sparkles of mind of different people here. that's te most important
So ,I don't think there is any problem to post such a case here.

 

[BeeBee]

I grew up a Quincy fan and thought for sure I would become an ME especially after shadowing one. I even said that in my high school yearbook my Senior year. After living a little however, I realized that I'm not interested in ANY field that has a high level of involvement with the Law as the lines between truth and fiction get blurred too often for my taste.

Blurred by whom 1Path? DA's or ME's?

It's sad you had such passion and then changed your mind.

 

[1Path]

Blurred by whom 1Path? DA's or ME's?
It's sad you had such passion and then changed your mind.

I'd say blurred by "life". I can think of far more useful places to apply my talents and skills where I feel like I won't have to deal with my integrity potentially being put on the line. So while I won't complete a fellowship to become an ME after a path residency, I still plan to become a pathologist. My true passion is health disparities translational medical research which is a good match for my strong background in research.

I'm wondering why others in this forum aren't interested in becoming an ME except Mindy, and I suspect that money may be a contributing factor for a lot of folks.

 

[Mindy]

I too wonder why there are not more forensics-bound people.

Here is my list of potential reasons:

1) Perceived to not offer the financial reward of other pathology specialties.

2) Very limited exposure to forensic issues in medical school or pathology training.
--Very few role models--most MEs do not work for an academic institution.
--Very small prevalence in pathology journals & forensic journals are difficult to access in many institutions.
--Negative connotations associated with a career in forensics as portrayed by various pathology departments.
--Medical students are residents are very swayed by the opinions (whether valid or not) of their peers and attendings.

3) Lots of people do not like autopsies or having a job that revolves around work with dead bodies.

4) The "coolness" factor associated with forensics is lost on a group of stressed residents/students who are simply wondering how they are going to keep afloat from day to day (rather than what the latest CSI fashion trend in ray-bans is!)
--this is the reason, I believe, why the public's perception of forensics is so different than physicians.

------------------------------------

So these are my top contenders for why I do not think there is broad interest in forensics.

So why am I going into forensics?

To me, forensics is an "outside the box" type of medical career. Last year, only 19 people became board certified FPs. There are only ~400 FPs practicing in the US. To me, this says "sky is the limit" for my own career. BUT! I have had to deal with very well-respected role models attempting to dissuade me from pursuing forensics early in my decision process. Fortunately, my hospital currently gives me a lot of (appreciated) support in this undertaking, but it came with a bit of a struggle, i.e. showing those around me it is a worthwhile goal.

Perception dictates a lot of the choices made by physicians. How many medical students on this forum want to be dermatopathologists because of their perception of the field? Is it grounded in solid experience? I always wonder.

The way I figure is that by taking "ownership" of a field that is in its academic infancy, I can make ***significant*** contributions. I am confident enough to believe "lifestyle" will resolve itself with time, if I chose to care about it more than I now do so. As someone close to me always advises: do what you love and the money will follow. Best of both worlds!

Forensic pathology to me is the hub of the community. Where else do you have such a beautiful intersection of medicine, law, laboratory science (tox, trace evidence, dna, etc. etc.), public organizations (police, military, DHHS, etc. etc. )? It is a very exciting field. And no, I really do not understand why others cannot see it the way I do.

Mindy

 

[1Path]

Forensic pathology to me is the hub of the community. Where else do you have such a beautiful intersection of medicine, law, laboratory science (tox, trace evidence, dna, etc. etc.), public organizations (police, military, DHHS, etc. etc. )?

Thanks for the inside scoop! I know I really appreciate it!

Ironically, I was talking with my grad adviser yesterday and I told him I was going to start attending pathology conferences in the Spring. I'm interested in chemical terrorism/neuropharmacology and out of the blue, he asked me if I had thought about a career in Forensics since he's well aware of my interest in pathology. I have to admit that somewhere in the recesses of my mind, I've thought about it especially since I really like neuropathology too. And I'll admit to a somewhat morbid interest in shows like Dr.G medical examiner and high profile autopsys (a lingering interest in the autopsy reports of the Challenger astronauts ).I guess the how people die question has always fasinated me and books abouts about ME's (Marker, A Case of Need, ect) are reread frequently when I have time.

We'll see, I don't think I'll specifically pursue Forensics, but some of my work may be peripherally involved in it.

 

[yaah]

IPerception dictates a lot of the choices made by physicians. How many medical students on this forum want to be dermatopathologists because of their perception of the field? Is it grounded in solid experience? I always wonder.

I agree with this, and to be frank, it irritates the crap out of me. When people become convinced as to what they want to do before they actually experience things, they basically get set on a track and dare not look aside to other possibilities as they progress along their training. So they start "showing interest" in the field, making connections, etc, before they even have any experience in it to know either 1) is it for them, and 2) are they even any good at it.

The fellowship process, as it is now, basically has to start occurring in the second year - which means you have to start thinking about it seriously during second year. Have you even had experience in every field yet? So what happens to you if you go into residency with an open mind and find that you love something (like hemepath, for example) but you don't discover that until midway through second year? What do you do? You start applying for fellowships, but get less respect because you 1) haven't "shown interest," and 2) haven't done projects in it. And you might be really good at hemepath and show real aptitude. But you will potentially be squeezed out of it by some gunner who started "showing interest" before he even knew what a promyelocyte looked like.

I guess there really isn't a great alternative to the current system - I mean, it's hard to pick the right candidates as it is - you have to go with intangibles such as who has published the most, etc. It just bothers me. The system as it is favors the bold and/or the obnoxious, regardless of whether they are truly the best candidates.

 

[1Path]

I guess there really isn't a great alternative to the current system - I mean, it's hard to pick the right candidates as it is - you have to go with intangibles such as who has published the most, etc. It just bothers me. The system as it is favors the bold and/or the obnoxious, regardless of whether they are truly the best candidates.

How would completing a PSF factor into a programs consideration of a potential applicant? It seems to me that with pathology getting more competitive, this would be a logical option but I've seen the idea poo-pooed in this forum. Despite this, I'm considering it.

 

[Mindy]

I was a post-sophomore fellow in pathology, going back before the retraction of the credentialing year. I would not have pursued pathology had it not been for the PSF.

If you know that you want to be a pathologist, there is very little reason to do a PSF. If you are unsure, need a break from med school, and just want to gain alternative exposure to the field, or if you think that you are heading into a surgical career like I did at the time, a PSF can be extremely valuable.

I now have 2 different programs as a background to my pathology training, so that I always can weigh in my head "well we did it differently at Upstate, but it still worked as well as it does at the General." Or this worked better, worse, etc. It does provide a broader perspective of the field.

Also Path1, I think you will find for every one person who applauds your potential choice of forensics, a dozen others will think you are crazy. In fact, I think there is even a tendency to question the intelligence/competence of folks who go into forensics, i.e. "I guess they couldn't make it as a real pathologist." This is disparaging, harmful, totally inappropriate, but believe me, it is out there (and not far away.) The bottom line is if you like forensics, you need to really steal yourself against a lot of negative opinions about the field.

Mindy

 

[1Path]

Also Path1, I think you will find for every one person who applauds your potential choice of forensics, a dozen others will think you are crazy. In fact, I think there is even a tendency to question the intelligence/competence of folks who go into forensics, i.e. "I guess they couldn't make it as a real pathologist." This is disparaging, harmful, totally inappropriate, but believe me, it is out there (and not far away.) The bottom line is if you like forensics, you need to really steal yourself against a lot of negative opinions about the field. Mindy

Thanks for the info, Dr.Mindy! I'll definitely keep my options open! I'm thinking my involvement in issues related to national security should allow me to get some solid exposure to Forensics when/if the time comes. And I strongly believe that mentorship is what makes a differnece when it comes to career decisions.

Speaking of that, I participated on a melanoma project at NCI a few years ago, and worked directly with dermatologists, dematopathologists, ect, ect. All I can say for that experiecne is that while I found the pathological mechanisms of melanoma interesting (especially it's association with certain other cancers), I didn't find the work in this field all that interesting. As a result, I'm in NO danger of getting "interested" in dermatopathology!

 

[Mindy]

My 2 best resident (well now one's a fellow, the other is applying now) friends are budding dermatopathologists...

They would just think I was jealous... I would just tell them they are too girly to appreciate forensics... They would just laugh and put on their Ben-gay smelling hand lotion...

(I hope the MGH lurkers get that inside joke!)

😉

Mindy