Showing posts with label autopsies. Show all posts
Showing posts with label autopsies. Show all posts

11 October 2020

Dr. Obenson: Doctor and Detective

Dr. Ken Obenson is one of only two certified forensic pathologists practicing in New Brunswick, Canada. He holds the distinction of being  first black pathologist certified by the Royal College of Physicians and Surgeons of Canada in forensic pathology. 

Although he investigates deaths in deceased of all age groups from babies to adults, it is with the death of babies where, “I often need to apply all the detective skills that I acquired through training and experience. Infants don’t have the usual stigmata of disease or injury unlike adults who tend to have well documented disease histories - and infants can sustain injuries that may not be as obvious at autopsy as adults.”

“My role, in the case of a natural death, is to make sure that I make the best effort to find the explanation for the death so I can allay some of the fears of the family,” Dr. Obenson explains. “When an infant dies, the parents almost always blame themselves. It can be heartbreaking for the parents when we are not  able to  provide a definitive cause of death. Unlike some other practice groups, we don’t use the term SIDS because it is a diagnosis of exclusion. SIDS or not, the cause death is undetermined and this is what they (the parents) worry about. Not just for this baby, but for others they may have in the future.” 

One case he investigated was particularly illuminating. It was the death of an infant who was only a few days old. The CT, X-ray, autopsy, toxicology, microbiology and other examinations found no cause of death. Information gathered by the police, revealed that the baby was visited by its’ large extended family who had all held the baby. On a preliminary examination of slides of the markedly autolyzed tissue that he had sampled at the autopsy Dr. Obenson found evidence of viral infection (suspected to be parvovirus) in one section of liver. Knowing exactly what to look for, he reexamined the slides more closely  and found  further evidence of the infection in several other organs. 

Because he was able to determine that death was the result of a viral infection, Dr. Obenson was able to allay the parents’ fears that something congenital was responsible for their baby’s death and reassure them that their next baby would not be at risk of dying. It also allows them to make different decisions about how many people their next baby comes into contact with while vulnerable and perhaps they may even insist on hand washing and other infection precautions in the future. Very importantly, it saves them from unspoken accusations that they might have done something directly to cause their baby’s death, like smothering, etc. 

Dr. Obenson was quite satisfied with the outcome in this case, knowing that the finding of a lethal viral infection probably helped  the parents in dealing with  their loss.  This is why he insists that as per international guidelines, a  thorough post mortem examination be performed in infants, after a comprehensive death scene investigation with review of  radiologic, toxicological, histologic and microbiological findings. 

“My role, when there is a homicide of an infant, is collect evidence such that the law is able to hold whoever is responsible to account,” he explained. “I have been qualified as an expert witness in court which means that because of my training, certification and experience, I am able to  give opinion evidence as to the cause and manner of death, unlike 'eye' witnesses who can only speak to what they have seen or heard.” 

Although for most of us, the murder of an infant is unthinkable, it does happen. Dr. Obenson explains that if there is an adult unrelated to the infant living in the house, like a new boyfriend, they are statistically more likely to kill that child. However, biological parents also do kill their babies, with fathers being more likely to do so violently than mothers. Unfortunately the less violent the trauma the more difficult it can be to detect physical evidence of foul play. For example, Dr. Obenson points out, if a baby is smothered, petechial hemorrhages in the eye  that are often seen in, but not exclusive to an asphyxial death are less likely to occur in infants- which is why these death investigations can be so complex. 

Dr Obenson takes his role as an impartial witness seriously and derives no personal satisfaction from a conviction. His only responsibility is use all available evidence from death scene, to social circumstances to post mortem examination and ancillary tests to arrive at a reasonable opinion on the cause of death. 
Dr. Obenson has practiced forensic pathology in the United States, in Jamaica and for nearly 20 years in Canada. He says, “We don’t have as many suspicious child deaths in Canada, particularly homicides. My theory is that the social safety nets in Canada alleviate some of the social stresses families feel.” 

This is the best argument I have ever heard for supporting families: protecting children.

11 February 2018

A Voice for the Dead

“I don't believe it, and none of us believe it.”[1]

That was the response to the police assessment of murder-suicide from one friend of billionaires Honey and Barry Sherman. This was followed by a chorus of agreement from many prominent Canadians, and subsequently by an expensive independent investigation which resulted in a revised new assessment of double murder.

Leigh Lundin asked me to look at this now high-profile Canadian crime being played out, blow by blow, in the news. So here I am looking at it. But with Canadian eyes.

Honey and Barry Sherman
Honey and Barry Sherman
My question isn't about what happened in this particular crime. I feel confident that it will play out in the investigation, and that the truth will emerge. My question is this: What would happen if a family disagreed, but did not have powerful friends or the money to conduct their own investigation? What if the family were poor, but still vehemently in disagreement? What if a murderer was on the cusp of getting away with it? Who would stop them? 

I brought this up with Dr. Coroner – not his real name but it would be a good one, because he is indeed a coroner. He is called in if a death occurs outside a hospital, and occasionally in it. His job is essentially to assess the manner and cause of death. Is this death natural, an accident, a suicide or a homicide?

The body can be photographed but cannot be touched until he is finished his assessment and releases the body. He looks at the story, told by the body, of the manner and timing of death. There is also the story told by the place of death, and the question for him is whether it is consistent with the story the body tells.

My question: If the family disagreed with a murder-suicide verdict, but were neither educated or moneyed – what would he do? What if the family was unable to articulate a story as well as the friends and family of the Shermans? What if they were angry and threatening, or in general made themselves unsympathetic?

He said often his job is to help reconcile the disbelief with the reality. Some counselling is often part of what he does with families.

Also, he argues that marriage – by the nature of the long term relationship – can lead people to kill each other, even if they look to others like they are happy. Marriage itself can be the reason for murder.

Those caveats aside, Dr. C. said there was enough from the story of the “murder-suicide” of the Shermans to make him suspicious, largely because the story is wrong. Domestic murder is often more violent, angry. Hanging is not what he would expect as a means of murder or suicide in this case. Hanging is more often seen in cases of mental illness or extreme distress. Further, why would a man who has copious drugs available to him choose this manner of death for himself and his wife?

If the stories of the body, manner of death and family assessment make Dr. C. suspicious in any way, he has many options to augment the evidence he gathers.
  • The authority of the coroner overrides privacy of information, so he can seize records from sources such as the family doctor, psychiatrists, and psychologists. This could provide a more fulsome picture.
  • He can seize all radiological and dental records, to see if there is evidence of previous abuse.
  • He can order a post mortem, or a forensic autopsy and refuse to complete the death certificate or even provide the funeral home with a warrant to bury, until he is fully satisfied.
Ultimately, the story must hang together. Regardless of the ability of the family to articulate their concerns, or their resources to investigate on their own, Dr. C. relies on having a coherent story told by the manner of death, the body, the family and the records seized. If there are inconsistencies – then a further investigation is warranted.

If a family were unable to mount the same vigorous objection and investigation as the Shermans have, it could be the coroner who stands between the constructed truth of the murderer and the actual truth of the victim.

Ultimately, all crime writing is social justice writing. And the poor have a voice – the coroner. The story of the body, uncovering the life lived, the manner of death, might be the key to catching a murderer. The background knowledge and tenacity of the coroner is what most of us rely on when our bank accounts are meagre.

Dr. C. said that the job of the coroner is to provide a voice for the dead, to listen carefully to the story they tell. This is the first step towards social justice for those without money and connections. They do this by asking the simple question:
Does the story of this death make sense?

07 January 2018

Radiology and Murder

Doctor John Doe (DJD) is a radiologist. That is not his real name, but it is his real profession. DJD is the doctor who reads CTs, MRIs and various other images that help diagnose illness. He is dedicated, competent, and once said a line which should be famous: ’When life hands me a lemon, I put it in a bag, find the person responsible and hit them over the head with the lemon.’ I adore him because feisty is always the way to go in life.

I asked him about his thoughts on murder:

DJD: I would be interested in seeing a two victim murder, in which the murderer uses the first victim as a pawn, believing that their death will cause such a deep grief for the the second victim, who is the person the murderer really wants dead, that their staged suicide will appear plausible. To the murderer, it appears like an undetectable crime. The murderer gives the first victim  a blow to the head and then throws them down the stairs or in front of an oncoming car, making it look like a terrible accident.

The second victim is someone who deeply cares about the first. They could be murdered by numerous means made to look like a suicide resulting from grief. Often people are prescribed sleeping pills or anti-anxiety meds to cope with a grievous loss. DJD suggests one easy way to kill them is to get them drunk and grind a deadly dose of the pills they have on hand into one of the drinks. At first blush, this looks like a drinking binge of a depressed person who decided to kill themselves because of grief. The murderer simply has to leave the staged evidence of a booze bottle and an empty, opened pill bottle. 

Could the chain of murders be unraveled, starting with a critical examination of the first, apparently random act? The radiologist could first examine cutting-edge radiological evidence postmortem.

DJD is sometimes called in when the coroner has questions about the cause of death. For example, did the blow on the head occur before the car accident, or was the victim lethally struck on the head and then pushed down the stairs? Using radiological evidence, that distinction can be made.

Although the forensic autopsy still remains the gold standard for post-mortem forensic assessment, the ‘virtopsy’ is catching up, sometimes augmenting or even replacing the autopsy. When there are religious or other reasons for excluding an autopsy, the virtopsy is the only evidence available. Sometimes, even with a pending autopsy, a virtopsy will be used. 

A virtopsy is the pre-autopsy whole-body CT or MRI scan, used to identify cause of death. Some studies have shown that a CT scan may be more effective in detecting some causes of death, and that the imaging may be better than a full autopsy to detect such causes of death as intracranial pathologies (such as strokes) and pneumothorax.

If someone is killed first, say with a blow to the head, and then pushed into the path of an oncoming car or thrown down a flight of stairs, most people assume that the serious and extensive injuries of the fall or impact will hide the original blow to the head. However, careful examination for the radiological evidence can clarify the timing of the injuries. And again, this can be done even if the family rejects, for religious or other reasons, a full autopsy. 

Impact from a car or a fall may show multiple bone fractures of the skull, ribs, vertebrae and extremities, as well as damage to organs. However, these impact lesions will lack the relevant surrounding hemorrhage which would have been expected under these circumstances. In short, if you die before impact, the lesions of impact will bleed less because your heart isn't pumping blood. This bleeding pattern will help identify the actual blow that caused death because of the extensive hemorrhage at that site of injury. 

This new radiological post-mortem examination is a cutting edge means of identifying cause of death and timing of injuries that were sustained. We will, I think, hear more about it as the techniques evolve.

One interesting use of CTs is identifying those who have been poisoned and then hit by a car or who have sustained other injuries. The amount of blood from impact injuries is reduced when the victim is previously killed by any means, including poison. 

A complex chain of events, like DJD’s proposed double murder, can be unraveled by tugging at the simplest loose threads. For radiologists, a virtopsy provides a cutting-edge method to find these loose threads and exploit them.

30 December 2011

Gamble Pays Off

Auld Lang Syne

As New Year's Eve rapidly closes upon us, I am reminded of this Scots phrase from Robert Burns. Auld Lang Syne: literally translating into English as “old long since” — or, more colloquially, perhaps: “Long, long ago . . .” A time to look back, to take stock, perhaps to dissect or deconstruct our past actions or thoughts . . .

Dissection can be messy.
I’m no book reviewer. I’ve never been paid to write a book review, nor have I ever written one before. This is not to knock book reviewers. Many do a wonderful job. I read book reviews just like anyone else – hoping to find clues to my next good read.

It’s a job I view with great trepidation however. Because:
(A) I worry about hurting people’s feelings.
(B) To me, reviewing books is just too much like dissecting them.

Whether the type of dissection under discussion is physical, mental or literary, my fear is that after you perform a dissection, you still end up with the guts of a once-living thing cut out, catalogued and stored separately (at least temporarily). Or — if I were handling the job — probably strewn all across creation.

I suspect Lucy Ricardo would make a better M.E. than I would; by the time I completed an autopsy, there’d probably be entrails hanging from the overhead lights. Not intentionally, of course; it’s just the way I do things—you should see what our kitchen looks like after I cook a meal. (Comparing autopsies to cooking . . . can’t tell I recently watched Sweeney Todd on DVD again, can you?)

As for literary dissection . . .

Dismembering story elements for study
Well, it still seems pretty messy to me. And, just as chilling. Even deconstructing a sentence seems to rob it of the life and character it once had. Clauses, sub clauses, words – each forever ripped from the bosom of its family, stored separately, catalogued, labeled.

And, quite dead.

Concerning Self-dissection — well that’s even more tricky.

I suppose dissecting your own writing is easier than dissecting your own body, but only just easier in my opinion. I sometimes have a terrible time trying to tell what’s wrong with a story I’ve written, even when I can clearly feel the “wrongness” within some certain part of it. And that problem increases exponentially when I get involved in novel editing. If you’ve been a faithful reader, then you know that I often turn to a critique group, for help, at times like these.

But one of the stranger tricks I’ve also learned (one which has helped me quite a bit) is to read works by now-best-selling authors, written back when they were in their early years — still “learning the ropes” as it were. The ease of recognizing errors committed in their earlier days is probably comparable to the relative ease of performing an autopsy on someone else, versus pulling one on my own cadaver. (I mean you have that whole “Dead people usually find it difficult to make voluntary movements,” thing to overcome.)

Comparing what went wrong in these early writings, against the way these authors surmounted their “writing problems” in later work, gives me the chance to recognize problem-patterns, then look for them in my own writing. Sort of like a med student learning to diagnose damaged organs contained within live bodies, by examining fatally flawed organs in cadavers. Such study provides the opportunity to seek out and diagnose flawed areas in my own work. It’s not quite as hands-on as an autopsy might be, or as I personally might prefer. But, I’ve learned to try and Go With the Flow! when it comes to the touchy-feely side of writing.

Oddly, perhaps, this is also one of the reasons Felix Francis’s writing appealed to me over the past few years. The son of mystery great Dick Francis, Felix has been finding his way from teaching physics to (and through) the writing thicket.

Not an easy trek.
His writing is much like his father’s in many ways. It’s as if there are similar family features on the faces of both their prose. But, especially in the beginning, there was a certain, unfortunate “flatness” to Felix’s writing — particularly compared to his father’s.

I don’t mean Felix’s stories suffered from flat characters; most were well-rounded and well-drawn. Nor do I mean that he's a bad writer; he's not. He's a good writer. It's just that, where Dick Francis' stories stood up and danced, Felix's seemed to fall flat on my tongue. His writing was flat in the same way that soda left in an open bottle becomes flat. Reading Felix’s work, I felt as if I were reading his father’s work, but it had lost its fizz — and a lot of the flavor along with it.

Now this is a problem I can recognize and sympathize with. I sometimes struggle with “flat writing” in my own work — and I find it one of the most perplexing problems to correct. So I was overjoyed to encounter Felix’s flat writing, because I knew it was so similar to his father’s, that I just might be able to diagnose the cause by comparing the two. In turn, this might open a door to healing my own writing ailments. “Let’s see if we can’t just find out,” I thought to myself, “what the reason for this loss of fizz is.”

Thankfully, I’ve got a pretty full library of Dick Francis paperbacks lying around my office (Yes: “lying around” – all part of that “entrails hanging from the light fixtures” thing!), so I got cracking. And those differences, I discovered, were primarily very small. Tiny even.

Perhaps the truest insight I gained was that the root of the problem (and the reason it’s such a tough nut to crack) lies in the tiny size of the transgressions, multiplied by the number of times they occur.

In retrospect, I decided the nature of the difficulty shouldn’t have surprised me. After all, while lack of carbonation (because it’s all escaped into the atmosphere) lies at the root of flat soda’s problem, it manifests itself through the absence of millions of tiny bursting bubbles. One overall problem -- but, lots of missing bubbles causing it.

One tiny bubble failing to rise to the surface of the soda, and burst there, would hardly be noticeable; a million missing bubbles and the soda is flat, lifeless. It’s no longer effervescent.

In other words: I discovered that (to me, at any rate) flat writing doesn’t seem to be a single problem; it’s a number of tiny problems that snowball, finally combining to rob the piece of flavor.

For example:

One difference I discovered was that Felix Francis’ characters often made outright philosophical statements. Either the reader agreed with those statements, or that reader didn’t agree with the character. I suspect that a little of this goes a long way toward erecting a barrier that keeps a reader, who didn't agree with the expressed opinions, from fully identifying with (and thus caring about) a protagonist, if that protagonist is the character making those statements. And that can be a big problem.

Dick Francis’ characters, on the other hand, seldom made philosophical statements as absolutes. Particularly when working in first person, his POV characters tended to couch such statements in gentle, very subtle ways, nearly always incorporating words such as nearly, almost, sometimes, or some to soften the blow.

It seems to me that using these "wiggle-room" words permits a reader to disagree with the sentiment expressed, but still agree and connect with the character, because the character’s own description has left room for that disagreement. It’s a subtle difference, but over the length of a novel I believe it can have a great impact.

One way to view this recurring difficulty is to think of these little problems as grains of sand at the beach. A beach is composed of millions of tiny grains of sand; if a few grains are misshapen — rough, or sharp edged — it makes little difference to your feet. The beach texture is still inviting. But, keep substituting misshapen grains in place of smooth ones, and eventually the sand texture becomes a little too rough on the toes. The beach becomes uncomfortable to walk on, barefoot. A person finds it hard to settle-in and relax on that beach. Next time they want to spend some time by the ocean, they’ll probably go somewhere else. Though they might have a hard time explaining why.

If I were the kick-ass analyst I wish I were, I would have been able to isolate some sort of Seldon’s Laws (to borrow a term from Asimov's Foundation series) concerning what constitutes the equivalent of “carbonation” in writing. In the real world, however, I’m just not that bright. Consequently, to me, it seems pretty difficult to fix a beach (or manuscript), once it’s filled with a bunch of misshapen sand grains. Because, you can’t just correct one problem to fix the overall flaw. Instead, you’ve got to first find then polish a lot of misshapen little pebbles. Not a quick and easy task — whether we’re talking about beaches, or manuscripts.

For a beach, you might be better off just scraping it clean, then bringing in all new sand. For a manuscript? Well, it might be a good idea to take a tip from the great Asimov and “run it through the typewriter again” completely rewriting that section.

For Felix Francis, however, there seems to have been another solution.
Gamble, Felix’s first book to be published since the death of his father, came out over the summer. Circumstances conspired to keep me from getting my hands on it until last week, however. And, I have to tell you: in my opinion his writing has improved by leaps and bounds. And, it is no longer flat.

In fact, I’ve been thinking a lot about it over the past week. (The kids have been home 24/7 with Winter Break, so it’s not like I was going to get much writing done.)

I’ve never met Felix Francis, haven’t even seen him at a book signing. So I did some online searching and this, coupled with my knowledge that his father died in 2010, has got me contemplating a possible reason for the change.

You see, part of what I think I noticed is that his prose has lost a few of those “family trait” characteristics. Don’t get me wrong; you can still clearly see the resemblance between the writing of father and son.

But, sometimes as a person grows, s/he loses some of the striking similarity in features that were so clearly prevalent in earlier years. It’s just part of the physical metamorphosis of growing up. Other times, a man’s son may do something that would be so uncharacteristic for his father (not necessarily a bad or evil thing—just different from what the father would do) that people are forced to realize the son isn’t just a carbon copy; he’s “his own man” so to speak.

This sort of subtle (on one level), but striking (on another) change, is what I believe I saw in Felix Francis’ writing. You could chalk it up to the idea that his writing is simply maturing, and no one could prove you wrong. But, I suspect another factor is also at play.

This is the first novel he’s written, in which his father has played no role. According to an interview in the British racing magazine Eclipse, Felix said that during the previous novels: “I would write the prose and he (Dick Francis) would then make suggestions or correct me if I had some of the racing not quite right. We never argued much – he seemed to like what I did.”

I’m not saying the earlier problems were being caused by Dick Francis. I’m sure that wasn’t the case. Instead, I’m left wondering if maybe Felix was stretching into a zone, when writing Gamble, which he couldn’t comfortably operate in when his father was alive.

The pressures on a son, writing under his father’s byline — particularly with the knowledge that his father is going to look over what he’s written before it gets sent to a publisher — are sure to be much different than if the son writes under his own byline. Gamble is billed on the cover as: “Dick Francis’s Gamble by Felix Francis.” This is subtly, but powerfully different from the billing Felix received on the previous novels he (evidently) largely wrote. Those were billed as being written by: “Dick Francis with Felix Francis.”

Later in the Eclipse interview, when Felix was asked if his father had left lots of book idea notes, Felix replied: “Sadly there are no notes. It’s all down to me now. It is a bit strange that he is no longer around to read the manuscript and criticise my grammar, but I am confident that he would be happy with the result.”

I believe he’s right; Dick Francis would be happy. Because, what I’m convinced I read in Gamble was a fresh new thing called Felix Francis’ voice. I don’t think he’s got it completely locked in yet. But, I do think he’s got at least one foot in the groove and is closing on target. When he gets there — who knows? Maybe his body of work will even eclipse his father’s.

One thing I’m sure of, however: choosing to write with his new voice took guts. Felix took the risk that long-time Dick Francis fans might slip away. It was a gutsy gamble to use his own voice in the novel. For Felix Francis, however, it looks as if his Gamble will probably pay off.

In Closing:

The great Dick Francis died in 2010, but I didn’t blog back then. So, during this time of Auld Lang Syne when we often look back in remembrance, I’d like to take a moment to acknowledge Dick Francis’ legacy through a series of photos borrowed from Felix Francis’ website.

Dick Francis as racing fans must have thought of him.

Dick Francis as I (for some reason) always think of him.

I love the pose here. His stance is so reminiscent of the jockeys he wrote about. And . . . gee, who are those two women he's talking to?

Dick Francis with his wife, Mary.

(L to R) Felix Francis, Dick Francis, and Felix's older brother, Merrick

(That photo at the top of today's blog, incidentally, is Dick Francis finishing a ride he may not have cared to remember too often.)

Happy New Year!

See you in two weeks,