10-16-07:
Wrist Slash—Murder or Suicide?
Q: I
would like to thank you in advance for your assistance, as
I am now attempting to write my very first story. My question
is - can a coroner distinguish between murder and suicide when
the victim's wrists have been slashed, and have there been
any forensics publications on such cases ?
Merav Tsary, Mevo Hamma, Israel
A: Maybe
and maybe not. If so, there are several clues the ME could
use to distinguish suicide from homicide. First, a little anatomy.
The two
bones of the forearm are the radius (thumb side) and the ulna (little finger
side). These bones are used to name the sides of the wrist. The radial side
is the thumb side and ulnar side is the little finger side. Along the palm
side of the wrist run the radial and ulnar arteries---they are on the radial
and the ulnar side of the wrist respectively. Also, the nerves and the flexor
tendons (the ones that allow gripping and balling the fist) run through the
same areas.
When the
wrists are cut, the arteries, nerves, and tendons can be damaged or severed
in any degree and in any combination. The ME would analyze the wrist wounds
to determine if the victim could have done it himself or not. He will, among
other things, look at these:
Angle and Direction of Cuts—Most
people, when attempting suicide this way, will lay their
hand palm up and slice across their wrist. This means that
if the knife is in his right hand and he is cutting his left
wrist (or vice versa), the blade will move in a radial to
ulnar direction. If the cut moved in the opposite direction,
then suicide would be less likely. If the ME saw this or
if the cut was at such an odd angle that the victim could
not comfortably have done it himself, then he would be suspicious
that the cuts had been made by someone else.
Blood Loss---If the victim was already
dead at the time the cuts were made, then there would no
bleeding. Dead folks don’t
bleed. So if the killer tried to make a death from some other
cause—drowning or strangulation for example—look
like a suicide by cutting the wrists post-mortem, the ME would
know the cuts were post-mortem.
Tendons---If the cuts were deep enough
to cut the tendons, then the ME would know that suicide wasn’t
possible. If the tendons to the left hand were cut first,
how would the person then grip the knife to make the cuts
on the other wrist?
Hesitation Marks—These are marks
where the blade makes shallow cuts. These are very common
in suicides. Why? Because it hurts and because the person
must gather the nerve to do it. This results in several minor
cuts before he is able to make a cut deep enough to actually
reach the blood vessels. Sort of like warming up. If the
ME saw no hesitation marks, he would be suspicious.
Intoxication or Restraints---Most people
wouldn’t sit
still and let someone cut their wrists. So, the victim must
be either restrained or intoxicated. The ME might see bruises
where the victim was held or bound and if so homicide becomes
more likely. He would also do toxicological exams to look for
intoxicants such as alcohol and narcotics. Many suicide victims
do take alcohol and drugs beforehand so the finding of the
drugs is not proof the person was a victim of foul play. But,
if the levels of the drugs or alcohol were such that he could
not have wielded the knife, then the ME would suspect homicide.
This was
a point of contention in the 1994 death of Nirvana singer Kurt Cobain. The
level of heroin in his blood at the time of his death by shotgun wound to the
head was very high. The question that remains unanswered is whether he was
too intoxicated to have shot himself. Opinions differ and his death remains
a controversy.
11-11-07: Kidney Failure and Transplant
Q: I
need a kidney disorder that will eventually (say, over a period
of
a year) require a transplant. The character in question (a
55-year-old woman) has only one functioning kidney due to a
congenital defect. I'd like her symptoms to be mild at first,
then progressively worse so that she must be on dialysis to
survive until a donor can be found. I need her to be reasonably
healthy after the transplant.
What condition
might fit this scenario? What would the symptoms be
(i.e., how would this woman feel as she gets sicker)? What
might outsiders see that would cause them to worry about her?
How long would her recovery be after the transplant (when could
she resume normal activities)?
Karen Sandler
www.karensandler.net
A: You
picked an extremely complex and difficult medical problem to
write about. It comes in so many types and flavors that it
is impossible to adequately cover the subject here. But, here
is an overview and this might help you construct your story.
Virtually any kidney disorder can progress to what we call
Chronic Renal Failure (CRF for short). This is where the kidneys
are so damaged that they no longer clean the blood, which,
along with getting rid of water, is their primary function.
This can be mild to very severe. Many people with CRF rock
along for years before function declines to the point that
dialysis and/or renal transplant are needed. This is highly
variable from person to person and from underlying condition
to underlying condition. This means that your character could
have CRF for a few months or a decade or so and anywhere in
between before either dialysis or transplant entered the picture.
Common underlying
causes of CRF are high blood pressure (a very common cause of CRF), Diabetes
(another common cause), Glomerulonephritis (comes in many types and as a group
are processes that inflame and damage the kidneys), many of the so-called autoimmune
diseases (Lupus, Scleraderma, Dermatomyositis, Rheumatoid Arthritis, and others),
and many other illnesses. A common congenital problem that would work for you
would be Polycystic Kidney Disease. It causes no real symptoms until CRF sets
in, which can begin at almost any age.
The symptoms
vary depending on the underlying cause. In general though CRF causes fatigue,
poor appetite, weight loss, and edema of the feet and hands. When it becomes
severe, added symptoms could be shortness of breath, sleepiness, confusion,
disorientation, coma, and death. Dialysis is used until a suitable kidney donor
is located.
Recovery
from the transplant is similar to any other abdominal surgery. Four or five
days to a week or so in the hospital, a few weeks of reduced activity and then
by about 6 to 10 weeks more or less back to normal.
11-11-07: Ulcer Disease Versus Stomach Cancer
Q: I
need to know of a medical condition that isn't fatal, but has
possibly serious symptoms (at least noticeable symptoms) and
could be mistaken for a fatal condition at first "glance",
so to speak. I read a book once that was set in the late 1800's
and an ulcer was mistaken for cancer by a quack. Is that plausible,
then or now?
Anne M.
http://www.allanne.com
A: Ulcer
disease—also called Peptic Ulcer Disease or PUD for short---is
a common medical problem and is often confused with cancer
(CA). The reason is that the symptoms of PUD and Stomach CA
are essentially identical. They include upper abdominal pain,
nausea, poor appetite, weight loss, indigestion and heartburn,
vomiting that can be bloody, and dark stools---this is from
slower bleeding into the stomach. The blood turns the stool
black. And CA not infrequently occurs in the presence of stomach
ulcers. So the two can easily occur together.
The diagnosis
is made by an Upper Gastrointestinal Endoscopy procedure---caller UGI Endoscopy
for short. The MD passes a fiberoptic tube down the throat and into he stomach.
He can then see the ulcer and or tumor and take biopsies, which will diagnose
the CA if present. Of course, these procedures weren’t available 100
years ago—or even 40 years ago.
So, the
two diagnoses can easily be confused even by competent MDs. |
