Author Question: How Long for Toxicology Results?

Susan Asks:

If suicide is suspected due to the mental health of victim, and it appears alcohol and opioids were involved, how long will it take to get a toxicology report back after the autopsy?

Jordyn Says:

Usually results such as these through a medical examiner’s office are 4-6 weeks.

However, if the patient was a medical patient and seen in the emergency department, these tests likely would have been done and would be resulted fairly immediately. The family could request a copy of the chart through the medical records department which should be more readily available. Or, if being investigated, the police can go through the courts to obtain a copy as well.

At times, in the event of a patient death, the doctor may choose to disclose medical findings to next of kin to explain the death and might choose to give these results, but likely wouldn’t give a physical copy of the lab report in something sensitive of this nature. The doctor might choose to say something vague such as, “We suspect your loved one died due to respiratory failure that could have been induced by drugs in their system.” Or they could leave out the suspected drug component all together due to concern over legalities.

Hope this helps and best of luck with your story!

Child Abuse Injuries: Part 2/2

April is Child Abuse Awareness Month. Last post, I covered how a given history for an injury may be a signal that an injury was intentionally inflicted. Today, I’m going to cover how the injury itself may give off clues for an abusive injury.

1. The injury is beyond the child’s developmental level. You’ll notice this is the first clue I gave concerning the history, but it also plays into the injury itself and I’m going to talk specifically about infants. Any bruising in an infant to the face, head and neck when they are not yet pulling themselves up to a standing position is concerning for abuse. To create an injury, you have to fall off of or run into something and you need to have some velocity behind it. Now, of course, injuries in this age group can have lots of accidental causes, but the story needs to match the injury.

2. The injury has a pattern. Consider typical childhood bruises. They are roundish in shape, of varying circumferences, and received from a low-velocity type injury . . . say the child running into a counter with their forehead. Anything that makes a visible pattern generally requires high-velocity force to imprint the pattern onto the skin. If I loop a belt and tap you with it, there likely won’t be any injury at all. However, if I take it and swing it at you like a pitcher throwing a baseball, it has the potential to create a loop like bruise.

3. The injury is not over a bony prominence. Again, if you have children, think back to their younger days when injuries were common. When they fell, where did they bruise? Head (scalp, forehead, nose, chin), elbows, shins, and knees. Most often, kids fall or run into something in a forward motion. Bruising to the buttocks in a diapered child is particularly concerning. Often, they will fall onto their bottoms, but they also have extra padding.

4. There are a lot of bruises. This is not definitive but can be a signal for abusive injury, particularly if the pattern is not a normal bruising pattern as in #3.

None of these items is taken in isolation as a single indictment against the caregiver. Let’s say you accidentally drop a toy onto your two-month-old’s face while cleaning up. It causes a bruise and you want it checked by the pediatrician. The pediatrician is not going to report you. Why? You have a plausible story (dropping something onto the baby’s face), it is a low velocity injury (the bruise is probably small and round) and there is only one.

Medical professionals look at the totality of the child’s case: the history, the social environment, and the injury is considered before a report to child services is made. Reports are not made lightly.

The above offers some beginning guidelines. In the comments section, give a specific injury that might be concerning for abuse.

Child Abuse Injuries: Part 1/2

Nothing is more heartbreaking than to take care of a child that has been abused. April is Child Abuse Awareness Month so I thought I’d do a few posts about child abuse injuries and how medical providers pick up on the fact an injury may be intentional or inflicted.

As a pediatric nurse, I’ve been witness to child homicide at the hands of abuse. Yes, it is murder. It’s a necessary part of my job in dealing with these families, perhaps even the confessed abuser, as I care for the child abuse victim. And yes, there is a lot of conflict in these situations.

How do we as pediatric medical providers begin to suspect that an injury is abusive? During the initial evaluation of an injury, confession among abusers is rare (perhaps, they will confess later.) Often, there is a history given to account for the injury. Both parts: the history of the injury and the injury itself can give red flags for abuse. Today, let’s examine the story and how it may signal an abusive injury.

1. The story not realistic considering the child’s developmental level. This is more common than you might think. Most people cannot rattle off when a child should meet certain developmental milestones so they’ll say the child injured themselves in a manner that is beyond their developmental age. For instance, “my daughter broke her arm by rolling off the couch”. The baby is two-weeks old. Infants typically roll over starting at 3 months. Here’s a great resource for any writer/parent for developmental milestones.

2. The story changes. Just like other criminals, abusers can have a hard time keeping their story straight. Often times, the more abusers are questioned about the plausibility of the story, it will begin to change. Medical staff interviewing a potential abuser can be like a detective getting a criminal to confess. The doctor will often approach the caregiver several times to ask questions about the injury to see if the story changes. In later interviews, the doctor may say, “This injury is suggestive of abuse.”

3. The story has too much detail. This one may seem odd, but it can be a red flag for abusive injuries. If you have children, think back to their toddler/elementary school years when they seem to come home with lots of bumps, bruises, cuts and scrapes. If asked, could you come up with an explanation for each and every injury? Likely, no. Abusers will try and explain away every injury. A non-abusive parent will be truthful and likely say, “I have no idea how that happened.” and then probably feel guilty about not knowing.

What other parts of a medical history/story might give a signal for abusive injury?

Author Question: Frozen Body

Susan Asks:

I just stumbled on your site while doing a search, and I wonder if you can answer this question. The victim in my latest book has been pushed through a hole in an ice-covered lake. She drowns, and her body slips under the ice. Her body is not found for two days. Would the body literally be frozen, to the point that it would have to be thawed before an autopsy could be conducted? Or would it just be really, really cold?

Jordyn Says:

Hi Susan! Thanks for sending me our question.

My opinion is that the body would not freeze and would not need to be thawed for autopsy.

In researching this— it appears that water underneath an ice sheath on a frozen lake (though still really cold) is not at 32 degrees F but could be as warm as 40 degrees F. Since fish are cold-blooded and will take on the temperature of their environment and their tissue doesn’t freeze– then I don’t believe a deceased human’s would either.

Best of luck with your story!

Forensic Question: Testing a Blood Sample for Pregnancy

Jordyn Asks:

Can you test a blood sample to see if the person who left the blood behind is pregnant?

Amryn Says:

For most traditional tests, it would require a fair amount of blood be left behind in order for perform a pregnancy test. The blood would also need to still be in liquid form rather than dried.

It’s not something that would be done for a variety of reasons, not the least of which is that samples are usually conserved as much as possible for forensic testing. So while it’s possible with the right set of circumstances, it likely wouldn’t be done since the blood would be used for DNA testing rather than diagnostic testing.

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Amryn Cross is a full-time forensic scientist and author of romantic suspense and mystery novels. Her first novel, Learning to Die, is available on Amazon. The first book in her latest series, loosely based on an updated Sherlock Holmes, is available for pre-order on Amazon. Look for Warzone in January 2015. You can connect with Amryn via her websiteTwitter and Facebook.

 

How to Determine Blood Type

In the age of DNA testing, blood typing seems to have fallen by the wayside in use in novels but I think it can still be very valuable and add an element of suspense and surprise. A child’s blood type may be the first clue to a parent that they may not be biologically related.

Blood type is determined from two allele’s. An allele is a “form of genetic information that is present in our DNA at a specific location on a specific chromosome”.

There are four blood types: A, B, AB, and O. Blood type A can be designated either by AA or AO. Blood type B can be designated by BB or BO. This will be clearer below.

This is the easiest way I’ve been shown to determine a child’s potential blood type. In the square below, the top horizontal portion is one parent, the vertical side is the other parent. Each box with a single letter is the one allele that parent will give their child. A child receives one allele from each parent so you need to “cross multiply” each square to determine blood type.

A O
O AO OO
O AO OO

In the above instance you have one parent that is blood type A (designated AO) and one that is blood type O (designated OO). As you can see, their child would have a 50% chance of having blood type A and a 50% chance of having blood type O.

Let’s look at another example. Take a look at what happens when both parents are blood type AB.

A B
A AA AB
B AB BB

In this case, their biological child would have a 25% chance of being blood type A, a 50% chance of being blood type AB, and a 25% chance of being blood type B.

How can this work for your fiction? Let’s look at this example. You’re writing a novel that centers around a child diagnosed with leukemia. The child needs a bone marrow transplant. The presumed parents are blood type A (AO) and blood type AB. You have a child with blood type O. Can this child be the biological offspring of these two parents?

A O
A AA AO
B AB BO

Give your answer in the comments section.

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Resources: http://www.biology.arizona.edu/human_bio/problem_sets/blood_types/inherited.html. This resource includes a blood type calculator!

Visit with Colorado Coroner Chris Herndon

Most people imagine Sunday afternoons to be filled with watching sports and hanging with family. But, if you’re a nurse and an author, you think there’s nothing better than to go to a talk given by the local coroner, Chris Herndon.

Chris Herndon

That’s what I did a few Sundays ago (a few years ago!) This information is reposted from September 2, 2011. I’m working to preserve posts that didn’t transfer between Blogger and WordPress. And if you remember the first time this story ran, I owe you my sincere gratitude for being such a faithful blog follower!

As always, I’m always intrigued by medical things and myth busting. Here’s a few highlights that I thought were of particular interest for writers. One even busted a myth I had in Proof. Good thing I was able to change that before the book went to print.

Item One: Do coroners really wear Vicks VapoRub under their nostrils to mask the smell? She says no— going on to explain that this ointment “opens up the nasal passages” and “why would I want to do that?” Much better to work with a bad cold to block out the smell. I will say though that I will often put on a mask or chew gum to help me. Chris mentioned she always has mints on hand.

Item Two:  Six weeks for DNA testing unless done by a private lab.

Item Three: Victims who drown in flood waters are generally found nude as the water will rip off their clothing.

Item Four: Often times in suicide pacts, one person will not follow through.

Item Five: It really does not pay to drink then cut thyself.

Chris shared two stories that exhibited this.

The first was of a man who was drunk and high (double bad combo) and decided to harass an old girlfriend. He punched his hand through a window, cutting the underside of his arm, severing his brachial artery. After this, he staggered through the parking lot until he dropped dead. Upon police arrival, they follow the trail of blood to the broken window and asked this woman why she didn’t call police after he broke it. Sadly, she’d been harassed so often by this gentleman that she’d given up asking the police for assistance.

Second was of a man who was on the blood thinner Coumadin for atrial fibrillation (an irregular heartbeat.) This gentleman decided to cook while drunk. He dropped a knife on the top aspect of his foot and severed the dorsalis pedis artery. He doesn’t realize he’s injured himself as there was evidence that he’d walked to the garage to get paper towels to wipe up the mess. He begins to not feel well, so he sits at his kitchen table and places on a home blood pressure cuff. Loss of blood will cause you to feel weak, lightheaded, and dizzy. This is where he’s found dead. At the kitchen table, sitting up with a blood pressure cuff in place. A pool of blood by the injured foot.

His blood alcohol was over 0.350. That’s a professional drinker….

So people, please, no drinking with sharp implements! Really . . . no drinking in excess would be great for us ER professionals. Moral: Have at least one sober person that you haven’t relentlessly harassed present to call 911 for you.

What other morals do you see? Have you written any of these particulars in your manuscript?