The Death of Daniel

I did not know him; in fact, I had never met him at all. But I watched an autopsy be performed on him.

As you might guess, there is a back story here--and it is a cautionary tale pertinent to the celebration, perhaps I should say the over-celebration of St. Patrick's Day.

In the late 1980s and into the 1990s, I worked for the PA Department of Health. I was appointed as Deputy Secretary for Planning and Quality Assurance. One of my functions was to serve on various governing boards that the Secretary of Health had been named to. When laws are passed regulating various professions, such as medical doctors, the board composition frequently includes the following language: "and the Secretary of Health or his designee." Enter designee--that was me.

So, I served on the State Board of Medicine (and even got sued by an irate doctor that was not allowed to practice some questionable medicine) and I served on the newly formed State Coroners' Board.

Pennsylvania is one of those wondrous states (actually a Commonwealth) where anyone, and I mean ANYONE, can be a county coroner. All you have to do is get yourself elected. But, even a caveman (ha! I love those commercials) can figure out that you need to know something to be coroner. After all, you are dealing with dead bodies, and bodies that have frequently died under questionable, horrific or mysterious circumstances. So, rather than set standards for who can run for coroner, our state legislature decided that if you get elected as coroner and are not a medical doctor, you have to take a mandatory course and pass an exam. Enter the Coroners' Board. We set the educational standards, and wrote the exam.

OK--that is part of the back story. I attended parts of the first training where some of our state's famous coroners who were medical doctors were doing the teaching. I confess, I did leave the room when they began to throw up slides of victims who had succumbed to blunt force trauma. You see, blunt force trauma is caused by some object that tends to leave its imprint on the human skull. Understand why I left the room?

One thing I had not ever witnessed was an autopsy. So, I told one of my coroner buddies, who works in the neighboring county to where I live, that I wanted him to call me when he had an autopsy scheduled. He was a policeman before he became coroner, and a smart guy, so he had his autopsies done in a local hospital.

One Sunday I got a call from Mike, the coroner. Do you want to watch this autopsy? I asked of whom--since I really didn't want to see the autopsy of a small child. Well, it turns out it was a young man aged 25 who had collapsed in a friend's house and died. He had spent the day before drinking at the friend's house, in celebration of St. Patrick's Day.

So I drove to the local hospital where the pathologist conducted the autopsy. She was thrilled to have an audience and took more time than usual. She performed the typical Y incision on the chest of this young man, and proceeded to extract organs, weigh them, dissect them, and dictate into her microphone her findings. She took time to show me the vessels of the heart, as she dissected. She had to rule out causes of death--even though the young man had been somewhat overweight, his heart vessels were clear of fat.

For illustration, I picked an old painting of an autopsy, out of deference to the sensitivities of readers who probably don't want to see a photo of a real autopsy.

The pathologist dissected the kidneys, laying them open and marvelling at the wondrous tree-branching pattern that allows kidneys to do their cleansing work. Slowly she worked her way down the body.


While she was doing this work, her assistant had removed the small intestines and was flushing them with water in a stainless steel basin. Suddenly the room was filled with the odor of licorice. The cause of the young man's death was becoming clear. The story that the hospital personnel had been told was that Daniel, for that was his name, had drunk a 6-pack of beer at a friend's house on Saturday. (Remember--Saturday was St. Patrick's Day.) Then, to wash down the beer, he chugged an entire bottle of ouzo. Hence the licorice smell.


Even though the pathologist was fairly certain what caused Daniel's death--she was obligated to examine the brain. This is the only point at which I turned away--I did not watch the removal of a piece of skull. But, when the brain was exposed, I looked. It is amazingly white, seemingly devoid of blood.


So why did Daniel die? There was no sign of aspirate in his airways, so even though he had vomitted on his friend's laundry room floor, and even though his friend left him there unresponsive, he died not inhale any aspirate. So he didn't choke or suffocate. What caused his death was acute alcohol poisoning. At a certain point, the brain simply shuts down, unable to handle the overload of alcohol. For Daniel's friend, the tip should have been that he lost consciousness, but the friend probably thought he was doing Daniel a favor by letting him "sleep it off."


As I looked over this form of a human body, I had many thoughts. Who was Daniel? I only knew the barebones of his life: he had been an orphan, was in and out of foster homes, and had few friends. He held a steady job and seemed to be making it in spite of his less than solid beginning. I also wondered--what were his dreams? his hopes? And I wondered who would mourn him?


Sorry for this downer of a story linked to St. Patrick's Day. You all know the caution--if drinking alcohol is part of any celebration, drink (as the Greeks, the inventors of ouzo, would say) in moderation.



Post Script: Autopsies are one of the greatest ways that medical doctors advance their knowledge. Sadly, too many families decline the request for an autopsy. In fact, an autopsy can determine the cause of death, and overturn the first diagnosis as to cause of death.