A Medical Query

DanWendelstein

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Hello, dearest AbsoluteWriters,

In my most recent story, I have included a brief scene set in an anatomical theatre at a university in Belgrade, where students of forensic pathology are inspecting a corpse of a person that has suffered a very violent death.
The professor quizzes the students about several injuries and scars that can be found on the body for exam purposes.

However, I must confess that I have little to no experience in medicine or human biology, so I was quite a bit out of my depth when I took to writing these down.
Therefore, I would appreciate if someone who does know what he's talking about could look over these statements and direct my attention to any factual mistakes I have made terminology-, medicine-, anatomy- or even medical education-wise (seeing how this is mean to be a scene sat in medical school).

I have included these bits of dialogue down below:

Here, a student describes injuries the dead person (a thirty year-old woman who survived the Yugoslav Wars) had sustained during a landmine blast, during which she caught shrapnel in the back of her thigh that had to be surgically removed, several years before her death:

- Student: “Oh! I can see… lacerated skin at… four… five different locations.” She pointed a finger at a number of bulging scars that dotted and criss-crossed her leg muscles seemingly at random, “Minor hypertrophic scars. Heavily cicatrised. Judging by the state of healing, the wound age is around five years. Judging by the shape, the result of a surgical suture to treat a sharp trauma. There’s the possibility of damage of the ischiocrural muscles, particularly the biceps femoris. Debilitating, but most likely not life-threatening.”

In this portion, a student describes fairly recent injuries the victim took to the face when a heavy stone hit her on the left side on the jaw, injuring (among other things) her jaw and teeth, (only) a week or so before her death:

- Student: “Uh... a blunt force trauma. Effusion and tumefaction of the risorius muscle. Very probably a mandibular fracture resulting of the trauma. Wound age is less than a month before death.”

Here, a student and her professor argue about a very old wound the victim sustained when she was hit by a ricocheting rifle-calibre bullet in her shoulder (when she was a 13 year-old child), which too had to be surgically treated, almost two decades before her death:

- Student: “Uh… I see… a single hypertrophic scar. Cicatrised. Wound age… very high. Ten to fifteen years. Surgical suture to treat… intermedullary fixation of the clavicle? And… uh… uhm...”
- Professor: “Lacking, Miss Kazun. We are looking at a... ballistic trauma that severely fractured the clavicle. .30 Russian Short, close range, though probably a ricochet. Hence the need of an intermedullary fixation. (...)But was this life-threatening? What say you, Miss Kazun?”
- Student: “Uh… only if the subclavian artery were injured. Though there doesn’t seem to be any indication of that.”

In the following portion, the professor aks a student to come to the 'grand finale' of their examination: To describe the victim's death by by falling from great height, during which the body was partially destroyed during the collision:


- Student: “Ahem… Well… we are looking at… well... at severe fracturing of the lumbar spine, severe fracturing of the thoracic spine, severe fracturing of the Acetabulum, severe fracturing of both femurs, several fractures of the anterior inferior and superior iliac spines…”
- Professor: “Alright, alright. I don’t want to be too cruel. We’d be here all day if you had to go over every single one of those injuries. Just sum up the cause of death for me, will you?”
- Student: “A-alright. One can already see by the absence of healing process that these wounds were causal for the death. They are common injuries with fall victims from great heights. A fall upward of seven metres seems… very likely. She impacted on a hard surface with her pelvis. It was most likely the major trauma that killed her.”

Thanks in advance!
 
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cornflake

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Hello, dearest AbsoluteWriters,

In my most recent story, I have included a brief scene set in an anatomical theatre at a university in Belgrade, where students of forensic pathology are inspecting a corpse of a person that has suffered a very violent death.
The professor quizzes the students about several injuries and scars that can be found on the body for exam purposes.

However, I must confess that I have little to no experience in medicine or human biology, so I was quite a bit out of my depth when I took to writing these down.
Therefore, I would appreciate if someone who does know what he's talking about could look over these statements and direct my attention to any factual mistakes I have made terminology-, medicine-, anatomy- or even medical education-wise (seeing how this is mean to be a scene sat in medical school).

I have included these bits of dialogue down below:

Here, a student describes injuries the dead person (a thirty year-old woman who survived the Yugoslav Wars) had sustained during a landmine blast, during which she caught shrapnel in the back of her thigh that had to be surgically removed, several years before her death:

- Student: “Oh! I can see… lacerated skin at… four… five different locations.” She pointed a finger at a number of bulging scars that dotted and criss-crossed her leg muscles seemingly at random, “Minor hypertrophic scars. Heavily cicatrised. Judging by the state of healing, the wound age is around five years. Judging by the shape, the result of a surgical suture to treat a sharp trauma. There’s the possibility of damage of the ischiocrural muscles, particularly the biceps femoris. Debilitating, but most likely not life-threatening.”


So first, I have no idea how she's judging scar age like that. Once healed, it's healed. I've never, ever in an autopsy report, seen anyone age a healed scar. Second, one suture? Huh? Also, why is she speculating about potential damage from healed wounds? That's bizarre.

In this portion, a student describes fairly recent injuries the victim took to the face when a heavy stone hit her on the left side on the jaw, injuring (among other things) her jaw and teeth, (only) a week or so before her death:

- Student: “Uh... a blunt force trauma. Effusion and tumefaction of the risorius muscle. Very probably a mandibular fracture resulting of the trauma. Wound age is less than a month before death.”


Either it's fractured or it ain't.

Here, a student and her professor argue about a very old wound the victim sustained when she was hit by a ricocheting rifle-calibre bullet in her shoulder (when she was a 13 year-old child), which too had to be surgically treated, almost two decades before her death:

- Student: “Uh… I see… a single hypertrophic scar. Cicatrised. Wound age… very high. Ten to fifteen years. Surgical suture to treat… intermedullary fixation of the clavicle? And… uh… uhm...”
- Professor: “Lacking, Miss Kazun. We are looking at a... ballistic trauma that severely fractured the clavicle. .30 Russian Short, close range, though probably a ricochet. Hence the need of an intermedullary fixation. (...)But was this life-threatening? What say you, Miss Kazun?”

Sorry this is ludicrous. See above scar age. Then he's deciding that an old wound fractured the clavicle, which is healed, so why connect those? Then he's not only deciding on the bullet (which is NOT a forensic pathologist's job, and deciding it ricocheted?? It's just silly. None of this would ever happen. Wounds are discrete.


- Student: “Uh… only if the subclavian artery were injured. Though there doesn’t seem to be any indication of that.”

In the following portion, the professor aks a student to come to the 'grand finale' of their examination: To describe the victim's death by by falling from great height, during which the body was partially destroyed during the collision:


- Student: “Ahem… Well… we are looking at… well... at severe fracturing of the lumbar spine, severe fracturing of the thoracic spine, severe fracturing of the Acetabulum, severe fracturing of both femurs, several fractures of the anterior inferior and superior iliac spines…”

Again, no. Autopsy results are *specific* and discrete. No one is saying 'severe fracture of the spine...'

- Professor: “Alright, alright. I don’t want to be too cruel. We’d be here all day if you had to go over every single one of those injuries. Just sum up the cause of death for me, will you?”

Uh, the entire point is to go over every injury, in specific detail. Read an autopsy report or seven.

- Student: “A-alright. One can already see by the absence of healing process that these wounds were causal for the death. They are common injuries with fall victims from great heights. A fall upward of seven metres seems… very likely. She impacted on a hard surface with her pelvis. It was most likely the major trauma that killed her.”

Thanks in advance!

WHOA -- because the wounds aren't healed does not, in any way, shape or form, mean the wounds were the cause of death. Your professor is a quack. You know how many people strangle, poison, whatever, someone then chuck the body off something, start a fire, yada yada? You have to ACTUALLY determine cause of death if you're a pathologist doing that work. You don't just say 'wow, lot of vague, unhealed fractures, so that's what killed them.

If you're going to do this, you need to do a LOT of research. I'd suggest just skipping any scene with detail like this you're not familiar with.

Oh, also, uh.. why are random med school students doing this? Not a thing, afaik. Forensic path wannabes do but those are actual doctors already.
 
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DanWendelstein

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WHOA -- because the wounds aren't healed does not, in any way, shape or form, mean the wounds were the cause of death. Your professor is a quack. You know how many people strangle, poison, whatever, someone then chuck the body off something, start a fire, yada yada? You have to ACTUALLY determine cause of death if you're a pathologist doing that work. You don't just say 'wow, lot of vague, unhealed fractures, so that's what killed them.

If you're going to do this, you need to do a LOT of research. I'd suggest just skipping any scene with detail like this you're not familiar with.

Oh, also, uh.. why are random med school students doing this? Not a thing, afaik. Forensic path wannabes do but those are actual doctors already.

:flag:
Fair enough.
Don't send an artist to do a medic's work, I suppose.

Though in all fairness, I never said (that is, intended to say) that all of these wounds could have been/were the cause of death. She died from a fall from great height (and it's 'obvious' to every person in the room from the very start, due to the severity of these fall-induced injuries), but all the other scars are (non-lethal) injuries that she suffered at different previous points in her life that, as I mentioned, left their marks.

My idea was that the professor (who holds in his hands the dead woman's medical record and the necessary information on how these various injuries were sustained) would ask his students (who don't) to identify the nature of each such past injury by sight, and (if possible) to offer an explanation on how they were sustained, again by sight alone (which, admittedly, probably isn't very academically sound, but from a Doylist perspective, it is a damn fun way to offer exposition about that woman's life).

Evidently, I may have gravely overestimated the information a medical professional-in-training might draw from a couple few old scars, but even so, I'd be interested in what (if any) indicators they could deduce.
What information does, say, a distinctly shaped surgical scar tell someone with a trained eye about that deceased person's life?
And at what point in their education would a med student (who aims to become a forensic pathologist) commit to that kind of task?
 
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cornflake

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:flag:
Fair enough.
Don't send an artist to do a medic's work, I suppose.

Though in all fairness, I never said (that is, intended to say) that all of these wounds could have been/were the cause of death. She died from a fall from great height (and it's 'obvious' to every person in the room from the very start, due to the severity of these fall-induced injuries),

How is that obvious? It should NOT be obvious at all, is what I'm saying.

but all the other scars are (non-lethal) injuries that she suffered at different previous points in her life that, as I mentioned, left their marks.

My idea was that the professor (who holds in his hands the dead person's medical record and the necessary information on how these various injuries were sustained) would ask his students (who don't) to identify the nature of each such past injury, and (if possible) to offer an explanation on how they were sustained (which, admittedly, probably isn't very academically sound, but from a Doylist perspective, it is a damn fun way to offer exposition about that woman's life).

You can do what you want, but it's not in any way what a pathologist would do, or know. You asked if it was correct. It's completely not.

Evidently, I may have gravely overestimated the information a medical professional-in-training might draw from a couple few old scars, but even so, I'd be interested in what (if any) indicators they could deduce.
What information does, say, a distinctly shaped surgical scar tell someone with a trained eye about that deceased person's life?

That there's a scar there. I mean a C-section scar is usually a C-section scar, but why is any other surgical scar distinct to the procedure, especially when you're not even talking about anything standard?

And at what point in their education would a med student (who aims to become a forensic pathologist) commit to that kind of task?

They wouldn't, again afaik. It's a specialty.
 

call-of-the-mind

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When you're describing a laceration, it means that it is an open wound. You shouldn't really use the word laceration to describe a healed wound.

I'm a pre-med student, and a lot of the words you're using in their phrases aren't things that students would usually say. You're throwing together a lot of over-technical words which almost makes it sound like you know less rather than more. I really appreciate all the research you've clearly done (like the names of the muscles and bones, because those are super complex) but I would try to maybe simplify some of this. When I look at someone and describe their wounds, I would take a look and just see some old scars (based on their healing patterns I would be able to determine if they were surgically or accidentally done). For the first part as well, when you describe that they're surgical, surgical cuts aren't made at random, and never look at random. Surgical cuts are almost always made in line with the muscle fibers, depending on the shape of the muscle underneath (look up unipolar, multipolar, bipolar etc. muscles and look at where the lines are) so if there are a few cuts they would likely be parallel with each other.

Also, from a fall of seven metres, while it would definitely be horrific in damage i don't really think it would fracture so much. if it fractures the spine it likely wouldn't fracture the femurs, and vice versa. The femur is the largest bone in the body, and therefore the hardest to break. What you could say to make your cause of death more realistic is that the femur punctured the femoral artery when it broke. The femoral artery runs really close and parallel to the femur, and when it is punctured a victim can bleed out internally in minutes. If you add in something about a student asking whether the artery was punctured that would give you a bit more believability.

I know this sounds a little harsh but I really hope this was helpful :)
 

jclarkdawe

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Like Cornflake, I'm going to tell you that you need to do a lot of research. Autopsies are written in a certain style, and are for specific legal reasons. I do not know the style of autopsies in Serbia, but you'll need to read lots of them to get the proper feel. I do not know the requirements for forensic pathologists (note that not all pathologists are forensic pathologists) in Serbia. In the US, you are required to have completed your medical training and are a full-fledged doctor. You then decide to specialize as a pathologist. You then go the next step and become a forensic pathologist.

All doctors know how to do autopsies (it's part of their training to look at dead bodies and determine cause of death), and can testify as experts in the US, but there's a limit to how much they can testify. Forensic pathology reports are incredibly dense reading where every word matters. Although I've read way too many of the things, I doubt I could phrase it right.

Going through just one paragraph --

- Student: “A-alright. One can already see by the absence of healing process that these wounds were causal for the death. Not all of the wounds would have caused death. You need to identify the specific wounds and the probability of death from each. For example, An impacted femur fracture of the left leg, resulting from traumatic force, resulting in a shortening of the length of the femur by 10 centimeters, causing the femoral artery to be opened for a distance of 23 centimeters, causing the patient to have lost sufficient blood within one minute to lead to death from insufficient blood supply to maintain bodily functions. An impacted femur fracture of the right leg, resulting from traumatic force, resulting in a shortening of the length of the femur by two centimeters, causing the femoral artery to be opened for a distance of five centimeters, causing the patient to have lost sufficient blood within three minutes to lead to death from insufficient blood supply to maintain bodily functions. (I'm doing this from memory from a fall autopsy I read probably ten years ago. This autopsy had numerous causes of death, as the body suffered significant crushing due to a fall from about thirty meters.)

They are common injuries with fall victims from great heights. In the US, it would be a "typical" injury, not common. A pathologist would know that any fall from three times your height has a 50% chance of being fatal. In this case, the pathologist would be that the blunt force trauma of the body are consistent with a fall from five to ten meters. Basically you take the first point of impact, and then calculate by math and comparing to pictures what the damage done by the fall looks most likely to be. You end up with a result that says the injuries are say 80% consistent with a fall from five to ten meters, with a 95% chance that the fall was from four to fifteen meters.

A fall upward of seven metres seems… very likely. A fall from seven meters would have produced injuries consistent with those on this body 85% if the time.

She impacted on a hard surface with her pelvis. No. She did not. Falling from a height produces several different landings, such as feet first, head first, on your side, or face first. It is highly unlikely to have been pelvis first. (Think about falling from a great height and try to figure out how the pelvis would hit first. It's hard to do.) Most people falling from heights land feet first. This causes blunt force trauma to travel up your legs and eventually into your pelvis and then up your spine. Slip and falls are likely to end up with your pelvis (actually your butt) being the major point of impact.

It was most likely the major trauma that killed her.”
Conclusion of the autopsy -- Patient died of massive, blunt force trauma, causing fractures of ..., ruptured ... (list of the organs ruptured), and massive blood loss, consistent with a fall from a height of seven meters.

See how complex it is. And a pathologist would do an even more detailed answer. It's complicated stuff.

Jim Clark-Dawe
 
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cornflake

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Even that arterial scenario, I feel the need to point out, would NOT necessarily mean the fall was the means of death, or that it was obvious the fall killed someone unless a full autopsy has been done by the people discussing the means of death.

ETA: Because, again, until a full autopsy is performed (which is not just about looking at the body, that's the start of an autopsy) no one knows if the fall was the means of death. Someone could've been poisoned, icepicked in the ear, asphyxiated, whatever, moments before and then chucked off a bldg.

Same as you can pull a body out of the water but that doesn't mean the person drowned. You have to do a microscopic examination of the lungs, among other things, to determine that.
 
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jclarkdawe

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I should mention that a person falls from a building, after being shot through the heart by a gun, after ingesting poison, while suffering a heart attack, and after landing is run over by a truck. A forensic pathologist needs to sort through this mess and decide what was the cause of death, within a degree of medical certainty. Realize that the pathologist will find signs consistent with a cause of death for each of those causes.

By the way, this sort of information can be very critical. If someone poisons someone, who is then shot and the shot is the cause of death, then the person who poisoned the victim can't be convicted of murder. Attempted murder, yes. Murder, no.

Sometimes a pathologist can't figure out cause of death, but more often than not, a pathologist can determine which of multiple causes, is the actual cause of death.

Jim Clark-Dawe
 

cornflake

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Also, it may seem like what we're saying is ridiculous, but it's really not. This happens ALL THE TIME -- people are strangled and then the body is left in a building someone starts a fire in, or someone is bludgeoned then left outside, or buried in a shallow grave, or someone is stabbed 56 times and is then asphyxiated, or whatever combinations of things.

People who do this work have the skills to figure out that 56 stab wounds didn't actually kill the person, because, say, there's petechia (which is not even a conclusive determinant in and of itself), or because of something found in the tox screens or what the heck ever. You've got people basically looking at a body with a lot of stab wounds going, 'well obviously the cause of death was stabbing,' but that's, as I said, quackery. No professional would do that.
 

ironmikezero

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If I understand this correctly, you want to use this scene as a vehicle for exposition (re: the deceased's life prior to death). I'll echo what cornflake and Jim have said; this isn't something a medical examiner/forensic pathologist (or his/her students) would be tasked with doing.

It might be more appropriate to have a scene in which the heretofore unidentified body is the subject of dialogue between the investigating law enforcement officer and the pathologist after the autopsy, once the cause of death has been determined, and the postmortem report has been prepared. The assigned detective would very likely pick the pathologist's brain in an informal conversation in an effort to establish further details about the decedent which would typically not be included in the postmortem report, all in an effort to determine the ID and further the investigation. This can also weave a bit of mystery and intrigue into your tale.

You can introduce a great deal of background information (exposition) in such informal dialogue between two such characters, revealing only that which will maintain your pacing and move the story along as you deem fit.

Whatever you decide - best of luck!
 

jclarkdawe

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Another option here would be a forensic pathologist going into a classroom and using pictures to show what we can learn from a human body. For example, all tattoos have a meaning. The question is what does the tattoo mean. Sometimes it's easy to figure out, other times it is not. But beyond that, you can tell whether the tattoo was done in prison or not. You can tell to some extent which country the tattoo was done in. There are styles that can be recognized.

Or dental work. Dental work varies from country to country. But there's even more that a body can tell us. What drugs are in the person? How has the body been taken care of? For example, I have a couple of scars because I was too lazy to see a doctor and have it sewn up. Pull it together with a bandage works very well, thank you. How often is the body out in the sun? Did the person exercise or not? What are the contents of the stomach?

Depending upon the quality of the pathologist, there's a lot that can be learned from bodies. Take a look at Otzi -- https://en.wikipedia.org/wiki/Ötzi. But understand that level of research is not usually done nor does it contain a lot of information that could be used in identifying missing people due to the large cost involved.

I could see a pathologist teaching a class to law enforcement people about the clues on a human body that can be used in identifying missing people. Towards the end of the class, the pathologist could show pictures from one or more bodies and ask the class to attempt to identify where the body likely lived when it was alive. This would be a lot less technical than what a pathologist would use for even medical students. It is not unknown for talks like this to include pictures from bodies that have not been identified. You never know where something may trigger someone's memory.

Jim Clark-Dawe
 

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Thank you guys again for all your answers! They were much appreciated!

As things may stand, I will probably eschew most of the 'autopsy' portion (though it was not meant to be a proper autopsy in the first place) in favour of a coroner introducing the woman's body to a group of forensic pathologist aspirants (which, for all my ignorance, surely has to be a thing somewhere) in order to illustrate some typical high-fall-related injuries in a more professional manner (and perhaps take the opportunity direct their attention to her other 'marks' while quoting out of her medical record, in a somewhat more informal manner).

In case that might still prove not entirely believable, I am intending to wrap it in a veil of unreliable narration (as this scene will transpire in a deliberating character's imagination), which might very well profit from delivering the scene with a more 'romanticised' undercurrent.
 
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CWatts

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In case that might still prove not entirely believable, I am intending to wrap it in a veil of unreliable narration (as this scene will transpire in a deliberating character's imagination), which might very well profit from delivering the scene with a more 'romanticised' undercurrent.

This may not be what you meant, but can you please not "romanticize" or sexualize a dead woman? Especially not one who as already had a violent, tragic life. I get so sick of this trope on crime shows and other media.
 

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This may not be what you meant, but can you please not "romanticize" or sexualize a dead woman? Especially not one who as already had a violent, tragic life. I get so sick of this trope on crime shows and other media.

No.

No, that was not what I mean by "romanticised", CWatts.
I was referring to a more fantastic, theatrical image of what an autopsy looks like, rather than a portrayal that is strictly, clinically realistic.

Also, the 'character's imagination' to which I was referring, without giving too much away, was intended to be the woman herself (a former medical student, hence the setting), ruminating about her own possible looming demise.
 
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CWatts

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No.

No, that was not what I mean "romanticised", CWatts.
I was referring to a more fantastic, theatrical image of what an autopsy looks like, rather than a portrayal that is strictly, clinically realistic.

Also, the 'character's imagination' to which I was referring, without giving too much away, was intended to be the woman herself (a former medical student, hence the setting), ruminating about her own possible looming demise.

Good.