The Never-ending Story
See if you can tell where this begins. Or if it ends. I’m finally telling it because a young man asked me for a good story at the dinner table the other night. To end a wonderful meal, he wanted a good story. I got him to define “good story”. He said, “You know, one that has an ending. It doesn’t trail off into nothing…”
“OK,” I said. “I’ll start this one. You tell me if it’s a good story. Stop me if it’s bad. And we’ll all listen for an ending. Maybe it won’t trail off.”
So, it starts, I think, just a week ago. There’s a one car rollover in the Eastern County early in the AM. Single occupant driver, dead at the scene. 25-year-old male. Jeff Thompson. I get the call at the start of my day in the office, so I talk to the officers on the scene, get some information and instead of going to the scene of the accident I say I’ll look at the body in the funeral home once it’s brought in to determine the injuries that caused death. It would take an hour and a half to get out there and they take pictures and document everything anyway. They were agreeable. And probably glad they wouldn’t have to hold everything up for the coroner to get there.
Usually, you can find a broken neck, caved-in skull or chest injuries that will help you fill out the death certificate. I go about my morning with patients. Maybe my loyalty to the schedule influenced my decision not to go to the scene. But I wear both hats, don’t I?
I get a call at noon from the funeral home. When am I going to come look at the body? I’m not sure. Maybe this evening after office hours. Can they see any obvious cause? Not really, they say. Did you get blood? Yes, they sent blood off with the investigating State patrol officer. He’ll send it to the state lab to check for drugs and alcohol. Since they are calling and can’t see something obvious, I figure I better go out there on my noon hour and take a quick look. Before I go, I look through his medical record. It turns out this kid had a long history. Just four years ago he was in the hospital for a month after accidentally shooting himself in the neck with a handgun. He had been high on methamphetamine and drunk at the time. He had a revolver in his belt when he got out of a car. The gun had fallen out onto the ground. It discharged, shooting him in the neck. The bullet had entered in his lower neck right above the sternum, traveling up to the right exiting below the right ear. He required lots of surgeries, transfusions, and he couldn’t swallow for months. He was on tube feeding for a while. Then he’d been depressed and on pain meds and antidepressants. Oh yeah, drugs in his system when first admitted.
Quick run to the funeral home to look at Mr. Thompson. None of the staff were there. They had a funeral to run out in Palouse that afternoon, so I came in the always unlocked back door. The kid was laid out under a plastic sheet. The scars from his gunshot wound and surgeries were there. Small puncture wound over the heart where they had drawn blood. Faint abrasion over the right forehead and temple and some minor abrasions on the left elbow. No skull fractures. No broken neck. You check for that by twisting the head and listening for or just feeling for crunching. No rib or sternal fractures with the same crunching test. No long bone fractures. I thought that maybe his right collarbone was broken, it crunched a bit when I pushed on it, but that never killed anybody. The pelvis didn’t crunch.
But there was a significant finding. The whole head, face neck and upper chest in a shawl distribution had petechiae. These are the pinpoint purple marks on the skin when small blood vessels break. They’re usually the sign of obstruction to venous return or a significant abnormality to blood flow. That is, the heart is pumping but blood can’t get out of the area being perfused. They signify a blood pumping obstruction.
If you swing your arm in a circle real fast for a minute or two, you’ll get petechiae in your hand and forearm. The centrifugal force of your arm going around pushes the blood out the tiny delicate blood vessels from where it has been pooled in the veins. If you puke enough, your face will get petechia. Ladies get it across their face after pushing babies out. It’s a common occurrence in my field.
You will also see this in people who have something obstructing veins. A lady came into our Saturday clinic for “a rash”. The nurse practitioner called me out of a room to look at it. She described a pink, punctate rash, in a shawl distribution, from her face down across her shoulders.
From her description, I didn’t need to see the patient, but I did. Then I told the nurse practitioner to order a chest x-ray. Because this patient had something obstructing her blood flow back to her heart. Indeed, she had a mass in her chest, a lymphoma.
So, this was a sign for positional asphyxia or a crush to the neck or chest. I has seen this before in a man who was working underneath a car. It dropped off the jacks and came down on him. The weight of the car crushed him, but his heart kept pumping, building up the pressure on the small blood vessels. The pressure on his chest kept the blood from returning to the heart. That dead man had petechia from his nipples to the top of his head. The weight of the car restricted the flow of blood, though his heart was doing its best to push the life blood out there. The weight of the car was keeping it from coming back. Capillary don’t stand up to back pressure. They pop and you get petechia.
So, I was guessing this kid had gotten crushed somehow in the car wreck. But I hadn’t gone to the scene, so I didn’t know for sure how he’d been found. I will have to call the State patrol officer.
I thought maybe we ought to get an autopsy to make sure. I left a note for the funeral home that I was going to try to arrange for an autopsy that evening or afternoon. I asked them to try to get urine and a blood specimen for me since I never get a result from the state lab and I’d like to know in less than six months, which is what it usually takes for the state lab to run the tests.
Are you bored yet? Stop me if you want me to quit…
OK. The local pathologist guy who only charges about $900 for an autopsy wouldn’t do it. He was worried about it going to court. I call the forensic pathologist in Lewiston, and he said he’d do it tomorrow. But I start thinking. His starting fee is around $1500. Once you add in all the x-rays, toxicology etc. this is going to cost the county about $3000 and that’s just what this guy cost us after he died. Can’t imagine what his hospital bill from his gunshot wound cost. I’m sure the county paid for that since he was an unemployed drug addict. But I’ve got a job to do here, investigate deaths. Oh hell; I try to call the State patrol officer but he’s not in and doesn’t return my page. So, it’s kinda arranged that we’ll get an autopsy the next day. The funeral home agrees to take him down to Lewiston the next morning. This took up my lunch hour.
So, I could trail off here on the story, with how I’m agonizing over spending another dime on this kid who probably never paid a dollar in taxes and how I’ve got to do my duty. Kind of sum it up with a sense of doing the right thing in the face of all the screw ups in the world.
Is that a good ending? Are you bored yet? No? Good, because the story doesn’t really end here.
About three or four o’clock I get two rapid overhead pages in the clinic, ” Dr. Hawthorne, line 2″, then “Dr. Hawthorne, Line 5”. First is from the sheriff’s office. They want me to know they got a call from a Mr. Roberts, claims to be the father of the deceased and he’s mad as hell, doesn’t want anybody doing no autopsy on “his boy”. They were just giving me a heads up. I say thank you.
The next call is from the funeral home saying the same thing, that this guy, a “Mr. Roberts” is really mad. Would you please talk to him? They ask me. They want me to deal with this. I think in their line of work they are always trying to make people feel OK about things, death and all. They don’t really want to give them bad news if they can help it. So, I say I’ll call this guy. In between the last two patients I do a little research and look up the name. It seems a little odd, the dad having a different last name. Plus, the last name is a little familiar.
So which part do you want to hear first, the phone conversation or the history thing? Or I can stop right here. The phone conversation’s pretty short. We’ll do that, then you can go to the bathroom and let me know about going on.
So, I call the guy and he’s pretty drunk by four in the afternoon. He’s telling me he knows his boy was out partying last night, probably got high on meth and drunk and fell asleep on the road coming home. “Now what good is cutting him up going to do?”, he slurs to me over the wires. “I ain’t going to let no one cut my boy. He’s suffered enough in his life. Hell, he shot hisself once. And he’s been on drugs for years now. Let us all have some peace.”
“Mr. Roberts, when did you last see Larry?”, I try the just doing business approach.
“Just last night.”
“About nine. He said he was going out with some friends.”
“Had he been depressed?”
“Not recently. He used to be. He’d go up and down you know.”
“Listen Mr. Roberts. I appreciate how you feel here but you need to understand it’s my job to investigate deaths and I’m not sure how your son died. It is my decision if an autopsy will need to be done or not and I’ll make that decision based on my investigation.”
“Well just what good will an autopsy do? He rolled his car over an he’s dead. What more do you need to know?”
“You said he was using drugs. Maybe he took an overdose and rolled the car.”
“What? So, he was driving a car while he was overdosed? And just happened to roll it over? He couldn’t have done that. He warn’t that smart.”
“Well, look Mr. Roberts, I’m still investigating this, and I’ll be making a decision by tomorrow morning about the autopsy. I’ll let you know.”
You go ahead and go to the bathroom now. Then you can decide about the rest of the story. Should we have some coffee now?
Still interested? I’m warning you; it could trail off here pretty soon.
So, by the next morning I got ahold of the investigating State patrol officer. He described it as a fairly slow speed accident. Straight stretch of road and didn’t look like he’d swerved to try to correct or anything. So, it seemed like he could have just fallen asleep at the wheel like his “dad” had suggested. It was a small car with a sunroof. He got ejected and the car was actually lying on top of him when he was found so the positional compression asphyxia was a very reasonable cause of death.
I wondered whether he was awake as he was being crushed. These sorts of morbid thoughts are common for me. However, you never really know these things. So, I called the funeral home and pathologist and cancelled the autopsy. Save the county 3000 bucks. I also called and left a message with the family at 9AM that we weren’t going to do an autopsy. I’d make the old man’s day. I was relieved that a younger kid took the message.
So, is this the end?
Cause of death, crush, positional asphyxia.
Manner of death: accident.
Oh yes, his drug screen was positive for methamphetamine and marijuana. I guess we could end here. Good story? Endings are nice.
Oh yes, the history part. Well, I guess it was the name Roberts that triggered it. I got his mom’s name, and it reminded me of another death. A 10-year-old boy, eight years ago. Would’ve been a little half-brother to this Jeff Thompson.
David Thompson. I guess this is the start of another story. It might be related, you let me know. Or we could stop here. God, I wish it would stop somewhere. It seems like it just keeps going on.
So, this was eight years ago in the fall. I’m seeing patients in the office toward the end of my morning, and I get a knock on the door that the sheriff’s dispatch is on line three. I pick up and the dispatch lady is hysterical. “Oh Doctor, there’s been a horrible accident. It’s an emergency. They need you to go to Deary right away. Oh, it’s just a horrible thing. They need you their right away. It’s an emergency.”
I’m waiting for her to calm down. Finally, I interrupt her. “Ma’am. You are calling me as the coroner, right? OK, well then ma’am, is this person dead? OK, ma’am. If they are dead, it’s not an emergency. It’s a tragedy, but not an emergency. I will finish up with my last patient before noon then I’ll go out there.”
“They need you right away doctor. It truly is an emergency. A young boy has been shot. Can I tell them you’re on your way?”
“No, I’ll be leaving at noon. It’ll take me half an hour to get there. I’ll probably be there by 12:30. Goodbye.”
Five minutes later I get a call from the sheriff. “So, Doc,” he asks, “are you going to this scene or not?”
“I’ll be going at noon. I’ll be there around 12:30.”
“So, you are going?”
“Yes, I am going.” I imagined that the dispatch lady shared her disappointment with the sheriff.
“OK. See you there.” The sheriff was a pretty reasonable guy.
It was a beautiful fall day. I had to ask directions at the little store in town. The shopkeeper seemed to know where I needed to be. There were three sheriff’s department cars parked around the single-wide trailer up the hill. It was a couple maybe three streets off the highway next to a bunch of other trailers.
I spoke with the sheriff and the investigating detective who were waiting for me outside the singlewide. They outlined the scene for me.
It had been a teacher training day for the school district, so the kids weren’t in school. There were three boys playing in the trailer. No parents were home.
The detective prepares me. “When you go in, you’ll see evidence of them horsing around. They must have gotten into their fathers hunting stuff because there are arrows stuck in the wall and the ceiling.”
He outlined the events to me from interviewing the two surviving boys. The deceased was a fifth-grader, David Roberts. The other two boys, Jared Thomas and Billy Curtis were fourth graders, but were playing with him because they were buddies. At one point David took the other kids into the parent’s bedroom to show them his dads hunting rifle. Then he went into the bathroom and was sitting on the toilet. The Curtis kid went back into the bedroom and got the deer rifle and took it into the bathroom to tease the Roberts boy. The Thomas kid was trying to get them to stop he said.
I can just imagine the Roberts kid on the toilet taunts. “You don’t even know how to shoot that!”
“I do too, see!” The Curtis kid said he remembered racking the bolt once and chambering a round.
He held the gun up and pointed it at the kid on the toilet, the Roberts boy, and shot him.
I looked at the sheriff and at the detective. “You guys are calling this an accident?” Both looked at me and nodded.
“You talked to the prosecutor about this?” The sheriff nodded to me. I’m aware that there is an election in three weeks and the prosecutor doesn’t want to look like he’s hard on 10-year-olds.
I shake my head and go in. He got shot right between the eyes at close range. He had had his pants down and was sitting on the toilet. But the force of the shot had thrown his body over into the corner of the small bathroom, head down in the tub next to the toilet. His bare butt up was in the air with the pants down around his ankles. Like the kids might have been playing at sodomy if there hadn’t been a fine spray of blood and brain parts all over the walls, ceiling, window, sink, and bathtub. The floor was littered with small parts of skull. When I first stepped into the bathroom, I thought I was stepping on spilled Cat Chow. But no, the skull can be shattered into nice small little pieces. The boy had left a long, large, slightly curled turd in the toilet.
Cause of Death: gunshot
Manner of death: accident
So, is the story over now? That’s a pretty dramatic ending. Or should I tell you about the older brother of the Thomas boy? He got shot at a drug party in the southern part of the county. But he didn’t die. He lived despite a short-range handgun shot to his right chest. He never would tell the cops who pulled the trigger.
That’s not really the part of how the story goes on, but it’s somehow related, I think.
It really goes back a year or so before that poor kid got shot in the trailer.
I met the Thomas boy’s mom in the clinic. He was the one trying to talk down the other kid with the rifle. At least that’s the best I can do to sort all this out.
She came to see me because she was finally trying to deal with getting off booze and drugs. She was also pretty depressed and finally, actually talking about and angry about the years of sexual abuse she had while growing up. Her husband was supporting her efforts.
Apparently, she’d had to deal with a couple of uncles having sex with her from the age of 12 on. She got married at 16 just to get out of the mess.
Maybe you can tell here now that I’m starting to trail off… Maybe this really isn’t a very good story. I’m not sure how it’s going to end. I’m not sure I can stick an ending on it for you. Maybe we should end it here.