Hot On the Trail

It’s not CSI – it’s real life. Our forensic pathologists solve medical mysteries and assist law enforcement

Just the facts

About 200 community members met forensic pathologist Sam Land, M.D. (far right) and toured our new morgue during the final night of our 12th Mini Medical School. Titled “Hot on the Trail: The Life-and-Death Realities of Forensic Medicine,” the four-week educational course featured hospital doctors and nurses, laboratory technologists, forensic pathologists and professionals from the Pennsylvania State Police and District Attorney’s office. Participants learned the real story about how these professionals solve crimes and medical mysteries through forensic pathology.

Autopsy. The word conjures up images of television shows where glamorous people solve cases and catch criminals in 42 minutes. “But what you see on TV isn’t reality,” says forensic pathologist Samuel Land, M.D.

He and his colleagues—Barbara Bollinger, M.D., and Saralee Funke, M.D.—are among the nation’s 450 board-certified pathologists. They perform many autopsies a year at LVH—Cedar Crest, working with coroners from 20 counties statewide to investigate deaths and partnering with our doctors to learn more about diseases and causes of death.

Here’s a sneak peek into their real-life world.

Solving Medical Mysteries
A patient suffers a blood clot in his lung (pulmonary embolism). Despite the best evidence-based treatment, he dies a few days later. Was the clot to blame, or were other medical factors the cause? “We really don’t know without an autopsy,” says pulmonologist Daniel Ray, M.D. “Physicians use clinical suspicion, but the autopsy provides scientific fact.”

That’s why Ray and many of his physician colleagues take the time to observe autopsies on patients who have died during hospitalization. Autopsies allow doctors learn more about how diseases generate and progress, and whether or not treatment is effective. “We also recommend autopsies to provide clinical fact in cases that may pose future litigation,” says risk management administrator Georgene Saliba.

A recent autopsy allowed Ray to discover something new about a patient who was admitted to the hospital with constipation. The patient then suffered from ischemic colitis (a severe bowel inflammation) and died. The autopsy revealed the patient had a bacteria infection (C.difficile) that normally starts as diarrhea, not constipation.

Autopsies are important not just for the physician, but for the patient’s families. They are done at no cost to families, do not delay funeral services or change the body’s appearance, and are performed with dignity and respect. After observing an autopsy, Ray meets with families to explain the results. “They are thankful to gain a clear understanding of what happened to their loved one,” Ray says.

Solving Criminal Puzzles
In the televised world of forensic crime-solving, everything is high-tech and dramatic. In the real world, our forensic pathologists work in a new state-of-the-art morgue at LVH—Cedar Crest, but the tools of their trade are very basic.

“We rely on surgical tools and our sense of sight, smell and sound,” Land says. Forensic evidence is placed in paper bags, and gunpowder residue is collected with sticky notes. Land and his colleagues can sometimes visually determine the chronology of shots fired, tell if they all came from the same gun and find the lethal bullet. They also can give a general description of a weapon that caused blunt-force trauma and estimate the size of a knife used in a stabbing.

Our forensic pathologists are hired by coroners to investigate deaths that are sudden, violent or suspicious. They also investigate child deaths and deaths that happen while someone is in police custody. These autopsies determine the medical cause of death. Coroners then use the evidence and the autopsy report to make the final determination on manner of death.

“We don’t speculate what happens,” Land says. “We use all of the toxicology and laboratory results to support our finding and give law enforcement the medical certainty it needs to adjudicate a criminal case.”

- Amy Satkofsky

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