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Speaker 1: Welcome to pathology with doctor Priya. Doctor Happy, Happy Thanksgiving

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Speaker 1: you too.

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Speaker 2: I'm I must say I missed out on your baking.

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Speaker 2: Some of that Southern pecan pie look delicious.

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Speaker 1: Oh honey, let me tell you made with Lord too.

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Speaker 1: We weren't even trying to hide.

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Speaker 2: No, no, there's no there's no scrimping during the holidays, Nope.

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Speaker 1: And there's just no substitution. I mean, either it's going

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Speaker 1: to be you know, great Grandma's recipe or it's not.

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Speaker 2: Oh, I treasure those family recipes. Yes, So as as

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Speaker 2: we proceed, I want to share some funny holiday stories.

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Speaker 2: And you know, my upbringing was a little non traditional.

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Speaker 2: I think there's probably some listeners that can relate to

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Speaker 2: it because my parents were immigrants, right, so they didn't

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Speaker 2: grow up with Christmas.

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Speaker 3: But so now I'm a parent.

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Speaker 2: I think I've mentioned that in the past, and my

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Speaker 2: daughter is now going to be twelve next month, so

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Speaker 2: the charm of Santa's were worn off. But I did

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Speaker 2: want to say that some of the followers who see

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Speaker 2: me online, I shared a memory where I had So

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Speaker 2: this is a parenting hack, if you will. If anybody

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Speaker 2: has Santa believers in their house and I had put

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Speaker 2: the my cell phone number as an entry and I

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Speaker 2: called it Santa Claus, the Big Man in my phone.

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Speaker 2: So every year I would tell Dia that I could

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Speaker 2: text Santa if she was misbehaving or not reading, et cetera.

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Speaker 3: So I want.

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Speaker 2: People if if my uh you know, forensic mind when

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Speaker 2: when you when you need parenting help, you pull out

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Speaker 2: all the stops, you know. So I still have it

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Speaker 2: in me and my my own numbers called Santa Claus

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Speaker 2: the Big Man in my phone. So maybe someone else

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Speaker 2: will use it and they can blackmail their kids a

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Speaker 2: little longer.

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Speaker 1: Can I do tell you? I thought you were going

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Speaker 1: somewhere completely different. I thought you were going to say

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Speaker 1: you had David or a good friend call your phone

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Speaker 1: so that she could see who was calling to tell

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Speaker 1: her how great she was doing it, that she was getting.

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Speaker 1: Oh that is so f funny.

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Speaker 2: I mean I would text myself and then it would

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Speaker 2: say Santa Claus and she was I was like, see,

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Speaker 2: if you don't do your reading, Sana, I have a

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Speaker 2: direct line of Santa. She said what And she would

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Speaker 2: grab my phone and check and then see, and I'm like, yep,

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Speaker 2: you know. So she hadn't figured out the loophole. But

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Speaker 2: some people on Facebook when I shared that memory have

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Speaker 2: been laughing because they were like, that's so smart.

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Speaker 3: I was like, oh, yes, whatever it takes.

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Speaker 2: So without further ado, but maybe with the month of

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Speaker 2: December approaching, maybe some people can use this tip. It's

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Speaker 2: not Unfortunately now it's not working for me because we've

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Speaker 2: outgrown it.

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Speaker 1: Understood. Well, we just had Thanksgiving and you mentioned some

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Speaker 1: of the you know, dishes that were going to be

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Speaker 1: served all over the liace. So people had so much fun.

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Speaker 1: I know, I saw so many posts where people were

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Speaker 1: just celebrating with friends and family, and I know you

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Speaker 1: and I were just super grateful of all the people

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Speaker 1: we got to be around.

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Speaker 3: And that's why it's my favorite holiday.

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Speaker 2: I don't want it skipped over right, Like there's no gifts,

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Speaker 2: know nothing other than people, people you love far, you know,

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Speaker 2: near and far and grud food.

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Speaker 3: We're not skimping on the diet, that's right.

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Speaker 1: No, it's a wonderful holiday. It should not be overlooked

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Speaker 1: in any way, you know. But because of that, one

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Speaker 1: thing that was in my mind is slow deaths. And

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Speaker 1: you know, I think a lot of times people will

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Speaker 1: sometimes joke if there's somebody that don't care for and

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Speaker 1: an X or something, and they'll say, oh, I hope

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Speaker 1: his death is slow and painful. You know, yes, yes, yes,

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Speaker 1: But when you start looking at those deaths and the

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Speaker 1: one I want to start with just because we had Thanksgiving,

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Speaker 1: let's talk about starvation.

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Speaker 3: Oh it's heartbreaking.

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Speaker 1: Oh it's heartbreaking, and y'all the torture of it. I

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Speaker 1: just think for somebody like doctor Priya to walk us

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Speaker 1: through what happens to your body during starvation because you know,

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Speaker 1: in a southern household, if you're supposed to eat at

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Speaker 1: six and it's five point forty five, you're starving. You

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Speaker 1: will tell people my you know, stomach thinks, my throat's

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Speaker 1: been cut, Like I'm so hungry. I'm I'm starving to death.

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Speaker 1: But we're not starving to death. We're not even super

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Speaker 1: hungry yet. But we say starving to death. But if

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Speaker 1: you are literally starving to death, doctor, what happens to you?

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Speaker 3: Oh?

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Speaker 2: There's so much And I hate to say this. I

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Speaker 2: recently just I think last week, commented on a case

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Speaker 2: out of Wisconsin that was a starvation death in a

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Speaker 2: Oh god was it a teenager? But I mean she

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Speaker 2: weighed like thirty five pounds or something, you know, And

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Speaker 2: my daughter just went for her check up and DIAZ

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Speaker 2: five three and one hundred and ten pounds completely proportionate.

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Speaker 2: And I think that's eightieth percentile. So that just gives you,

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Speaker 2: like an idea. I think this girl was supposed to

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Speaker 2: be older than my daughter. And obviously, you know, hike

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Speaker 2: can differ, but just thirty five pounds or whatever it was,

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Speaker 2: it just gives you an idea, right, Like.

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Speaker 3: You don't even think about thirty five pounds. It's like

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Speaker 3: a toddler, you know.

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Speaker 2: I mean when we say skin and bones, the level

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Speaker 2: of torture that takes to get to that extreme level.

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Speaker 2: And I say extreme, you know, we you know, in

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Speaker 2: this diet culture, you know, can be taken too far.

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Speaker 2: And I want to say that starvation is not always

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Speaker 2: a homicide, okay, And I say that because unfortunately, eating disorders,

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Speaker 2: you know, I've had friends with eating disorders, body image issues,

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Speaker 2: and it's very much in the media, and that is

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Speaker 2: a severe illness and unfortunate. I have autopsy people who

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Speaker 2: have died from anorexia, believe it or not. So even

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Speaker 2: in this country where food is plentiful, you know, sometimes

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Speaker 2: it's self induced, right, so the anorexia bolima goes so

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Speaker 2: far that it is severe and leads to starvation.

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Speaker 3: So whether it's.

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Speaker 2: Self induced or you know, food is restricted because of abuse,

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Speaker 2: you know, it's the same physical changes. Do you understand,

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Speaker 2: Like it's just restricting food, and during anorexia there could

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Speaker 2: be over exercising to compensate, you know, to burn more calories.

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Speaker 3: So again, the rate of getting there.

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Speaker 2: The path of getting there, the psychology behind getting their psychology, psychiatry,

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Speaker 2: if you will, of getting.

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Speaker 3: There can be different.

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Speaker 2: But when we say starvation it is bad, it is

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Speaker 2: not I'm trying to lose a few pounds before putting

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Speaker 2: on my black dress for a gala. Do you understand

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Speaker 2: this is pro law o months and months of nutritional depletion.

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Speaker 2: This is not I'm cleaning up my diet. So I

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Speaker 2: want to be you know, I sort of want to

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Speaker 2: have a trigger warning in this discussion as well, because

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Speaker 2: if anybody knows anybody with the eating disorder or you know,

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Speaker 2: can be triggered with this conversation, just to step away, please,

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Speaker 2: because it can be such a chronic condition. Now moving

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Speaker 2: away from I mean, I'm not a psychological expert. It's

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Speaker 2: just what i've you know, personally dealt with. And unfortunately,

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Speaker 2: even in this day and age, both in my medical training,

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Speaker 2: I had seen a young girl who I thought was beautiful,

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Speaker 2: and she was beautiful but like healthy, you know, on

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Speaker 2: the outside. I was seeing her in an outpatient setting

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Speaker 2: with another doctor when I was rotating, and I remember

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Speaker 2: she was a college student and she said, I have anorexia.

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Speaker 2: So we had to like work her up for electrolyte problems,

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Speaker 2: protein efficiency. I mean, you know, when we go for

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Speaker 2: a check up, she looked great, do you know what

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Speaker 2: I mean?

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Speaker 3: She looked athletic.

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Speaker 2: To me, she looked well dressed, meet and clean. I

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Speaker 2: still remember her face. She had a blonde bob. I mean,

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Speaker 2: no one on the streets would say, oh, she looked sick.

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Speaker 2: She was walking talking jolly, you know. And I think

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Speaker 2: that's the sad part is even when we are facing it,

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Speaker 2: people don't always register it as a active issue, you

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Speaker 2: know what I mean. So that's where the awareness has

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Speaker 2: to come in. And then there's the horrific part. We

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Speaker 2: just had an abuse case in Rhode Island. I did

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Speaker 2: not autopsy that person, but what was released on the

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Speaker 2: news was also sort of like a chronic abuse. And

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Speaker 2: I wonder if there was a malnutrition component to it

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Speaker 2: or a starvation you know, where she was kidnapped and

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Speaker 2: held hostage and abused in many ways. And so and

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Speaker 2: I also don't want to make it just a gender

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Speaker 2: like the female gender. There it's well known that men

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Speaker 2: or males, you know, people who identify as male can

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Speaker 2: be affected by eating disorders or they could potentially kidnapped

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Speaker 2: and also held hostage. So I mean, unfortunately, the stories

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Speaker 2: that I know of just happened to be in women.

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Speaker 2: But I don't want that to be to you know,

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Speaker 2: paint the wrong picture that the awareness everywhere.

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Speaker 1: Well you know we've seen pictures even in wartime, I

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Speaker 1: mean starving people, men in concentration camps. I mean exactly

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Speaker 1: that standard. Yeah, right, But I know, for me, the

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Speaker 1: first time I ever heard anything about anorexia, I'd never

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Speaker 1: heard of it, didn't know anything about it was Karen Carpenter, Yes, yes,

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Speaker 1: And I mean I was a huge fan, you know,

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Speaker 1: and she was so popular, She was so popular and

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Speaker 1: so gifted.

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Speaker 2: And I mean she had I mean, if you think

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Speaker 2: about it, in the circles that she traveled, I mean

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Speaker 2: there was people would probably cater to her any whim.

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Speaker 2: If she wanted to eat something flown across the world,

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Speaker 2: she could get it, you know what I mean. It

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Speaker 2: wasn't that it was a lack of food, but the

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Speaker 2: psychological it's a manifestation of how severe the psychological disease is.

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Speaker 2: You know, now, like when we think about either self

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Speaker 2: induced starvation aka anorexia, bolima, eating disorders or I mean,

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Speaker 2: in some ways you see starvation as the end result

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Speaker 2: of a complication, like let's say long standing dementia or cancer.

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Speaker 2: Even right, the cancer eats away at the body. I

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Speaker 2: mean when people people I hate to say don't die

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Speaker 2: necessarily have cancer or dementia. It's a complication. But oftentimes

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Speaker 2: you'll hear at the end of life, elderly people stop

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Speaker 2: eating and drinking, right, and then they waste away.

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Speaker 3: So all of.

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Speaker 2: These things that are happening is that you know, the

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Speaker 2: body is shutting down again. The rate at which they

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Speaker 2: get there, the severity, it can all differ. But we

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Speaker 2: you know, we regard regardless of what we're dieting and

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Speaker 2: what we're doing. If you think about it, I can

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Speaker 2: eat a cheeseburger tonight, that's terrible for me, then I

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Speaker 2: can turn around eat a salad like. Our body regulates

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Speaker 2: all that, right, the amount of salt we eat, the

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Speaker 2: amount of sugar, whether we have five thousand calories on

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Speaker 2: Thanksgiving like, and then we eat a lot less the

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Speaker 2: next day because we don't feel good. Whatever it is,

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Speaker 2: there's a very tight regulation, right. And then to the

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Speaker 2: body is built to retain that equilibrium, right, because everything

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Speaker 2: works within a very narrow range, and that's how our

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Speaker 2: body is built, and everything's connected.

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Speaker 3: So as soon as we start pushing.

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Speaker 2: Away from giving the body the energy, the water, the

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Speaker 2: electrolytes it needs, that's when things are going to shut down.

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Speaker 2: So specifically what happens is, you know when we go

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Speaker 2: to starvation. I mean, especially if you have stuff, you know,

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Speaker 2: pictures like unfortunately concentration camps or I mean you've seen

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Speaker 2: African countries that go through famine, right, all of those

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Speaker 2: are very uh what I would say, prototypical pictures of

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Speaker 2: what the bodies look like.

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Speaker 3: They just look like skin and bones.

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Speaker 2: You know, and the body ultimately has to eat away

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Speaker 2: at muscle and fat stores to try to survive. Right,

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Speaker 2: So everything is being broken down. So even people who

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Speaker 2: are you know when they get anorexic if you think

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Speaker 2: about it, or they lose so much body weight to

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Speaker 2: try to compensate anorexia being one pathway if you will,

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Speaker 2: you know, the body starts breaking down energy stores. Now

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Speaker 2: energy stores there are sort of smaller ones in the

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Speaker 2: liver and muscle, which are just what we use for

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Speaker 2: short term energy, like glucose like and but that's what

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Speaker 2: gets us through exercise, even a marathon or something like that. Right,

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Speaker 2: but days out, weeks out, months out, that's no longer present.

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Speaker 1: Dodge, let me ask you this. In those famine countries,

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Speaker 1: why are the children's bellies poked out like they're stuffed?

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Speaker 3: Sure, so if I.

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Speaker 2: Could just keep going and then we'll get to the kids.

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Speaker 3: Sorry, yes, because it looks like you're.

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Speaker 2: Like you have a fat belly, right, almost like that

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Speaker 2: those toddler bellies, you know what I mean. So what

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Speaker 2: happens is it's actually this weird presentation of starvation. So

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Speaker 2: once we go down to like we can't we don't

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Speaker 2: have any more sugars to break down in our body,

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Speaker 2: we then go down to breaking down fat and then muscle. Okay,

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Speaker 2: and people don't see muscle as a form of energy.

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Speaker 2: But when everything is gone, you know, we think about

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Speaker 2: first sugars.

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Speaker 3: Then fats, then muscle.

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Speaker 2: Okay, we don't want to break down muscle because that's

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Speaker 2: a weakening. But what happens is at some point something's

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Speaker 2: got to give, right, the body is gonna self digest itself,

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Speaker 2: trying to keep itself alive, and then you get all

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Speaker 2: these weird manifestations, meaning the heart gets weaker, the lungs

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Speaker 2: get weak, or your immune system gets weaker where you

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Speaker 2: can be very susceptible to infections, and this weird sort

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Speaker 2: of bloating that you see. Okay, the starvation body habits,

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Speaker 2: especially in those kids, like when you know, you see

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Speaker 2: toddlers with bellies where their abdominal walls are weak and

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Speaker 2: they have these big toddler bellies sticking out. Well.

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Speaker 3: In starvation, what happens is.

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Speaker 2: Those abdominal muscles get weak because they get eaten away.

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Speaker 2: There's you know, the body's trying to hold onto any

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Speaker 2: fluid possible.

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Speaker 3: Okay, and then you get.

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Speaker 2: This nutritional wasting with severe protein deficiency. Now this is

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Speaker 2: a big word, but I had to look it up

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Speaker 2: in preparation. Quashy core all right, Uh no, it's quashio

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Speaker 2: core that is like severe protein deficiency associated with starvation.

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Speaker 2: So it really is disrupting your metabolism, like the body

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Speaker 2: slows down to basically like trying to regulate temperature and

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Speaker 2: expend as little energy as possible to function. Do you

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Speaker 2: understand this is not any kind of extra energy being expended,

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Speaker 2: So this koashier core is a it's like a type

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Speaker 2: of malnutrition, and you get like fluid and air building

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Speaker 2: up in the abdomen, you get that bloating. But the

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Speaker 2: rest of them, if you think about those pictures, you

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Speaker 2: get very gaunt faces, like there's no cheek fat, their

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Speaker 2: temples are sunken in because the temples have muscle, like

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Speaker 2: the rest of it's just wasted.

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Speaker 3: So it's this very i would.

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Speaker 2: Say, characteristic presentation. And then what the other thing you

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Speaker 2: see is that sometimes the body will grow very fine

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Speaker 2: hairs called lunugo.

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Speaker 3: It's almost like baby hair.

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Speaker 2: Some of you know, I have naked cats and then

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Speaker 2: sphinx cats and in the winter they get these like

285
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Speaker 2: almost like velvet type growth on their body because their

286
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Speaker 2: bodies are adapting to the colder environment. And that's literally

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Speaker 2: like analogous to what happens in the human body when

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Speaker 2: it's so cold and there's no fat and muscle to regulate,

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Speaker 2: that's when you know the body that's a very end stage,

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Speaker 2: like a very severe sign of starvation.

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Speaker 1: Other than starvation, let's talk about radiation. So the radiation damage,

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Speaker 1: I think most people would think, like Aaron Brockovic, like

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Speaker 1: over time, like how long is this going to take?

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Speaker 3: Well, that's harder for me to say.

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Speaker 2: I think the big thing you have to talk think

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Speaker 2: about is, you know, because it's a dose dependent and

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Speaker 2: how much radiation you're getting exposed to, Like, so is

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Speaker 2: it environmental radiation? Like you know, you think about like chernobyl,

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Speaker 2: like no one can go in there right after that

300
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Speaker 2: that area is not safe. But they're supposedly like chernobyl

301
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Speaker 2: cats or something thing that are radioactive.

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Speaker 3: And you know, so.

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00:17:07,080 --> 00:17:11,480
Speaker 2: You have to think about how much is in the environment,

304
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Speaker 2: and then you know, what is your proximity?

305
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Speaker 3: Does that make sense?

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Speaker 2: Like how close you are to it now? And is

307
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Speaker 2: it in the soil? Is it getting in your food?

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Speaker 2: Is it in the water? You know, And that's the

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Speaker 2: kind of if I recall correctly, she was Aaron Brockovich

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Speaker 2: was concerned about like contaminated water. But if you think

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Speaker 2: about it, like you can have you can live near

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Speaker 2: a nuclear plant, you can live you know, there's all

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Speaker 2: these things we don't know of about, you know, whether

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Speaker 2: businesses are leaching chemicals or you know, into the environment.

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Speaker 2: When we work with radiation. When I've worked with radiation

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Speaker 2: both in a hospital in the emy setting, So usually

317
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Speaker 2: what happens is radiation can be used as cancer treatment, right,

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Speaker 2: And I have a friend's son who's actually getting pediatric cancer,

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Speaker 2: who's getting radiation quite a bit of it, and they're

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Speaker 2: monitoring him, and you know, he has to worry about

321
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Speaker 2: exposing the family, right if in a house. So then

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Speaker 2: what happens Sometimes I get patients who pass away but

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Speaker 2: they have received radiation beads for prostate cancer or colon

324
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Speaker 2: cancer or whatnot, and they will set off the.

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Speaker 3: Detector for radiation.

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Speaker 2: We scan them, you know, so because we would have

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Speaker 2: to let that deteriorate before we can safely do an autopsy,

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Speaker 2: you know.

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Speaker 3: And so this goes back.

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Speaker 2: To our exposures are work risks, right, So sometimes we

331
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Speaker 2: have to delay the autopsy until the Geiger counter reads zero.

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Speaker 3: And so everything is slow.

333
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Speaker 2: But there can't I mean, I think when you have

334
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Speaker 2: radiation exposure. I would think it's years of exposure to

335
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Speaker 2: cause enough DNA damage to then result in cancer. You understand,

336
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Speaker 2: because it's at the DNA level that this mutation's happening.

337
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Speaker 2: And then it has to happen, and the body has

338
00:19:08,800 --> 00:19:11,360
Speaker 2: to fail at getting rid of those pre cancerous cells,

339
00:19:11,840 --> 00:19:14,080
Speaker 2: do you understand, So it has to be multiple hits,

340
00:19:14,240 --> 00:19:20,560
Speaker 2: and then your body usually has a sort of monitoring system,

341
00:19:20,600 --> 00:19:24,000
Speaker 2: if you will, you know, trying to keep the house

342
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Speaker 2: clean and get rid of cancer cells. But sometimes that fails,

343
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Speaker 2: and then that one cell becomes the trigger for a

344
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Speaker 2: cancer's growth. Right, it evades the body systems and starts

345
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Speaker 2: taking over. But I suspect that is years to happen,

346
00:19:40,800 --> 00:19:44,520
Speaker 2: and I wouldn't say that it's one hundred percent of

347
00:19:44,560 --> 00:19:47,800
Speaker 2: people that are exposed to radiation are going to get cancer.

348
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Speaker 3: Do you understand that?

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Speaker 2: Like, I think there's incidences of higher like types of

350
00:19:53,480 --> 00:19:56,239
Speaker 2: cancer in certain areas. Like they think, what was that

351
00:19:56,280 --> 00:19:58,879
Speaker 2: thing in Boston or Boston area they were talking about

352
00:19:59,000 --> 00:20:01,720
Speaker 2: a few nurses that had there was a cluster of

353
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Speaker 2: nurses or something that had cancer.

354
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Speaker 3: But I don't think there's a.

355
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Speaker 2: I don't know that case I'm not involved in it,

356
00:20:10,000 --> 00:20:12,160
Speaker 2: so I could be misquoting it. But I don't think

357
00:20:12,240 --> 00:20:15,840
Speaker 2: there's been a direct cause and effect, you know. I

358
00:20:15,840 --> 00:20:19,879
Speaker 2: think there's a suspicion. And the cluster of nurses was

359
00:20:20,000 --> 00:20:23,159
Speaker 2: or hospital workers was very concerning, you know. And so

360
00:20:23,240 --> 00:20:25,439
Speaker 2: if you see that in kids, or or if you

361
00:20:25,520 --> 00:20:27,680
Speaker 2: see it you know there's a cluster of kids in

362
00:20:27,720 --> 00:20:31,080
Speaker 2: a certain area or a certain type of disease that

363
00:20:31,160 --> 00:20:33,520
Speaker 2: shows up, you know, that's when you think about environment

364
00:20:33,800 --> 00:20:37,359
Speaker 2: such as radiation or chemicals that are dumped, you know,

365
00:20:37,480 --> 00:20:42,560
Speaker 2: unknowingly in the area, toxins that then go to cause cancer.

366
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Speaker 1: Well, the last thing I want to ask you about

367
00:20:45,960 --> 00:20:48,879
Speaker 1: this kind of comes to my mind every time I

368
00:20:48,920 --> 00:20:52,640
Speaker 1: think of a slow, crazy death. There was a guy

369
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Speaker 1: in Atlanta that got stabbed in the head with a

370
00:20:55,359 --> 00:20:59,760
Speaker 1: pretty significant butcher knife, and he's sitting up, he's talking

371
00:20:59,760 --> 00:21:03,600
Speaker 1: to the medical folks, he's talking to law enforcement, and

372
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Speaker 1: the result was if we leave it in, he's going

373
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Speaker 1: to die. If we remove it, he's going to die.

374
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Speaker 1: And it was just strange for me watching this man

375
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Speaker 1: sit there talking, you know, perfectly able to communicate and

376
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Speaker 1: move about, knowing he was on limited time.

377
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Speaker 2: Well, That's so interesting because I had a very similar case,

378
00:21:28,480 --> 00:21:33,000
Speaker 2: unfortunately end in depth because it was an autopsy, but

379
00:21:33,240 --> 00:21:36,639
Speaker 2: similar stabbed in the head, sliced in the head the

380
00:21:36,680 --> 00:21:38,679
Speaker 2: side of the head where there was a huge gaping

381
00:21:38,800 --> 00:21:41,640
Speaker 2: wound and really bleeding to death from it. This guy

382
00:21:41,720 --> 00:21:44,640
Speaker 2: was able to drive around for quite a bit, not

383
00:21:44,680 --> 00:21:47,400
Speaker 2: just and he didn't go to the hospital unfortunately, and

384
00:21:47,440 --> 00:21:50,719
Speaker 2: so it became this. They could have stopped the bleeding

385
00:21:50,760 --> 00:21:53,800
Speaker 2: and sutured the wound and treated him, you know what

386
00:21:53,880 --> 00:21:57,280
Speaker 2: I mean, But it just didn't happen, and then he died,

387
00:21:57,320 --> 00:21:59,359
Speaker 2: and I'm like, oh my god. And you know, the

388
00:21:59,440 --> 00:22:02,760
Speaker 2: amount of blood loss was all throughout the car and

389
00:22:02,800 --> 00:22:03,600
Speaker 2: his clothing.

390
00:22:03,640 --> 00:22:05,719
Speaker 3: It was voluminous, and we're like, my god.

391
00:22:05,880 --> 00:22:08,600
Speaker 2: When I say that scalp wounds can bleed, this was

392
00:22:08,680 --> 00:22:13,920
Speaker 2: like the extreme manifestation of it because it was one slice,

393
00:22:14,040 --> 00:22:16,960
Speaker 2: you know, an argument gone wrong, and then now this

394
00:22:17,119 --> 00:22:21,440
Speaker 2: kid is dead, you know, so that is not I mean,

395
00:22:21,480 --> 00:22:24,800
Speaker 2: that could be hours, you know before someone like that dies.

396
00:22:24,880 --> 00:22:28,280
Speaker 2: If it's a simple what I would say, like your

397
00:22:28,320 --> 00:22:30,720
Speaker 2: case had a little bit more penetration into the brain

398
00:22:31,400 --> 00:22:34,440
Speaker 2: or the skull, but this one was absolutely uninjured. Skull

399
00:22:34,560 --> 00:22:39,080
Speaker 2: just completely slice the scalp diagonally and the muscle.

400
00:22:39,680 --> 00:22:41,600
Speaker 3: And it's crazy.

401
00:22:41,240 --> 00:22:44,960
Speaker 2: Because you know, the attorney generals were very distraught, like

402
00:22:45,000 --> 00:22:46,840
Speaker 2: how are we going to prove this is a murder

403
00:22:46,880 --> 00:22:50,960
Speaker 2: because he drove around for a while, you know, and

404
00:22:50,960 --> 00:22:53,920
Speaker 2: and it is like if not for that wound, would

405
00:22:53,920 --> 00:22:55,760
Speaker 2: he have died? You know, That's really what you have

406
00:22:55,800 --> 00:22:59,600
Speaker 2: to think. And I don't actually remember how that case went,

407
00:22:59,720 --> 00:23:01,719
Speaker 2: so you know, it's not a bias. It was just

408
00:23:01,720 --> 00:23:04,800
Speaker 2: something I handled years ago. But you have to remember

409
00:23:04,840 --> 00:23:10,400
Speaker 2: whether it's hours delayed or days, weeks, even years, right,

410
00:23:10,440 --> 00:23:13,600
Speaker 2: Like sometimes we have people who have an injury, then

411
00:23:13,680 --> 00:23:16,760
Speaker 2: become paralyzed, then die of a complication that's like a

412
00:23:16,800 --> 00:23:20,640
Speaker 2: medical complication, right, kind of like bleeding to death if

413
00:23:20,680 --> 00:23:24,399
Speaker 2: you will, right, and then it's still a homicide. Now

414
00:23:25,000 --> 00:23:27,720
Speaker 2: that's not again, right, we are always going back. That's

415
00:23:27,760 --> 00:23:30,960
Speaker 2: a manner of death. That doesn't imply what will happen

416
00:23:31,000 --> 00:23:34,080
Speaker 2: in the court system. You know whether there'll be charges

417
00:23:34,160 --> 00:23:37,600
Speaker 2: or not, but or what the charges will be. But seriously,

418
00:23:37,680 --> 00:23:40,200
Speaker 2: like if you think about it, if someone dies, if

419
00:23:40,200 --> 00:23:43,720
Speaker 2: someone gets shot in the back and then five, ten, fifteen,

420
00:23:43,760 --> 00:23:47,399
Speaker 2: twenty years later they die of I don't know an

421
00:23:47,440 --> 00:23:51,720
Speaker 2: infection because they're paralyzed, but the paralysis was due to

422
00:23:51,840 --> 00:23:52,760
Speaker 2: the gunshot wound.

423
00:23:53,040 --> 00:23:54,840
Speaker 3: It all goes back. Yep.

424
00:23:54,920 --> 00:23:57,160
Speaker 1: We had those cases too, absolutely, yeah.

425
00:23:57,160 --> 00:24:00,919
Speaker 2: And it's interesting, like I remember there's some cases where

426
00:24:02,000 --> 00:24:04,960
Speaker 2: and unfortunately those people are passing away, But there were

427
00:24:05,000 --> 00:24:07,520
Speaker 2: war veterans, you know, where someone got shot in the

428
00:24:07,560 --> 00:24:11,800
Speaker 2: war and then they were paralyzed and lived throughout and

429
00:24:11,800 --> 00:24:14,720
Speaker 2: then passed away at the veterans home, and then we're like,

430
00:24:14,800 --> 00:24:17,879
Speaker 2: oh my god, like they were shot at wartimes, so

431
00:24:18,000 --> 00:24:21,240
Speaker 2: like we had to we don't know all the intricacies

432
00:24:21,320 --> 00:24:26,760
Speaker 2: of the event even you know, you're like nineteen whatever, right,

433
00:24:26,880 --> 00:24:30,040
Speaker 2: like you might put Vietnam, or you might put abroad

434
00:24:30,160 --> 00:24:33,959
Speaker 2: like because people don't know necessarily, and his family's deceased, whatever.

435
00:24:34,280 --> 00:24:36,800
Speaker 2: But if you think about it, it could be decades later,

436
00:24:37,480 --> 00:24:39,600
Speaker 2: you know. So it could be not going to the

437
00:24:39,640 --> 00:24:41,919
Speaker 2: hospital because you're bleeding from a moon, I'll be fine

438
00:24:42,000 --> 00:24:44,880
Speaker 2: to all the way to decades later having a complication

439
00:24:46,080 --> 00:24:49,719
Speaker 2: that doesn't seem.

440
00:24:48,400 --> 00:24:50,679
Speaker 3: Like a trauma complication, but it is.

441
00:24:51,320 --> 00:24:56,560
Speaker 2: And so that is oftentimes some of the hardest cases

442
00:24:56,560 --> 00:24:58,920
Speaker 2: to explain in court as well, because people don't see

443
00:24:58,920 --> 00:24:59,840
Speaker 2: the connection.

444
00:25:00,680 --> 00:25:03,680
Speaker 1: Right, he shot him five years ago, when you're charging

445
00:25:03,760 --> 00:25:05,080
Speaker 1: him with murders today, right, and.

446
00:25:05,040 --> 00:25:07,159
Speaker 2: Then there may have already been assault with the deadly

447
00:25:07,240 --> 00:25:08,919
Speaker 2: weapon or you know what I mean, they may have

448
00:25:08,960 --> 00:25:12,080
Speaker 2: already been charges, so they're like, why are we punishing

449
00:25:12,160 --> 00:25:12,919
Speaker 2: this twice?

450
00:25:13,040 --> 00:25:14,440
Speaker 3: Or you know, but then they up charge it.

451
00:25:14,520 --> 00:25:17,800
Speaker 2: Right, there's a you know, so that's really where it's

452
00:25:17,840 --> 00:25:21,200
Speaker 2: finessing the legal you know, aspects of it and then

453
00:25:21,280 --> 00:25:27,320
Speaker 2: showing that, oh, look, this is still if not for

454
00:25:27,440 --> 00:25:30,960
Speaker 2: this one event, right five years ago, ten years ago,

455
00:25:31,000 --> 00:25:34,200
Speaker 2: a week ago, hours ago, whatever it is, he would

456
00:25:34,240 --> 00:25:35,679
Speaker 2: have been he or she would have been in the

457
00:25:35,720 --> 00:25:39,800
Speaker 2: same healthy state. And in the interim they didn't bounce

458
00:25:39,880 --> 00:25:41,119
Speaker 2: back to that healthy state.

459
00:25:41,240 --> 00:25:42,360
Speaker 3: Right, there's nothing.

460
00:25:42,080 --> 00:25:44,879
Speaker 2: That's if they go they get injured, and like if

461
00:25:44,920 --> 00:25:46,960
Speaker 2: I break a leg, I don't know in a fight,

462
00:25:47,000 --> 00:25:49,960
Speaker 2: but my leg heels fine and I'm running and acting

463
00:25:50,000 --> 00:25:51,639
Speaker 2: and then something happens to me and I die of

464
00:25:51,680 --> 00:25:55,040
Speaker 2: an infection in the same leg. That's not related because

465
00:25:55,040 --> 00:25:57,840
Speaker 2: I was able to get healthy again. Right, But really

466
00:25:57,920 --> 00:26:01,919
Speaker 2: understanding that it's always downhill, even if the slope is

467
00:26:02,160 --> 00:26:05,879
Speaker 2: very very shallow, takes years, you know, you can still

468
00:26:05,920 --> 00:26:08,359
Speaker 2: get to the end and have to connect the dots

469
00:26:08,440 --> 00:26:12,240
Speaker 2: back up to the initial event. That's a delayed death,

470
00:26:12,280 --> 00:26:13,439
Speaker 2: I mean, the ultimate delay.

471
00:26:14,680 --> 00:26:17,919
Speaker 1: I've heard people say death by a thousand cuts, but

472
00:26:18,000 --> 00:26:21,880
Speaker 1: you know that was a torture practice. I'm not sure

473
00:26:21,920 --> 00:26:27,600
Speaker 1: I'm pronouncing it right, but ling cha lin Kai, I'm

474
00:26:27,600 --> 00:26:30,240
Speaker 1: not sure I pronounce it, but it was straight up real.

475
00:26:30,400 --> 00:26:33,200
Speaker 1: I mean, it was a torture mechanism for sure, right.

476
00:26:33,400 --> 00:26:36,800
Speaker 2: And you know the other thing is when we have

477
00:26:37,280 --> 00:26:39,320
Speaker 2: we're talking sort of going into manner of death, but

478
00:26:39,680 --> 00:26:42,480
Speaker 2: when we look at injuries and bleeding out or whatnot,

479
00:26:42,720 --> 00:26:46,000
Speaker 2: they all contribute, right, and then you have some that

480
00:26:46,040 --> 00:26:49,320
Speaker 2: are more serious than others, but they can all I mean,

481
00:26:49,359 --> 00:26:53,040
Speaker 2: you can have superficial what seems to be non lethal

482
00:26:53,080 --> 00:26:56,280
Speaker 2: wounds when I say superficial that cause bleeding, but if

483
00:26:56,440 --> 00:26:58,840
Speaker 2: you have enough of them, like a thousand, they're going

484
00:26:58,920 --> 00:27:02,600
Speaker 2: to cause enough wait, blood loss, excuse me, and so

485
00:27:02,760 --> 00:27:06,160
Speaker 2: then you die from that mechanism, you know, And these

486
00:27:06,200 --> 00:27:09,080
Speaker 2: are really this is why I like to say, you know,

487
00:27:09,119 --> 00:27:11,399
Speaker 2: I like to teach, but it's not black and white

488
00:27:11,480 --> 00:27:15,600
Speaker 2: like TV. You know, this is where the nuance of

489
00:27:15,800 --> 00:27:19,600
Speaker 2: death certification. I mean, when someone dies twenty thirty years later.

490
00:27:19,640 --> 00:27:22,280
Speaker 2: Think about it. We have to review as many medical

491
00:27:22,320 --> 00:27:27,920
Speaker 2: records as possible to then connect those dots. I think

492
00:27:27,960 --> 00:27:30,320
Speaker 2: I just reviewed a case in private practice and I

493
00:27:30,359 --> 00:27:33,320
Speaker 2: told them please, it was two or three thousand pages

494
00:27:33,400 --> 00:27:35,520
Speaker 2: of records and I was like, oh my or eight

495
00:27:35,520 --> 00:27:38,639
Speaker 2: thousand it was something insane. And I was like, I can't, Like,

496
00:27:38,760 --> 00:27:42,280
Speaker 2: we really need to narrow this down. I just don't

497
00:27:42,280 --> 00:27:44,880
Speaker 2: have the time or you know, and you know, things

498
00:27:44,920 --> 00:27:47,679
Speaker 2: can be repetitive, and it was such a long process,

499
00:27:47,800 --> 00:27:53,240
Speaker 2: and you know, it was very tedious, and I don't

500
00:27:53,320 --> 00:27:55,840
Speaker 2: like billing for needless work, you know. So I was like,

501
00:27:55,880 --> 00:27:59,680
Speaker 2: if we can rehone hone down on what's important, then

502
00:27:59,680 --> 00:28:01,400
Speaker 2: I can and you know, do it. And I think

503
00:28:01,440 --> 00:28:04,520
Speaker 2: that thousands of pages, that's five or eight thousand something

504
00:28:04,520 --> 00:28:07,119
Speaker 2: insane was brought down to like eight hundred pages, like,

505
00:28:07,119 --> 00:28:09,600
Speaker 2: you know, a tenth of it. So that makes more sense.

506
00:28:09,640 --> 00:28:13,960
Speaker 2: But think about the voluminous details that happen in that

507
00:28:14,160 --> 00:28:16,959
Speaker 2: time frame, right when we're talking about years and this

508
00:28:17,000 --> 00:28:21,160
Speaker 2: person was in the nursing home needing exquisite care. That

509
00:28:21,280 --> 00:28:28,080
Speaker 2: it then gets really complicated to really prove it. You

510
00:28:28,119 --> 00:28:30,879
Speaker 2: know that there isn't an intervening event, you know, and

511
00:28:30,920 --> 00:28:33,000
Speaker 2: that's where defense lawyers are going to come in and say, hey,

512
00:28:33,680 --> 00:28:35,960
Speaker 2: you know, they had a stroke or they had something

513
00:28:36,040 --> 00:28:37,360
Speaker 2: completely unrelated.

514
00:28:37,400 --> 00:28:39,360
Speaker 3: Why are you saying it's the gunshot? Right?

515
00:28:39,400 --> 00:28:42,600
Speaker 2: They're just getting old and they had a natural medical event,

516
00:28:42,680 --> 00:28:43,280
Speaker 2: and it's you.

517
00:28:43,240 --> 00:28:47,960
Speaker 3: Know, that's really where it becomes you know, difficult.

518
00:28:47,960 --> 00:28:49,840
Speaker 2: You really have to sort out the facts, you know,

519
00:28:49,920 --> 00:28:54,160
Speaker 2: the timing, the extent, the location, whatever. Absolutely, you can't

520
00:28:54,160 --> 00:28:57,640
Speaker 2: just start charging people without being sure that the events

521
00:28:57,640 --> 00:28:58,040
Speaker 2: are in men.

522
00:28:58,480 --> 00:29:02,760
Speaker 1: Well, doctor, appreciate it. I tell you, next time I

523
00:29:02,800 --> 00:29:04,880
Speaker 1: hear somebody say, well, I hope they have a slow,

524
00:29:05,040 --> 00:29:07,920
Speaker 1: painful death, you know what, I hope you know what

525
00:29:07,960 --> 00:29:11,240
Speaker 1: you're talking about because it is horrifying.

526
00:29:11,360 --> 00:29:15,440
Speaker 2: Well yeah, and even our eye drop keis right, that

527
00:29:15,520 --> 00:29:19,520
Speaker 2: wasn't that wasn't an instant death, right, think about I mean.

528
00:29:19,960 --> 00:29:25,200
Speaker 3: Different, Yeah, that's right, that's right.

529
00:29:25,760 --> 00:29:28,480
Speaker 1: Well, I appreciate you so much and we will talk again.

530
00:29:28,560 --> 00:29:31,760
Speaker 3: Money, Yes, take care of them, thank you, ma'am. Right,