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Speaker 1: Y'all, Welcome to Pathology with Doctor Pria, Ellen Greenberg, Part two.

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Speaker 1: So Doctor Pria last week was giving us a great

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Speaker 1: introduction to autopsy one on one and she started to

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Speaker 1: explain the injuries that she notated with Ellen Greenberg. Now

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Speaker 1: she's going to jump right back into where she was

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Speaker 1: where she's talking about the two injuries on the back

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Speaker 1: of the head that would have rendered Ellen incapable of

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Speaker 1: stabbing herself even more. And that's critical because as y'all know,

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Speaker 1: when she was found the knife was in her chest,

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Speaker 1: which would have meant there was at least one more

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Speaker 1: stab wound after those two that she's already pinpointed. Doctor Pria,

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Speaker 1: Welcome back and thank you again for taking us through

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Speaker 1: this important case.

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Speaker 2: Yes, so I do want to, you know, just revisit

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Speaker 2: the issue that when I look at anybody who's been

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Speaker 2: stabbed multiple times, it's the order is you know, is

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Speaker 2: impossible to determine unless it's on video. Okay, now we

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Speaker 2: know the last stab wounds the one with the knife,

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Speaker 2: and we can we need to pay attention at autopsy

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Speaker 2: whether there's bleeding with each wound in stab or in

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Speaker 2: size or cutting wound to see if it was while

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Speaker 2: she was physiologically alive. Okay, So that is where we're

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Speaker 2: talking about. Now. We know that the chest wound is

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Speaker 2: the last one because it has a knife in it.

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Speaker 2: That's the only one I can tell. Okay. I can't

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Speaker 2: tell you if it's neighbor on the chest or the

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Speaker 2: neck was first, middle, you know, second to last. We're

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Speaker 2: just gonna have to look at each one. Okay. Now,

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Speaker 2: when these wounds are described, we just we can't say

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Speaker 2: wound number one two because I think that implies too

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Speaker 2: much of an order. So like what's done in this case,

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Speaker 2: I always do ABCD and I put a huge caveat

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Speaker 2: at the top of my report that these are labeled

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Speaker 2: purely for descriptive purposes and in any order in which

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Speaker 2: they were sustained is not implied. Okay, So just remember that,

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Speaker 2: even though I'll talk about letterings that have been assigned,

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Speaker 2: we just know that they happened before she died with

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Speaker 2: the knife in her chest. Okay. That being said, diagrams

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Speaker 2: that were shown to me, generated separately by other parties

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Speaker 2: this week had two wounds N and T. Okay, and

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Speaker 2: I don't recall I don't remember which one was which.

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Speaker 2: If N was in the base of the skull, and

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Speaker 2: T was at the at the spinal column. So I'll

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Speaker 2: take those letters out and just refer to these wounds

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Speaker 2: by location for clarity. So there's one at the base

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Speaker 2: of her skull that goes into the skull through the dura. Okay.

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Speaker 2: The dura is the thick covering over the brain and

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Speaker 2: brain stem and into a very critical part of the

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Speaker 2: brain stem that controls motor function. Now that's a lot

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Speaker 2: of language. Okay, what does that mean. She was stabbed

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Speaker 2: in the back of her head at the base of

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Speaker 2: the head and the knife cut through all of the

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Speaker 2: structures into the brain tissue. Okay. Now, the part of

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Speaker 2: the brain tissue that it affected is called the brain stem. Okay,

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Speaker 2: as you guys are listening, as I'm sitting here talking

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Speaker 2: a mile a minute, we're not thinking about heartbeat and breathing, right.

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Speaker 2: That happens all by itself, and it's the brain stem

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Speaker 2: that we call sometimes the reptilian brain because you know,

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Speaker 2: reptiles are simple, but they're still alive. This is housekeeping

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Speaker 2: brain function. Okay. Now, there's a part of where this

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Speaker 2: injury landed was in the cerebral ped uncle. So this

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Speaker 2: is part of sorry, Sarah, Sarah Beller ped uncle where

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Speaker 2: the back of your brain that controls like balance and

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Speaker 2: motor skills, your movement. It's where how these messages are communicated.

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Speaker 2: And there was bleeding there from the stab wound, which

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Speaker 2: means this critical portion of the brain was injured. Okay.

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Speaker 2: Brain doesn't like any blood, any irritation because that short

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Speaker 2: circuits at the signals can't get through. Okay, let's think

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Speaker 2: about it that way. That's highly concerning because they absolutely

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Speaker 2: saw bleeding with this, So she was physiologically alive when

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Speaker 2: that happened, so her movement isn't going to be affected.

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Speaker 2: Her ability to move. This is a devastating injury. Okay.

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Speaker 2: Then we're going to move lower down her neck now

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Speaker 2: again just to lay out the anatomy. Our neck has

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Speaker 2: seven vertebras, Okay, so when we say neck, that's called

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Speaker 2: the cervical region. So for abbreviation we say C. So

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Speaker 2: C one through seven are the seven cervical vertebrae, the

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Speaker 2: neck vertebrae the bones in our neck that help us

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Speaker 2: form our neck, and then are the cage basically formed

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Speaker 2: around the spinal cord in that area. Okay, So the

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Speaker 2: skull connects to the spinal column at C one. That's

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Speaker 2: a very tight connection. That's what between C one and

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Speaker 2: C two, they're special anatomy of those structures that allow

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Speaker 2: us to nod yes, no, side to side, round and

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Speaker 2: round without becoming injured. Okay, because that's a very stable setup. Now,

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Speaker 2: in Ellen's case, she was stabbed between C two and

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Speaker 2: C three, So the cervical vertebrate two and the cervical

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Speaker 2: vertebrate three, so high up. Okay, Remember we have all

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Speaker 2: of our neck is through seven, so we're in the

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Speaker 2: upper section of the cord. And I don't know if

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Speaker 2: I specified. C one starts at the base of the

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Speaker 2: skull and C seven is closer to the back of

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Speaker 2: the neck before the chest starts. Okay, so we're going

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Speaker 2: one being the highest, seven being the lowest. So just

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Speaker 2: to know the anatomy. So when you're talking about C

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Speaker 2: two through three, that is a critical area of the

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Speaker 2: spinal cord, and we have nerves coming out of every

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Speaker 2: level of the spinal cord. So again we use that

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Speaker 2: vertebral region C two nerves, C three nerves to talk

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Speaker 2: about what it's being supplied. Now, what I do want

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Speaker 2: to point out is that the arms are controlled by

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Speaker 2: C five six and seven. So a little bit lower

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Speaker 2: is where we are dealing with nerves to the arms. Okay,

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Speaker 2: Now why is this also important? And I'm blathering on

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Speaker 2: about this, Well, remember see five, six and seven. It

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Speaker 2: is controlling the arms. If we have an injury high

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Speaker 2: up on the neck. If you have an injury at

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Speaker 2: C one, basically that can be immediately fatal. Okay, where

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Speaker 2: the skull separates, because you're going to even injure that

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Speaker 2: brain stem right where the spinal cord connects. As soon

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Speaker 2: as we move a little bit lower, we're moving into

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Speaker 2: what's called the quadriplegia. Okay. So like when we say

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Speaker 2: someone is quadriplegic, that means they cannot they're paral their

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Speaker 2: arms and legs are paralyzed. Okay. So it's usually a

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Speaker 2: lower cervical uh vertebral body a server cervical injury. Okay.

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Speaker 2: And and this is where we really got to see,

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Speaker 2: like what's going on. So I have an injury above

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Speaker 2: where the arms are controlled. Okay. So this the stab

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Speaker 2: wound is documented as going through the verse to bray,

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Speaker 2: through the covering of the spinal cord and the spinal

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Speaker 2: cord is bulging through that wound. Let me tell you

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Speaker 2: what should not be bulging the spinal cord, okay, and

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Speaker 2: whether there's bleeding or not, whether it's in place or not.

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Speaker 2: I mean, any disruption to the spinal cord is markedly abnormal.

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Speaker 2: And you know I've talked about it before. I'm a

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Speaker 2: football fan. Well, we've seen on the field where someone

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Speaker 2: gets hit right and sometimes their spinal cord is stunned

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Speaker 2: where they can't move their arms and legs, but later

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Speaker 2: it heals and they can move it. But we know

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Speaker 2: just from a non penetrating injury like that shock, it

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Speaker 2: can affect the spinal cord. Okay. So here we have

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Speaker 2: a distinct wound into the spinal cord that's causing it

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Speaker 2: to shift or swell. That makes for a spinal cord

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Speaker 2: that's injured. And they were very wishy washy in the

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Speaker 2: report about this. And also I want to say that

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Speaker 2: the spinal cord was examined in a limited capacity where

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Speaker 2: they looked at it with the naked eye, but not

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Speaker 2: under the microscope. Okay, So taking that in totality, there's

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Speaker 2: no way in my mind that she could move her

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Speaker 2: arms from this injury. Okay. So basically anything above where

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Speaker 2: her arms needed the nerves to function, is now injured.

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Speaker 2: So how can she stab herself if the spinal cord

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Speaker 2: is injured, if the brainstem is injured, And that's really

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Speaker 2: the meat of it. Okay, that is my critical assessment. Now,

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Speaker 2: does she bleed from the other wounds? Yes, I'm not

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Speaker 2: negating that the other wounds contribute to her death. She

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Speaker 2: bled to death from the wounds. That was quite a

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Speaker 2: bit of blood in the sack around the heart, which

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Speaker 2: is called the pericardium. But all in all, that's how

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Speaker 2: she died. But this neurologic deep defect, right, not being

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Speaker 2: able to move your arms, not being able to have

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Speaker 2: motion motor control, to me as a critical aspect. Now

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Speaker 2: I'm going to sort of be an extremist. And if

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Speaker 2: I make one assumption, I e. That these wounds to

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Speaker 2: the back of the head and neck came early in

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Speaker 2: the array of injuries, Well, she can't move her arms,

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Speaker 2: she can't have defensive wounds, right, Okay, So that is

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Speaker 2: an assumption, okay, and I have no medical proof of that.

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Speaker 2: So this is now me playing. I'm just playing Devil's advocate.

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Speaker 2: But it could be one reason why she doesn't have

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Speaker 2: defensive wounds. Okay, And that is something I really wanted

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Speaker 2: to put out there that you know, the order. And

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Speaker 2: I again, this is a complete assumption on my part

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Speaker 2: to prove, you know, to make to sort of put

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Speaker 2: it out there. But I can't prove that, and I

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Speaker 2: don't want to be misconstrued about that. But could have

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Speaker 2: happened that way. And I don't think when you look

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Speaker 2: at the directionality of these stab wounds and the depth,

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Speaker 2: I just don't think a lot of the wounds on

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Speaker 2: the back can be achieved by her self step like

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Speaker 2: by she stabbing herself. That's just it's very awkward positions.

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Speaker 2: Now this takes me into sort of other issues, like

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Speaker 2: I have had stab wounds or cases that died of

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Speaker 2: sharp force injuries numerous okay, ten twenty fifty ninety that

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Speaker 2: were self inflicted. So it's not just the number that

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Speaker 2: is alarming. Now, is it alarming? Yes? I mean I

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Speaker 2: go to every case and I'm like, whoa, Nelly, we

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Speaker 2: need to figure this out and make sure this isn't

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Speaker 2: you know, oh, Doc, this is a this is a suicide. Wait, whoa?

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Speaker 2: You know? That's my conclusion and I go through step

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Speaker 2: by step. And when I say I go through step

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Speaker 2: by step anything abnormal like this, I go to the scene.

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Speaker 2: I used to go to the crime scene so like

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Speaker 2: because I want to see it, you know, and I

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Speaker 2: need the police to work it through with me. There's

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Speaker 2: often times I'm calling blood spatter experts because I'm not one.

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Speaker 2: You know, we're dumping this day and age. We have

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Speaker 2: so much electronic data, like video surveillance. We need to

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Speaker 2: make sure I'm looking at psychiatric history. You know. I

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Speaker 2: had one case in Rhode Island that was ninety plus

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Speaker 2: stab wounds and a schizophrenic woman but in very you know,

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Speaker 2: damaging areas not only her torso but her genitalia. And

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Speaker 2: I was just horrified, like what is happening? Because it

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Speaker 2: makes you think of a sexual crime, right, like someone's

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Speaker 2: really mad at her. But after we went through the scene,

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Speaker 2: the bloodstain pattern, you can see one set of footprints

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Speaker 2: moving around. She had schizophrenia that was untreated, like no

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Speaker 2: one else was coming in or out of the apartment.

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Speaker 2: Like it took weeks, you know, I'm summarizing it, but

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Speaker 2: this was a very detailed process, lots back and forth

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Speaker 2: before I was able to stomach it does that make

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Speaker 2: sense and call it a suicide? So it's not that

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Speaker 2: I haven't and it's not you know, it's horrific and

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Speaker 2: people think, oh my got twenty stabus that automatically makes

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Speaker 2: it a homicide. No, it's not automatic. But you have

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Speaker 2: to see what is effected, is it plausible? What is

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Speaker 2: the other history? And if you think about it, any

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Speaker 2: history of mental illness does not make you suicidal. I

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Speaker 2: think that is also you know too much to assume.

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Speaker 2: I mean, mental illness is widespread, there's no stigma about it.

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Speaker 2: I think more people. I wish more people had the

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Speaker 2: help they need, you know. And can it be associated

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Speaker 2: with suicidality? Of course, right, that's what we worry about.

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Speaker 2: But any sort of stress or any sort of history

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Speaker 2: doesn't automatically just support suicide either, you know. And as

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Speaker 2: I think I've talked about in the past, I get

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Speaker 2: all the medical history I can because that's part of

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Speaker 2: the investigation. But looking at Ellen's stab wounds, these two

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Speaker 2: are the ones that really like gave me pause.

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Speaker 1: As I described, let me ask you this, what do

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Speaker 1: the bruises along with the stab wounds and insize or

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Speaker 1: say to you.

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Speaker 2: Bruising is I'm more cautious about. Okay. What I mean

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Speaker 2: is there are a lot of bruises that were described

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Speaker 2: and some were not described that I think is malpracticed

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Speaker 2: because people have even heard me in court. They'll ask,

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Speaker 2: you know, they'll be like, why is a quarter inch

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Speaker 2: nick on the shin important? You know, when we have

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Speaker 2: a gunshot wound case, do you understand it has nothing

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Speaker 2: to do with any of it? And it's because my

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Speaker 2: job at autopsy is to mark everything. Okay, anything that's

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Speaker 2: abnormal with the body needs to be described. Now. Am

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Speaker 2: I going to call that a major injury if the

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Speaker 2: ey's been shot six times? Obviously not right, but you

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Speaker 2: never know. And any abrasion, right, Like I remember a

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Speaker 2: kid had a drug overdose and he had all these

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Speaker 2: scratches on his forearm. Why And I said, where are

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Speaker 2: these from? Oh? He got a new kitten, right, So

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Speaker 2: I just have to be able to explain and notate

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Speaker 2: the injuries. Did it have anything to do with his death?

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Speaker 2: Obviously not, you know. But so the job of the

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Speaker 2: forensic pathologist is really to do a very detailed one

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Speaker 2: over on the body and document everything. And that's why

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Speaker 2: we also take pictures right to correlate with the descriptions.

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Speaker 2: So that is what bothered me about this case. And

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Speaker 2: then anytime you have you know, you leave out an

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Speaker 2: injury or injuries, then that weakens your total assessment, your believability.

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Speaker 2: So that's really what frustrated me about this. Now, there's

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Speaker 2: been a lot of studies on bruises that show you

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Speaker 2: can't just look at a bruise and tell how old

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Speaker 2: it is, okay, And this comes up a lot in

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Speaker 2: child abuse because people just try to date bruises. So,

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Speaker 2: you know, I don't want to get into the literature

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Speaker 2: too much, but you can't just look at a bruise.

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Speaker 2: I mean, if you hit Cheryl, if I hit you

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Speaker 2: and then you hit me with the hammer, even with

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Speaker 2: the same force on the arm, where two different people,

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Speaker 2: we're gonna bruise differently. You know, we may heal differently.

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Speaker 2: It could be our you know what medications were on

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Speaker 2: our age, our genetics.

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Speaker 1: Oh yeah, I have one sister she bruises super easy

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Speaker 1: and another one that Harley bruises at all correct.

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Speaker 2: And they could both bump their shin or bump their

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Speaker 2: elbow right, And so you cannot just look at a

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Speaker 2: color of a bruise. So it's improper to say there

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Speaker 2: are bruises in various stages of healing. Okay, I don't

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Speaker 2: like that, because you can if you hit me with

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Speaker 2: a hammer on my thigh and then hit me on

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Speaker 2: the shin, right, my shin has hardly any meat on it,

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Speaker 2: my thighs have much more meat on it. Right. So obviously,

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Speaker 2: even though it's the same force, the same hammer, the

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Speaker 2: same hit, if you will, just the nature of the location, well,

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Speaker 2: the bruise will be different, okay, and the how we

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Speaker 2: each heal is different. Are are what we're affected with, genetics, medications, whatever.

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Speaker 2: So I never say bruises in different stages of healing.

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Speaker 2: I will say there are multiple bruises, okay. But sometimes

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Speaker 2: I even have to and this gets into other deaths,

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Speaker 2: like police custody deaths, where I have to look, I

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Speaker 2: have to cut into deeper tissues like the back or

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Speaker 2: the butt that may not be apparent, like if you're so,

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Speaker 2: if it's a thick area of the body, you can

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Speaker 2: have bleeding inside, but the bruise you can't. You don't

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Speaker 2: even see it on the surface. Okay, So that's the

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Speaker 2: depth of the tissues that are affected, et cetera. All

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Speaker 2: play into how a color can be different. Now there's

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Speaker 2: papers that say, like, if you look at it under

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Speaker 2: the microscope, which was not done in this case, you

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Speaker 2: can sort of get a better idea of when the

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Speaker 2: bruise was there, like eighteen hours. But we're talking almost

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Speaker 2: a day before you can see a reaction to it,

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Speaker 2: you know what I mean. And so the one thing

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Speaker 2: that I will say is she had bruises, and what's

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Speaker 2: happening is, yes, they're there. I cannot say that they

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Speaker 2: were associated with the stabbing assault, or they could have

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Speaker 2: been from another assault, or they could have been or

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Speaker 2: some of them could be from another assault, some of

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Speaker 2: them could be just knocking around exercising whatever it is.

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Speaker 2: Do you understand that? So, that to me is what

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Speaker 2: I make of the bruises. I don't want to overinterpret them.

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Speaker 2: She was quite thin.

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Speaker 1: I just think thirty one one that's a lot of bruises.

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Speaker 2: That's a lot, right, And for someone who's not a toddler, right,

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Speaker 2: you know little kids shocking around.

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Speaker 1: Right, Yeah, she's not a toddler. She's not a professional athlete,

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Speaker 1: she's not right clumsy.

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Speaker 2: I don't know how she sustained them, but it would

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Speaker 2: be improper to automatically assume that they were related to

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Speaker 2: this assault.

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Speaker 1: Understood, but her heart had to be beaten for that

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Speaker 1: to occur.

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Speaker 2: Correct, Correct, Because a bruce is bleeding. Okay, it's a

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Speaker 2: crush injury, so it's a different type of injury. Your

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Speaker 2: tissue gets crushed and then you have bleeding into it.

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Speaker 2: So you know, without getting further into that, a bruce

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Speaker 2: is an injury. So she has to be alive when

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Speaker 2: she sustained it. But how she sustained it and when

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Speaker 2: she sustained it, I cannot say. So to then assume

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Speaker 2: that all of these could some of them be? Definitely?

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Speaker 2: Do you understand? But I can't say all of them

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Speaker 2: were a theater with this only this incident.

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Speaker 1: In your professional opinion, how important would it be for

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Speaker 1: her parents to be able to sit down with five experts,

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Speaker 1: ten experts that had knowledge intimate knowledge of the autopsy

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Speaker 1: and explain to them how this ruling could possibly be.

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Speaker 1: I mean, even what you said, and for people to understand.

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Speaker 1: You know, that's why they call it a sea collar.

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Speaker 1: Like just that limited area told you so much? How

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Speaker 1: could her mama ever move off of this and move forward?

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Speaker 1: I would be losing my mind.

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Speaker 2: Right, I'm a girl mom. I've said it probably on

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Speaker 2: every episode because I talk about my daughter so much

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Speaker 2: like she is my life force. And I'm not being

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Speaker 2: over dramatic, you know, And so I don't know. I

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Speaker 2: don't know. I think, you know, her parents' courage to

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Speaker 2: me to keep fighting is really remarkable. And I'm not

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Speaker 2: saying this because I thought about this as I've spoken

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Speaker 2: about the case during the week. The fact that this

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Speaker 2: has gone on for years, you know, really just is

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Speaker 2: a power of their love and they want the correct answer.

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Speaker 2: You know. I don't know anything else about the dynamics

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Speaker 2: of the family, the dynamics between the fiancees fans. I

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Speaker 2: mean that goes beyond the medicine and beyond what's important

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Speaker 2: to me in this case. But I think to me,

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Speaker 2: it would be very difficult knowing what I do to

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Speaker 2: provide closure to them with the ruling that's just been issued.

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Speaker 1: Doctor Pria, Thank you so much. This case has bothered

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Speaker 1: me from day one, and I just appreciate the way

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Speaker 1: you and only you could walk us through it. So

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Speaker 1: thank you so much.

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Speaker 2: Thank you for having me on this. I know I

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Speaker 2: came off pretty passionate, and I do want to say

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Speaker 2: I approached it with caution when I first, you know,

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Speaker 2: was sort of peripherally involved because of the work and Sarah,

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Speaker 2: Kayleen and you know Hulu it. I actually had not

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Speaker 2: followed it. So most people know I don't really follow

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Speaker 2: cases unless I'm asked to comment on them, right. I

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Speaker 2: don't get involved because we all have our own load

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Speaker 2: of work to do, right And so it's as I've

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Speaker 2: been really digging into the medicine behind it, the forensic pathology,

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Speaker 2: that I could make statements like I did this in

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Speaker 2: these two episodes.

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Speaker 1: Well, I appreciate it, and you know, I know that

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Speaker 1: our listeners are going to get a lot out of it.

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Speaker 1: There's just so much information, and again, to me, the

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Speaker 1: way you lay it out, it's pretty compelling that I

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Speaker 1: appreciate you so much