1 00:00:08,039 --> 00:00:13,000 Speaker 1: Welcome to Pathology with Doctor Pria. Doc so good to 2 00:00:13,039 --> 00:00:15,360 Speaker 1: talk to you. How are you, honey, I'm doing well. 3 00:00:15,480 --> 00:00:16,880 Speaker 2: Thank you. 4 00:00:16,880 --> 00:00:20,440 Speaker 1: You know you and I talked off air yesterday. We 5 00:00:20,600 --> 00:00:24,959 Speaker 1: lost a great judge and a better man, and you 6 00:00:25,000 --> 00:00:28,040 Speaker 1: know you had such wonderful things to say. I'm just 7 00:00:28,120 --> 00:00:30,840 Speaker 1: gonna give you the mic so you can honor him. 8 00:00:31,200 --> 00:00:35,839 Speaker 2: Well, it's hard. I'm gonna try not to shed some tears. 9 00:00:35,920 --> 00:00:39,519 Speaker 2: So you know. The one thing is I didn't know 10 00:00:39,680 --> 00:00:43,640 Speaker 2: him personally. I knew him more professionally, just like the 11 00:00:43,680 --> 00:00:46,120 Speaker 2: rest of the world did. I'm talking about the honorable 12 00:00:46,240 --> 00:00:50,479 Speaker 2: Judge Frank Caprio who passed away, and you know, as 13 00:00:50,520 --> 00:00:55,320 Speaker 2: a doctor, he asked for prayers the night before and 14 00:00:55,880 --> 00:00:57,960 Speaker 2: I hate to say it, I was worried then that 15 00:00:58,040 --> 00:01:00,600 Speaker 2: he seemed weak, you know, but he's meant, he was 16 00:01:00,640 --> 00:01:03,920 Speaker 2: so strong. I was just hoping and praying that it, 17 00:01:04,880 --> 00:01:08,080 Speaker 2: you know, wasn't the end for him. But pancreatic cancer 18 00:01:08,240 --> 00:01:12,560 Speaker 2: is just an evil, evil disease. And you know, I 19 00:01:12,600 --> 00:01:18,039 Speaker 2: think with so much negativity and you know, whatever's going 20 00:01:18,080 --> 00:01:21,040 Speaker 2: on in our lives around us, he just saw the 21 00:01:21,120 --> 00:01:24,880 Speaker 2: light and the pure joy in life and people, and 22 00:01:24,920 --> 00:01:27,680 Speaker 2: I think that's what I always took away from him. 23 00:01:27,720 --> 00:01:32,199 Speaker 2: You know, he was locally known from a very prestigious 24 00:01:32,240 --> 00:01:36,800 Speaker 2: family because of his work, and then you know, he 25 00:01:36,920 --> 00:01:41,520 Speaker 2: became a national superstar really because of his generosity as 26 00:01:41,520 --> 00:01:45,280 Speaker 2: a judge, which just you know, uncommon to see, you know, 27 00:01:45,400 --> 00:01:51,480 Speaker 2: right on the bench, the soft, kind hearted understanding. He 28 00:01:51,680 --> 00:01:54,880 Speaker 2: was a municipal judge, so he dealt with people who 29 00:01:54,960 --> 00:01:58,840 Speaker 2: were really hard up in life. And I think people 30 00:01:58,880 --> 00:02:03,800 Speaker 2: come with excuses sometimes to court, but he really saw 31 00:02:03,840 --> 00:02:06,120 Speaker 2: the best in people. And that's what I want to 32 00:02:06,240 --> 00:02:09,359 Speaker 2: like remember him for, and what we can learn from 33 00:02:09,440 --> 00:02:14,240 Speaker 2: him is just to try to be positive despite all challenges. 34 00:02:14,320 --> 00:02:18,919 Speaker 2: I mean, there's nothing like pancreatic cancer. And so I 35 00:02:19,000 --> 00:02:22,680 Speaker 2: just want to honor him and send my sincere condolences 36 00:02:22,760 --> 00:02:26,160 Speaker 2: to his family and his loved ones, his colleagues and friends. 37 00:02:26,760 --> 00:02:29,280 Speaker 2: But you know, we're such a small state here in 38 00:02:29,320 --> 00:02:33,359 Speaker 2: Rhode Island, but it sent ripples around the country because 39 00:02:33,360 --> 00:02:37,720 Speaker 2: so many people knew him from his work that as 40 00:02:37,720 --> 00:02:41,239 Speaker 2: soon as he passed and we were all just, I 41 00:02:41,240 --> 00:02:43,160 Speaker 2: don't know, sort of speechless. What you know, how do 42 00:02:43,200 --> 00:02:45,239 Speaker 2: you honor such an honorable man. 43 00:02:46,320 --> 00:02:50,680 Speaker 1: That was beautiful and you're absolutely right, all right, So listen. Now, 44 00:02:51,200 --> 00:02:56,919 Speaker 1: last week we talked about the external exam when you're 45 00:02:56,919 --> 00:03:00,280 Speaker 1: looking at clothes and tattoos and jewelry and staying and 46 00:03:00,320 --> 00:03:05,240 Speaker 1: et cetera. Tonight we're going to talk about the internal. 47 00:03:05,720 --> 00:03:10,720 Speaker 1: So y'all know what it starts with? That why shaped incision? 48 00:03:11,280 --> 00:03:12,560 Speaker 1: So dot take it away? 49 00:03:13,080 --> 00:03:16,480 Speaker 2: Yeah, so you know, we sort of describe it separately, 50 00:03:16,520 --> 00:03:20,560 Speaker 2: but they're really everything is connected. Right, So we left 51 00:03:20,600 --> 00:03:24,919 Speaker 2: off looking at the outside of the body, any markings, right, 52 00:03:25,040 --> 00:03:31,240 Speaker 2: tattoo scars, but really that's sort of a stamp or 53 00:03:31,280 --> 00:03:34,519 Speaker 2: a glimpse of what I'm going to find inside. Right, 54 00:03:34,920 --> 00:03:39,400 Speaker 2: Sometimes we have you know, surgery scars, we have maybe 55 00:03:39,560 --> 00:03:46,440 Speaker 2: genetic developmental changes, and then of course we're trauma and 56 00:03:46,520 --> 00:03:50,520 Speaker 2: so and remember it's not they're not mutually exclusive, right, 57 00:03:50,760 --> 00:03:55,040 Speaker 2: normal people can have multiple things. And so I want to, 58 00:03:55,160 --> 00:03:59,920 Speaker 2: you know, say that this is where the two worlds 59 00:04:00,120 --> 00:04:03,440 Speaker 2: sort of meat. And we started started gathering like the 60 00:04:03,440 --> 00:04:06,880 Speaker 2: rest of the data of the autopsy. So when we 61 00:04:07,200 --> 00:04:09,680 Speaker 2: talked about it last week, I just want to say, 62 00:04:09,800 --> 00:04:13,640 Speaker 2: we sort of talked about a variety of things, but nonetheless, 63 00:04:13,720 --> 00:04:18,159 Speaker 2: this is a medical procedure and it's I do it, 64 00:04:18,200 --> 00:04:20,880 Speaker 2: and I teach it in a very like systematic way. 65 00:04:20,960 --> 00:04:23,920 Speaker 2: So like when we're living and we go to the doctor, right, 66 00:04:23,960 --> 00:04:27,400 Speaker 2: they take our height and wait, and then they check 67 00:04:27,480 --> 00:04:30,040 Speaker 2: our blood pressure, and they listen to our heart and 68 00:04:30,160 --> 00:04:32,960 Speaker 2: lungs and then press on our belly. It's basically the 69 00:04:33,040 --> 00:04:34,599 Speaker 2: same thing in an autopsy. 70 00:04:34,720 --> 00:04:34,880 Speaker 1: Right. 71 00:04:35,320 --> 00:04:38,160 Speaker 2: So anytime I'm doing the outside of a person, I'm 72 00:04:38,200 --> 00:04:41,640 Speaker 2: looking top to bottom. I always do the right side, 73 00:04:41,640 --> 00:04:43,480 Speaker 2: then the left side, and then I do the back, 74 00:04:43,760 --> 00:04:46,720 Speaker 2: you know, And so it's the same thing for the inside, 75 00:04:47,320 --> 00:04:50,760 Speaker 2: which means I start with this famous wy decision. Now 76 00:04:51,200 --> 00:04:54,599 Speaker 2: it's exactly done in that shape. So what I do 77 00:04:54,760 --> 00:04:57,359 Speaker 2: is I use my scalpel blade to cut through the 78 00:04:57,560 --> 00:05:00,920 Speaker 2: skin and the soft tissues from schol to shoulder, and 79 00:05:00,960 --> 00:05:03,760 Speaker 2: I bring it down like I'm painting the top of 80 00:05:03,800 --> 00:05:07,320 Speaker 2: a y on the body, right to the middle of 81 00:05:07,360 --> 00:05:10,880 Speaker 2: the chest, and then I cut all the way down 82 00:05:11,240 --> 00:05:16,160 Speaker 2: to the pelvic area and the pubic bone. And then 83 00:05:16,520 --> 00:05:21,240 Speaker 2: that's the stem of the Why that is like unlocking 84 00:05:21,279 --> 00:05:25,240 Speaker 2: the body. Okay, I just entered it. Now I have 85 00:05:25,320 --> 00:05:29,880 Speaker 2: to pull all that back, which you know, I think 86 00:05:29,960 --> 00:05:33,080 Speaker 2: the beauty of it all is we're all built the same, 87 00:05:33,200 --> 00:05:36,960 Speaker 2: no matter what our skin color, no matter how heavy 88 00:05:37,040 --> 00:05:41,320 Speaker 2: or light we are. Really it's skin and fat, okay, 89 00:05:41,360 --> 00:05:45,840 Speaker 2: and some muscle. And then once those are removed, I'm 90 00:05:45,880 --> 00:05:48,400 Speaker 2: looking at the chest plate. So you imagine it like 91 00:05:48,440 --> 00:05:51,760 Speaker 2: a body of armor. Okay, and I take that off 92 00:05:52,120 --> 00:05:54,120 Speaker 2: and believe it or not. I hate to be very 93 00:05:54,200 --> 00:05:57,040 Speaker 2: crude about it, but there's not a lot of fancy tools. 94 00:05:57,040 --> 00:06:01,599 Speaker 2: We use an autopsy and some people use like a 95 00:06:01,720 --> 00:06:05,400 Speaker 2: surgical type saw, but most of the time I was trained, 96 00:06:05,440 --> 00:06:10,040 Speaker 2: we use tree cutting shears from a hardware store, so 97 00:06:10,120 --> 00:06:12,719 Speaker 2: they can cut through limbs, they can cut through bone 98 00:06:12,760 --> 00:06:16,599 Speaker 2: like ribs, and we remove the chest plate. And it's 99 00:06:16,600 --> 00:06:21,000 Speaker 2: sort of the ultimate look inside. Right, I'm looking at 100 00:06:21,080 --> 00:06:24,359 Speaker 2: everything from the collar bones to the pelvic bone. I 101 00:06:24,400 --> 00:06:26,839 Speaker 2: see the heart, it's in its sack. I see the 102 00:06:26,920 --> 00:06:31,520 Speaker 2: lungs right, and then that's the chest. So I do 103 00:06:31,600 --> 00:06:36,440 Speaker 2: it very systematically, in an orderly fashion. I first take 104 00:06:36,520 --> 00:06:40,080 Speaker 2: out I open the sack around the heart, make sure 105 00:06:40,160 --> 00:06:43,920 Speaker 2: that is not punctured or filled with fluid. I look 106 00:06:43,960 --> 00:06:46,960 Speaker 2: at the heart itself. I remove the heart, make sure 107 00:06:47,000 --> 00:06:50,640 Speaker 2: there's not a clot between the lungs and the heart, 108 00:06:50,839 --> 00:06:53,320 Speaker 2: and then go from there. We weigh each organ, So 109 00:06:53,360 --> 00:06:57,720 Speaker 2: the heart gets weighed and then each lung is separated. 110 00:06:58,360 --> 00:07:01,560 Speaker 2: Now all this time looking at are these in the 111 00:07:01,640 --> 00:07:04,800 Speaker 2: right position? Is there any fluid around them that shouldn't 112 00:07:04,800 --> 00:07:08,560 Speaker 2: be there? Is there any blood infection? So every step, 113 00:07:09,800 --> 00:07:12,480 Speaker 2: you know, like I said, I'm not gonna talk about 114 00:07:12,840 --> 00:07:15,800 Speaker 2: every single thing in my mental checklist, but it's there, 115 00:07:16,600 --> 00:07:20,440 Speaker 2: you know, And that's how I train my junior doctors. 116 00:07:20,920 --> 00:07:23,920 Speaker 2: You know, you think I'm not. I'm just going through 117 00:07:23,960 --> 00:07:27,280 Speaker 2: the motions, but really my eyes and brain are constantly 118 00:07:27,360 --> 00:07:31,480 Speaker 2: communicating what do I have here? Okay? Is the heart enlarged? 119 00:07:31,640 --> 00:07:34,720 Speaker 2: Is the heart in the normal connection? Is their heart 120 00:07:34,760 --> 00:07:37,680 Speaker 2: surgery in the past, right? There may have been clues 121 00:07:37,720 --> 00:07:39,880 Speaker 2: to that on the skin on the outside or the 122 00:07:40,000 --> 00:07:42,360 Speaker 2: chest plate, if there's heart surgery in the past, and 123 00:07:42,440 --> 00:07:45,320 Speaker 2: now I'm going to see it on the inside, like 124 00:07:45,360 --> 00:07:48,400 Speaker 2: what was done? You know, I don't often have the 125 00:07:48,440 --> 00:07:52,440 Speaker 2: full story and medical records when I'm doing an autopsy, 126 00:07:52,480 --> 00:07:54,840 Speaker 2: and they may come in later, you know, and the 127 00:07:54,880 --> 00:07:57,080 Speaker 2: family may know that, oh he had heart surgery. But 128 00:07:57,200 --> 00:08:02,200 Speaker 2: you know, you can't always expect detailed medical record when 129 00:08:02,200 --> 00:08:05,360 Speaker 2: you're going in. So sometimes I am learning as I go, 130 00:08:05,480 --> 00:08:07,440 Speaker 2: and I just have to be very careful with the 131 00:08:07,480 --> 00:08:13,360 Speaker 2: dissection that you know, I document everything and also sort 132 00:08:13,360 --> 00:08:19,480 Speaker 2: of disconnect things gently and systematically, so I can see, Okay, 133 00:08:19,520 --> 00:08:23,280 Speaker 2: this artery was you know, routed to the heart because 134 00:08:23,320 --> 00:08:26,200 Speaker 2: this person had a bypass in the past. Oh that 135 00:08:26,280 --> 00:08:28,120 Speaker 2: means they might have had a heart attack or some 136 00:08:28,160 --> 00:08:32,480 Speaker 2: sort of hurt problems. Right, Like these are all this 137 00:08:32,559 --> 00:08:34,840 Speaker 2: is how my mind works as I'm doing it. Like 138 00:08:34,880 --> 00:08:38,520 Speaker 2: what clues are revealed and what does that represent? You know, 139 00:08:38,760 --> 00:08:39,880 Speaker 2: were they a smoker? 140 00:08:40,120 --> 00:08:40,320 Speaker 1: Right? 141 00:08:40,360 --> 00:08:42,680 Speaker 2: I can tell by looking at the lungs or did 142 00:08:42,720 --> 00:08:46,080 Speaker 2: they have a lung cancer? Or is there are the 143 00:08:46,160 --> 00:08:49,719 Speaker 2: lungs so discolored and heavy that there might be an 144 00:08:49,720 --> 00:08:53,840 Speaker 2: infection like a pneumonia? And I think, you know, we 145 00:08:54,040 --> 00:08:57,160 Speaker 2: just went through the cod we can't forget about COVID, right, 146 00:08:57,280 --> 00:09:02,280 Speaker 2: So that was really injurious to the lungs. Right, The 147 00:09:02,400 --> 00:09:05,520 Speaker 2: lungs were not working for many people who are dying 148 00:09:05,600 --> 00:09:08,840 Speaker 2: from COVID. So I could just see, oh my gosh, 149 00:09:08,840 --> 00:09:12,080 Speaker 2: these lungs are dense. They're not filling with air, They're 150 00:09:12,120 --> 00:09:15,800 Speaker 2: filled with fluid and infection. So I mean that's gonna 151 00:09:15,800 --> 00:09:21,560 Speaker 2: send me down, you know, almost like a different pathway meaning, Okay, 152 00:09:21,640 --> 00:09:24,000 Speaker 2: I need to figure out what infection this is. I 153 00:09:24,120 --> 00:09:29,800 Speaker 2: might send microbiology studies, you know, infection studies from the 154 00:09:29,880 --> 00:09:34,800 Speaker 2: lung tissue or usually both. I'll also take tissue samples 155 00:09:34,800 --> 00:09:38,240 Speaker 2: to look under the microscope. Right. So this is where like, 156 00:09:39,280 --> 00:09:45,960 Speaker 2: it's not one one recipe for everybody, right, because depending 157 00:09:45,960 --> 00:09:48,440 Speaker 2: on what I'm finding, depending on the case, you know, 158 00:09:48,520 --> 00:09:51,600 Speaker 2: case by case, just like every crime scene isn't that 159 00:09:51,760 --> 00:09:55,040 Speaker 2: isn't handled the same, right, It just depends depends on 160 00:09:55,080 --> 00:09:58,160 Speaker 2: the crime, depends on the flavor of the scene. Well, 161 00:09:58,200 --> 00:10:00,920 Speaker 2: what's the flavor of the autopsy. Right. If it's a young, 162 00:10:00,960 --> 00:10:05,079 Speaker 2: healthy person who drops dead, well then I think drugs, 163 00:10:05,920 --> 00:10:12,400 Speaker 2: maybe something genetic more often drugs, trauma, maybe a heart condition, 164 00:10:12,720 --> 00:10:16,640 Speaker 2: you know. But unfortunately, drugs being the most you know, 165 00:10:16,800 --> 00:10:20,480 Speaker 2: common in our daily lives, I need to make sure 166 00:10:20,520 --> 00:10:25,040 Speaker 2: I get every dang you know, toxicology sample I need, right, 167 00:10:25,160 --> 00:10:28,679 Speaker 2: And that's true with everybody. I mean, I was I 168 00:10:28,720 --> 00:10:30,960 Speaker 2: had an interview for a different program and I was 169 00:10:31,040 --> 00:10:36,040 Speaker 2: joking with the casting director. I'm like, what's the oldest 170 00:10:36,480 --> 00:10:40,000 Speaker 2: you know, drug abuser that I've handled case? And she 171 00:10:40,080 --> 00:10:43,360 Speaker 2: said eighty five. I said, no, nineties, you know, so 172 00:10:43,679 --> 00:10:49,640 Speaker 2: I run toxicology on everybody. Okay, so like even Grandma 173 00:10:49,679 --> 00:10:51,719 Speaker 2: who may not be able to walk. Well, I've had 174 00:10:51,760 --> 00:10:56,160 Speaker 2: those cases where they have meth amphetamine in their system 175 00:10:56,200 --> 00:10:58,320 Speaker 2: and I'm like, how is Granny getting meth But that's 176 00:10:58,360 --> 00:11:00,720 Speaker 2: not my pro that's not my role to find, right, 177 00:11:01,120 --> 00:11:04,400 Speaker 2: It's it's the fact that that may impact her heart 178 00:11:04,440 --> 00:11:07,360 Speaker 2: condition and could lead to her death. Right, So I 179 00:11:07,679 --> 00:11:10,280 Speaker 2: don't pass judgment. I just sort of have it that, 180 00:11:10,760 --> 00:11:15,480 Speaker 2: you know, toxicology is so important that you know, I 181 00:11:15,520 --> 00:11:18,320 Speaker 2: need to test it on everybody and then I you know, 182 00:11:18,559 --> 00:11:21,080 Speaker 2: so that's sort of jumping ahead. But because we get 183 00:11:21,080 --> 00:11:26,400 Speaker 2: blood samples from the heart and the leg and sometimes 184 00:11:26,400 --> 00:11:30,200 Speaker 2: the stomach contents if I think someone has eaten, like 185 00:11:30,520 --> 00:11:35,600 Speaker 2: ingested a lot of medication or some chemical purposefully. Right, 186 00:11:35,640 --> 00:11:38,400 Speaker 2: so we're looking at all these sort of issues. 187 00:11:38,840 --> 00:11:41,800 Speaker 1: Well, cannot jump in here a second, because the stomach 188 00:11:41,880 --> 00:11:46,760 Speaker 1: contents are always fascinating to me and critical. A lot 189 00:11:46,800 --> 00:11:50,000 Speaker 1: of times. It'll give us a starting point. I know 190 00:11:50,120 --> 00:11:53,360 Speaker 1: with John B. Nay Ramsay, it was the pineapple, you know, 191 00:11:53,480 --> 00:11:55,880 Speaker 1: and that goes away so quick, so that means she 192 00:11:56,200 --> 00:11:59,439 Speaker 1: ate right before she was killed just about and then 193 00:11:59,559 --> 00:12:01,640 Speaker 1: other people have a steak dinner and they're supposed to 194 00:12:01,720 --> 00:12:04,400 Speaker 1: be poor or you know, you see the red wine 195 00:12:04,480 --> 00:12:05,400 Speaker 1: whatever it might be. 196 00:12:05,800 --> 00:12:08,200 Speaker 2: Yeah, it tells a lot and it's hard sometimes to 197 00:12:08,280 --> 00:12:13,240 Speaker 2: tell visually because it may not look like the food 198 00:12:13,320 --> 00:12:16,600 Speaker 2: you know that was chewed up and swallowed, because it's 199 00:12:16,640 --> 00:12:21,360 Speaker 2: not all mixed together. But it's really important, like even 200 00:12:21,400 --> 00:12:24,880 Speaker 2: in something like drowning, did they swallow water? You know, 201 00:12:25,200 --> 00:12:27,959 Speaker 2: is there water that sort of separates out in their 202 00:12:28,000 --> 00:12:30,680 Speaker 2: stomach that kit that can be a sign of drowning. 203 00:12:30,720 --> 00:12:33,760 Speaker 2: It's not exclusively, but it's something that I like to 204 00:12:33,800 --> 00:12:38,120 Speaker 2: look at, you know, so you know, everything is done 205 00:12:38,160 --> 00:12:41,040 Speaker 2: sort of in context right of what the background is. 206 00:12:41,679 --> 00:12:45,960 Speaker 2: But you know, we're continuing from the heart, lungs. Now 207 00:12:46,000 --> 00:12:48,560 Speaker 2: we're in the stomach. Then we look at the liver. 208 00:12:48,800 --> 00:12:53,960 Speaker 2: The liver is is so resilient but tell so much 209 00:12:54,000 --> 00:12:56,600 Speaker 2: of a story in in US, you know, it's the 210 00:12:56,679 --> 00:13:02,520 Speaker 2: detoxifying center. It can have cancers, but usually if there's 211 00:13:02,520 --> 00:13:08,160 Speaker 2: an infection like a hepatitis or drug abuse, you can 212 00:13:08,240 --> 00:13:11,920 Speaker 2: see scarring, you know, alcoholism, that's probably the number one 213 00:13:11,960 --> 00:13:16,120 Speaker 2: thing I see, you know in the liver. The changes right, 214 00:13:16,480 --> 00:13:21,280 Speaker 2: so you know, then I go to the spleen, which 215 00:13:21,320 --> 00:13:23,880 Speaker 2: is this sort of bag of blood that sits on 216 00:13:23,920 --> 00:13:27,680 Speaker 2: the side, but you can have you know, I've had 217 00:13:28,200 --> 00:13:34,400 Speaker 2: undiagnosed blood cancers because I'm like, Wow, this spleen's really big. 218 00:13:34,440 --> 00:13:37,560 Speaker 2: What's going on with it? You know? And I've looked 219 00:13:37,600 --> 00:13:39,840 Speaker 2: at it and then suddenly I'm like, hey, there's this 220 00:13:40,040 --> 00:13:44,120 Speaker 2: blood cancer that no one knew about, you know, So 221 00:13:44,160 --> 00:13:46,520 Speaker 2: that's really important that you know. The spleen is sort 222 00:13:46,559 --> 00:13:49,760 Speaker 2: of this the blood cleaning system, and it'll get bigger, 223 00:13:50,480 --> 00:13:56,040 Speaker 2: it'll react. So if anybody's had mononucleosis or epstein bar 224 00:13:56,200 --> 00:14:01,400 Speaker 2: infection EBV, sometimes you know, the spleen gets big and inflamed, 225 00:14:01,480 --> 00:14:05,360 Speaker 2: and that's when kids aren't allowed to play contact sports 226 00:14:05,400 --> 00:14:09,120 Speaker 2: because the screen can burst. It's so thin from you know, 227 00:14:09,200 --> 00:14:11,280 Speaker 2: from a hit, and so when it's enlarge, you can 228 00:14:11,360 --> 00:14:16,800 Speaker 2: imagine the balloon stretched even more. So. Like you know, obviously, 229 00:14:16,840 --> 00:14:21,240 Speaker 2: in any kind of trauma, I'm always looking for breaks 230 00:14:21,440 --> 00:14:25,440 Speaker 2: or tears in these organs. Is there blood tracking anywhere 231 00:14:25,440 --> 00:14:28,760 Speaker 2: that gives me an idea where the injury started? 232 00:14:29,400 --> 00:14:32,360 Speaker 1: And you know, Doc, you mentioned an STD and I 233 00:14:32,360 --> 00:14:34,840 Speaker 1: want to ask you two things. Get ready to make 234 00:14:34,840 --> 00:14:38,720 Speaker 1: fun of me, but when I was you know, young 235 00:14:38,800 --> 00:14:42,480 Speaker 1: and first starting you know, twenty twenty one, I thought 236 00:14:42,760 --> 00:14:47,360 Speaker 1: STDs were only owned sex organs, so well I know 237 00:14:47,680 --> 00:14:51,400 Speaker 1: now I know then and like, there was somebody that 238 00:14:51,440 --> 00:14:53,480 Speaker 1: I was dealing with that was a regular in court 239 00:14:53,560 --> 00:14:55,720 Speaker 1: and he would get arrested all the time. Well he 240 00:14:55,800 --> 00:14:58,600 Speaker 1: had these sores on his hands, and I was like, oh, 241 00:14:58,680 --> 00:15:00,440 Speaker 1: you know, poor thing, because he's homeless. I mean, it 242 00:15:00,480 --> 00:15:03,440 Speaker 1: could be ants whatever. I had no idea that. 243 00:15:03,440 --> 00:15:05,359 Speaker 2: Was syphilis, Dallas syphilis. 244 00:15:05,640 --> 00:15:11,120 Speaker 1: Right. So again I have heard sometimes with the internal 245 00:15:11,240 --> 00:15:16,800 Speaker 1: exam some of the STDs are so rampant. 246 00:15:16,160 --> 00:15:20,640 Speaker 2: Right if they can get really you know extin bar mono. 247 00:15:20,720 --> 00:15:23,440 Speaker 2: They call it a kissing disease, but there are other 248 00:15:23,600 --> 00:15:26,320 Speaker 2: ways to get it, so I don't necessarily call it 249 00:15:26,360 --> 00:15:29,880 Speaker 2: in the STD. But it's very contagious. Does that make sense, 250 00:15:30,880 --> 00:15:35,800 Speaker 2: meningitis because these are just like little saliva droplets breathing 251 00:15:35,840 --> 00:15:40,040 Speaker 2: on people can even give you know, transfer the highly 252 00:15:40,160 --> 00:15:44,560 Speaker 2: contagious infection. You know, that's when we see it in 253 00:15:44,600 --> 00:15:48,880 Speaker 2: young people sharings, you know, glasses, drinking from the same glass, kissing, 254 00:15:48,920 --> 00:15:52,520 Speaker 2: whatever it may be. But I think, you know, sometimes 255 00:15:52,560 --> 00:15:56,720 Speaker 2: people have other issues going on that go undetected, and 256 00:15:56,760 --> 00:16:00,320 Speaker 2: I've definitely seen it, like whether it be like something 257 00:16:00,360 --> 00:16:05,640 Speaker 2: like gonorrhea, chlamydia inside especially I hate to say it, 258 00:16:05,640 --> 00:16:09,160 Speaker 2: and a female, you know, women's organs that carries up 259 00:16:09,200 --> 00:16:14,040 Speaker 2: and into the pelvis, and I've seen horrible abscesses, pockets 260 00:16:14,040 --> 00:16:18,720 Speaker 2: of infection. You know, things just get destroyed inside and 261 00:16:18,760 --> 00:16:21,720 Speaker 2: it may not be as a parent on the outside. 262 00:16:22,400 --> 00:16:24,520 Speaker 2: So you know, men and women both get it, but 263 00:16:24,560 --> 00:16:29,480 Speaker 2: it really reeks havoc in a very destructive fashion if 264 00:16:29,480 --> 00:16:32,000 Speaker 2: it's not treated. Of course, antibiotics, you know, if you 265 00:16:32,000 --> 00:16:35,280 Speaker 2: do get detected or it's easy to treat. But so 266 00:16:35,480 --> 00:16:39,480 Speaker 2: you know, that's the sort of takeaway from this is 267 00:16:39,520 --> 00:16:42,120 Speaker 2: if we can teach the living, go see your doctor 268 00:16:42,200 --> 00:16:43,480 Speaker 2: and practice safe sex. 269 00:16:43,600 --> 00:16:43,760 Speaker 1: Right. 270 00:16:43,880 --> 00:16:48,320 Speaker 2: But you know, and I mean when we talk about 271 00:16:49,600 --> 00:16:53,000 Speaker 2: hepatitis C, HIV, I mean all of these can be 272 00:16:53,040 --> 00:16:57,400 Speaker 2: blood borne but also sexually transmitted. So you know, all 273 00:16:57,440 --> 00:17:00,760 Speaker 2: of these are so important to think about that I think, 274 00:17:01,120 --> 00:17:03,800 Speaker 2: not to say complacency, but I think people are now 275 00:17:03,960 --> 00:17:06,600 Speaker 2: less afraid of them in a way because there's treatments 276 00:17:06,680 --> 00:17:12,359 Speaker 2: or preventions. But I don't think anything is is totally gone. 277 00:17:12,720 --> 00:17:16,359 Speaker 1: Right, Well, the plague, what the heck what. 278 00:17:16,240 --> 00:17:19,880 Speaker 2: The heck, right, We're seeing that pop up every now 279 00:17:19,960 --> 00:17:24,760 Speaker 2: and then. But you know, a historical thing is when 280 00:17:25,320 --> 00:17:28,200 Speaker 2: talk about like back in the day, when families would meet, 281 00:17:28,240 --> 00:17:34,680 Speaker 2: like a dad would meet a daughter's, you know, possible spouse, 282 00:17:35,080 --> 00:17:38,240 Speaker 2: they would shake hands and would feel the elbow region 283 00:17:38,359 --> 00:17:42,640 Speaker 2: because there's lymph nodes there that can get enlarged and syphilis, 284 00:17:42,640 --> 00:17:46,000 Speaker 2: so that was like one of the tests for it, 285 00:17:46,200 --> 00:17:49,480 Speaker 2: you know. And if you hear that, yeah, yep, and 286 00:17:49,520 --> 00:17:52,080 Speaker 2: then you know, you sometimes have to get syphilis testing 287 00:17:52,200 --> 00:17:56,560 Speaker 2: antiquated for marriage licenses, you know, because that those laws 288 00:17:56,560 --> 00:18:00,439 Speaker 2: were set so far back. And then there's even things 289 00:18:00,520 --> 00:18:03,000 Speaker 2: like well I didn't talk about in the external, but 290 00:18:03,119 --> 00:18:06,240 Speaker 2: there's a nodule like if someone has cancer brewing on 291 00:18:06,280 --> 00:18:10,119 Speaker 2: the inside, sometimes a lymph node right above the belly 292 00:18:10,160 --> 00:18:14,400 Speaker 2: button can pop up as a sign of cancer. And 293 00:18:14,480 --> 00:18:16,560 Speaker 2: so you know, if I see something like that and 294 00:18:16,600 --> 00:18:18,840 Speaker 2: I'm looking inside, I want to know, it's usually a 295 00:18:18,840 --> 00:18:21,639 Speaker 2: gi cancer like a gut cancer, and I'm like, I 296 00:18:21,680 --> 00:18:23,880 Speaker 2: want to know where this, you know, is it colon cancer, 297 00:18:24,040 --> 00:18:27,320 Speaker 2: some bowel cancer, stomach cancer that I'm missing. So there 298 00:18:27,320 --> 00:18:30,879 Speaker 2: could be a lot of like subtle signs and the 299 00:18:30,960 --> 00:18:33,399 Speaker 2: hard part is I again, I can't talk to the 300 00:18:33,440 --> 00:18:37,240 Speaker 2: person and say, have you had belly pain? Right, or 301 00:18:37,840 --> 00:18:41,120 Speaker 2: you know, some sort of discharge for a month, right, Like, 302 00:18:41,680 --> 00:18:45,960 Speaker 2: so I'm taking inside looking for things, right, That's. 303 00:18:45,720 --> 00:18:49,280 Speaker 1: Really what it is. I'm just you know why I'm laughing. 304 00:18:49,600 --> 00:18:52,760 Speaker 1: Remember our dinner in Atlanta when I was like, you 305 00:18:52,800 --> 00:18:54,879 Speaker 1: are going to be no fun because there was a 306 00:18:54,920 --> 00:18:56,920 Speaker 1: man at the next table. You were like, oh, he 307 00:18:57,000 --> 00:19:02,760 Speaker 1: don't need any of that, Like, yeah, now you got 308 00:19:02,840 --> 00:19:12,080 Speaker 1: people out there grabbing people's elbows, and ah. 309 00:19:12,560 --> 00:19:17,040 Speaker 2: Kids stand out very differently, so you know, a lot 310 00:19:17,080 --> 00:19:19,400 Speaker 2: of what I'm describing, And I mean I still approach 311 00:19:20,080 --> 00:19:23,560 Speaker 2: child autopsies the same way, like top to bottom, going 312 00:19:23,640 --> 00:19:25,840 Speaker 2: from you know, I think I left off at the kidneys, 313 00:19:25,920 --> 00:19:29,359 Speaker 2: right describing the kidneys. The biggest thing we often see 314 00:19:29,480 --> 00:19:34,560 Speaker 2: is like high blood pressure changes in the kidney's, diabetic 315 00:19:34,680 --> 00:19:37,879 Speaker 2: changes in the kidneys where the kidneys are scarred. Maybe 316 00:19:37,880 --> 00:19:41,880 Speaker 2: someone's had a kidney transplant that can put them at 317 00:19:41,960 --> 00:19:45,640 Speaker 2: risk for infection, you know, maybe a cancer. So there's 318 00:19:45,640 --> 00:19:47,680 Speaker 2: a lot of those things, you know, And so I'm 319 00:19:47,720 --> 00:19:50,560 Speaker 2: looking at every organ after the kidneys, I'm looking at 320 00:19:50,600 --> 00:19:55,480 Speaker 2: the at either the female organs, the uterus, bladder, ovaries, 321 00:19:55,480 --> 00:19:58,719 Speaker 2: fallopian tubes, or I'm looking at the testicles along with 322 00:19:58,760 --> 00:20:01,480 Speaker 2: the bladder and prostate in a man. So you can 323 00:20:01,520 --> 00:20:03,960 Speaker 2: see how we just worked our way down from the 324 00:20:04,000 --> 00:20:08,439 Speaker 2: top to the bottom. Right, And remember everything is not 325 00:20:09,280 --> 00:20:12,600 Speaker 2: just looked at in its place inside the body. I'm 326 00:20:12,640 --> 00:20:16,639 Speaker 2: handling it, and then I'm looking, you know, taking it 327 00:20:16,680 --> 00:20:19,560 Speaker 2: out of its place, and then I'm weighing it. And 328 00:20:19,640 --> 00:20:22,600 Speaker 2: then once I take everything out of the body, I 329 00:20:22,640 --> 00:20:28,480 Speaker 2: actually step aside and dissect everything, you know, very carefully. 330 00:20:28,480 --> 00:20:31,520 Speaker 2: When I say carefully, it's you know, a few millimeter 331 00:20:31,640 --> 00:20:35,359 Speaker 2: slices through the coronary arteries, you know, which are the 332 00:20:35,680 --> 00:20:38,160 Speaker 2: large vessels to the heart. Like you slice through the heart, 333 00:20:38,200 --> 00:20:41,040 Speaker 2: you slice through the lungs. Everything is looked at. And 334 00:20:41,119 --> 00:20:43,359 Speaker 2: why we slice through it is because you don't want 335 00:20:43,400 --> 00:20:45,880 Speaker 2: to just look at the outside of something. You want 336 00:20:45,880 --> 00:20:48,240 Speaker 2: to really look at it inside and get as much 337 00:20:48,280 --> 00:20:51,800 Speaker 2: of a look as you can. So it's very detailed 338 00:20:51,880 --> 00:20:55,439 Speaker 2: in that sense where if you cut it, like just 339 00:20:55,440 --> 00:20:57,200 Speaker 2: think about a loaf of bread, right, if you look 340 00:20:57,200 --> 00:21:00,159 Speaker 2: at the crust, only you're not seeing the inside of 341 00:21:00,200 --> 00:21:03,639 Speaker 2: the crumb. Is it crunchy, is it soft? Is it dry, 342 00:21:03,800 --> 00:21:07,240 Speaker 2: Is it bubbly? Right? Is there cheese inside of it? 343 00:21:07,359 --> 00:21:09,800 Speaker 2: Or their herbs? You have no idea just looking at 344 00:21:09,800 --> 00:21:13,520 Speaker 2: the outside. So that's why we slice it right, just 345 00:21:13,560 --> 00:21:15,960 Speaker 2: like a loaf of bread. And you're really getting all 346 00:21:16,080 --> 00:21:19,120 Speaker 2: these looks, all these slices to look at front and back, 347 00:21:19,160 --> 00:21:23,719 Speaker 2: if you will, throughout any organ that's sort of the 348 00:21:23,760 --> 00:21:26,919 Speaker 2: big chunk of it. But we haven't looked at the 349 00:21:26,920 --> 00:21:31,000 Speaker 2: brain and the neck yet. And would you know this? 350 00:21:31,240 --> 00:21:35,360 Speaker 2: Why why I go back to the brain and then 351 00:21:35,480 --> 00:21:38,600 Speaker 2: the neck. Do you have any recollection from your training, Cheryl? 352 00:21:39,000 --> 00:21:42,719 Speaker 1: Well, I mean probably to see if somebody's been strangled. 353 00:21:42,280 --> 00:21:44,840 Speaker 2: Or right, But do you know why there's sort of 354 00:21:44,840 --> 00:21:46,000 Speaker 2: strategy to do that? 355 00:21:46,640 --> 00:21:47,760 Speaker 1: No? 356 00:21:47,760 --> 00:21:50,959 Speaker 2: No, okay, So we then look at the brain. After 357 00:21:52,280 --> 00:21:57,400 Speaker 2: the you know, the torso the main body cavities are done. Okay, 358 00:21:57,640 --> 00:22:00,000 Speaker 2: So I go back and I cut into the skin 359 00:22:00,080 --> 00:22:02,880 Speaker 2: out and then we look at the skull make sure 360 00:22:02,920 --> 00:22:07,840 Speaker 2: there's no abnormal bruising or fractures. I'm looking at every step, 361 00:22:07,880 --> 00:22:10,160 Speaker 2: so I'm looking at the scalp. I want to make 362 00:22:10,160 --> 00:22:12,639 Speaker 2: sure I feel around the hair because hair can hide 363 00:22:12,680 --> 00:22:15,960 Speaker 2: so much. But fear not, because if I didn't even 364 00:22:16,119 --> 00:22:18,520 Speaker 2: you know, if the hair's hiding so much dreadlocks. I mean, 365 00:22:18,520 --> 00:22:20,879 Speaker 2: sometimes people have so much hair it's very hard to see. 366 00:22:21,480 --> 00:22:24,040 Speaker 2: But the beauty is when I cut through the scalp 367 00:22:24,080 --> 00:22:26,600 Speaker 2: and I flip it, I'm getting to see the entire 368 00:22:26,840 --> 00:22:30,840 Speaker 2: underside of the scalp. So if there's any bruising that 369 00:22:31,960 --> 00:22:34,840 Speaker 2: was hidden, if you will, on the outside, it becomes 370 00:22:35,800 --> 00:22:42,240 Speaker 2: super visible on the underside, Okay. And so usually, unfortunately, 371 00:22:42,880 --> 00:22:46,560 Speaker 2: if it's a massive head trauma case, especially in a homicide, 372 00:22:47,440 --> 00:22:51,960 Speaker 2: I usually have to shave a portion of their head, 373 00:22:51,960 --> 00:22:54,399 Speaker 2: if not the whole head. But I try to be 374 00:22:54,440 --> 00:22:59,879 Speaker 2: as respectful as possible and do my work, you know, 375 00:23:00,160 --> 00:23:05,239 Speaker 2: without necessarily changing their appearance, you know, as much as 376 00:23:05,320 --> 00:23:08,000 Speaker 2: can be preserved. At the same time, it's a very 377 00:23:08,040 --> 00:23:12,000 Speaker 2: delicate balance. I need to get my information, and especially 378 00:23:12,040 --> 00:23:14,840 Speaker 2: if there's wounds to the head, they need to be photographed, 379 00:23:14,880 --> 00:23:19,520 Speaker 2: measured and documented. So, you know, sometimes it does come 380 00:23:19,640 --> 00:23:23,879 Speaker 2: into shaving the whole head. And then we're going deeper. 381 00:23:23,920 --> 00:23:26,920 Speaker 2: We're going to take the skull cap off and look 382 00:23:26,920 --> 00:23:29,040 Speaker 2: at the brain. The brain's going to be sitting there. 383 00:23:29,440 --> 00:23:34,200 Speaker 2: And again what I'm doing, layer by layer is looking 384 00:23:34,280 --> 00:23:38,000 Speaker 2: at the covering of the head, so the skull, the scalp, 385 00:23:38,080 --> 00:23:40,639 Speaker 2: the skull. Then I'm going to look at the dura, 386 00:23:40,840 --> 00:23:44,720 Speaker 2: which is that thick sort of I describe it like tievek, 387 00:23:45,359 --> 00:23:49,680 Speaker 2: like this thick opaque covering over the brain, the dura 388 00:23:49,840 --> 00:23:55,200 Speaker 2: moter that's like a protective layer over the brain. And 389 00:23:55,240 --> 00:23:57,440 Speaker 2: then we're looking at the brain itself. Now I want 390 00:23:57,440 --> 00:24:04,160 Speaker 2: to see if there's infection, meningitis, if there's a stroke, 391 00:24:04,359 --> 00:24:07,520 Speaker 2: if there's bleeding in and around the brain. Right, all 392 00:24:07,640 --> 00:24:13,080 Speaker 2: of these have been you know, they're so important in 393 00:24:13,119 --> 00:24:16,119 Speaker 2: the brain. And then I actually look at the brain. 394 00:24:16,359 --> 00:24:20,040 Speaker 2: Oftentimes we see swelling of the brain that can be 395 00:24:20,280 --> 00:24:23,320 Speaker 2: either part of the brain or the whole brain. Okay, 396 00:24:23,720 --> 00:24:26,959 Speaker 2: And sometimes we see the swelling just because as someone 397 00:24:27,040 --> 00:24:30,240 Speaker 2: is dying from a lack of oxygen, the brain is 398 00:24:30,280 --> 00:24:33,040 Speaker 2: the most sensitive to that and it will start swelling. 399 00:24:33,080 --> 00:24:35,639 Speaker 2: So it's not the primary cause, like even in a 400 00:24:35,720 --> 00:24:39,760 Speaker 2: drug overdose or something where or a you know, heart attack, 401 00:24:39,800 --> 00:24:42,280 Speaker 2: where someone may be dying slowly. If they drop dead, 402 00:24:42,280 --> 00:24:44,439 Speaker 2: you're not going to see the brain swelling. But if 403 00:24:44,440 --> 00:24:48,359 Speaker 2: they're resuscitated on a ventilator, all sorts of things like that, 404 00:24:48,440 --> 00:24:52,040 Speaker 2: we see swelling of the brain. So you know that 405 00:24:52,080 --> 00:24:55,760 Speaker 2: may be sort of what is irreversible, especially in a 406 00:24:55,800 --> 00:24:59,480 Speaker 2: drug overdose or something of that nature. That's where the 407 00:25:00,480 --> 00:25:04,360 Speaker 2: really bad injury occurs from not breathing, having a lack 408 00:25:04,400 --> 00:25:10,080 Speaker 2: of oxygen, and then going from there. Hell, it looks 409 00:25:10,080 --> 00:25:11,720 Speaker 2: like I've talked a lot, but I do want to 410 00:25:11,720 --> 00:25:15,160 Speaker 2: come back to the very essential point is after we've 411 00:25:15,200 --> 00:25:19,480 Speaker 2: taken the brain out, made sure that's evaluated. Remember, I 412 00:25:19,640 --> 00:25:21,879 Speaker 2: have the neck left, and the neck is such a 413 00:25:22,000 --> 00:25:25,439 Speaker 2: vulnerable part in the body. We cannot forget it. So 414 00:25:25,960 --> 00:25:29,359 Speaker 2: why I've now saved the best for last, if you will, 415 00:25:29,520 --> 00:25:33,199 Speaker 2: is because by taking the brain away and cutting it 416 00:25:33,240 --> 00:25:36,119 Speaker 2: out and then cutting the organs out, what I've done 417 00:25:36,160 --> 00:25:40,000 Speaker 2: is drain the blood away from top and bottom, Okay, 418 00:25:40,040 --> 00:25:42,800 Speaker 2: and that really clears the field, which you know is 419 00:25:42,880 --> 00:25:47,400 Speaker 2: sort of a medical way of saying. The blood drains 420 00:25:47,440 --> 00:25:50,000 Speaker 2: out from the muscles and the structures. There's so much 421 00:25:50,000 --> 00:25:51,679 Speaker 2: going on in the neck. I want to get a 422 00:25:51,800 --> 00:25:54,919 Speaker 2: very detailed look at it. And so then I'm going 423 00:25:54,960 --> 00:25:58,520 Speaker 2: to go in and do a layer by layer dissection. 424 00:25:58,880 --> 00:26:03,479 Speaker 2: And really what I'm looking at is not just you know, 425 00:26:03,560 --> 00:26:06,719 Speaker 2: the muscles, the airway, the thyroid. I want to make 426 00:26:06,760 --> 00:26:09,880 Speaker 2: sure there's no injury there. Okay, that's the big thing. 427 00:26:09,960 --> 00:26:13,080 Speaker 2: We have the hyoid bone, we have the airway, the larynx, 428 00:26:13,119 --> 00:26:17,040 Speaker 2: the voice box, and we really need to make sure 429 00:26:17,119 --> 00:26:21,159 Speaker 2: that everything's intact there or if it's not, really hone 430 00:26:21,160 --> 00:26:23,560 Speaker 2: in on that. 431 00:26:23,560 --> 00:26:27,920 Speaker 1: That is amazing. Now, y'all listen, we've done external and internal. 432 00:26:28,720 --> 00:26:33,160 Speaker 1: Next week, doctor Priya is gonna be talking about things 433 00:26:33,200 --> 00:26:37,040 Speaker 1: that she has found in bodies that ain't supposed to 434 00:26:37,040 --> 00:26:37,520 Speaker 1: be there. 435 00:26:37,800 --> 00:26:40,280 Speaker 2: Oh, there's so much on that. That may be two episodes. 436 00:26:40,320 --> 00:26:43,600 Speaker 1: You never know, it needs to be two episodes, so 437 00:26:43,800 --> 00:26:47,440 Speaker 1: y'all get ready. Doctor. Thank you so much to Judge 438 00:26:47,480 --> 00:26:50,560 Speaker 1: and being with us and just teaching us so much. 439 00:26:51,280 --> 00:26:53,040 Speaker 2: Thank you for having me. Till next time.