December 3, 2025 • 22 mins
Content Warning: This episode contains graphic descriptions of infectious disease, autopsy procedures, and workplace exposure. If you’re sensitive to these topics, this episode may not be for you.
In the morgue, danger doesn’t end when the heart stops beating. In this second installment of Exposure, Chief Medical Examiner Dr. Kendall Crowns recounts two life-threatening encounters with invisible hazards that linger within the morgue. From a chance exposure to meningococcal meningitis that turned a friendly chat into a medical emergency, to a tuberculosis case that nearly landed him on a delinquent-patient arrest list, Dr. Crowns reveals the real-world risks faced by medical examiners who work at the edge of science and safety. Part science lesson, part cautionary tale, this episode exposes the ongoing threat of infectious disease and the discipline required to work among it.
If you missed the first episode in this series, listen to Mayhem in the Morgue | Exposure (Part 1)
Highlights
• (0:00) Welcome to Mayhem in the Morgue with Dr. Kendall Crowns
• (0:30) Recap of Exposure (Part 1) and an introduction to autopsy hazards
• (1:30) Case 1: Meningococcus: a deadly bacterium and a moment of exposure
• (3:45) The friend, the mask, and the realization that came too late
• (6:00) Preventive treatment and a lasting reminder to always wear PPE
• (6:45) Case 2: Tuberculosis: an ancient pathogen meets modern medicine
• (8:00) The resident-year autopsy that led to lifelong TB exposure
• (13:15) Public health protocols, medications, and unexpected consequences
• (21:00) A near-arrest for missing a medication pickup after his daughter's birth
About the Host: Dr. Kendall Crowns
Dr. Crowns is the Chief Medical Examiner for Travis County, Texas, and a nationally recognized forensic pathologist. He las led death investigations in Travis County, Fort Worth, Chicago, and Kansas. Over his career, he has performed thousands of autopsies and testified in court hundreds of times as an expert witness. A frequent contributor to Crime Stories with Nancy Grace, Dr. Crowns brings unparalleled insight into the strange, grisly, and sometimes absurd realities of forensic pathology.
About the Show
Mayhem in the Morgue takes listeners inside the bloody, bizarre, and often unbelievable world of forensic pathology. Hosted by Chief Medical Examiner Dr. Kendall Crowns, each episode delivers real-life cases from the morgue, the crime scene, and the courtroom. Expect gallows humor, hard truths, and unforgettable investigations.
Connect and Learn More
Learn more about Dr. Kendall Crowns on Linkedin. Catch him regularly on Crime Storieswith Nancy Grace and follow Mayhem in the Morgue where you get your podcasts.
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See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Today's episode, I will be discussing the deaths of individuals.
If this sort of thing upsets you, may suggest you
read a book, maybe something like of Mice and Men Welcome.
You may have an imare with your host, Doctor kinder Crown.
(00:21):
Today's episode Exposure Part two TB or not TB. This
is the second episode of four in which I am
discussing the hazards of autopsies. If you didn't listen to
part one, I suggest you go back and listen to
part one before continuing. In the last episode, I mentioned
there are six hazards that can occur during an autopsy.
(00:43):
We previously discuss mechanical, sharp force, radiation, and electrical hazards.
Today we'll be discussing infectious diseases. Everybody can be carrying
an infectious disease, and just by looking at the body
you can't necessarily tell if a deadly bacteria or virus
is on the inside of them. Blood is the main
source of the infection. It can carry everything from viruses, bacteria, fungi,
(01:05):
or even parasites. And over the years I have been
exposed to a large number of different viruses, fungi and bacteria,
but not so much parasites. I myself am a carrier
of a particularly nasty strain of bacteria called Saphococcus aureus.
An X rays of my lungs light up like a
Christmas tree with the scars of a fungus called histoplasmosis.
When I'm doing an autopsy, I'm wearing my ppe, so
(01:28):
that means I'm pretty much protected from getting any diseases
from the body. And there's only been two times in
my career in which an exposure from an infectious disease
agent resulted in significant consequences, and both of these were
from bacteria. And today I'll be discussing these two particular exposures.
The first one we'll be talking about was an exposure
to Nicia meningitis or meningecaccus. It's a bacteria that causes meningitis,
(01:52):
which is an infection of the membranes of your brain.
Meningitis itself can be caused by different bacteria, viruses, fungi,
and less commonly again and parasites. But typically when I
think about meningitis, it's usually caused by a bacteria, specifically
Niceria meningitis or men ing Caucus meninguccus is a gram
negative bacteria that's been infecting people for thousands of years.
(02:13):
Humans are the only carrier of it, and they don't
really know where it exactly came from or when it
appeared in human history. Ten percent of us are carriers
of Meningoccus in our nasal passages or a pharyngeal region
of our mouth, and those people are asymptomatic, and they're
the ones that don't get meningitis from niceria meningitis, but
they can pass it on to the rest of the
population by coughing or sneezing and exposing people to their
(02:36):
saliva or respiratory droplets. Once meninjucaccus gets into your body,
it infects the linings of your brain and spinal cord
and causes the brain to swell, and this can result
in you dying. It can also get into your blood
stream and go widely throughout your body, causing sepsis or septicemia,
which is basically an infection of your entire body with
the bacteria, and this can cause damage to blood vessels,
(02:58):
which causes your limbs to become the chrotic and die,
and then you end up with multiple amputations. Menja caucus
is really not something you want to screw around with.
Most people make it to the hospital with this infection
and they get treated with antibiotics and they don't end
up dying. But if they end up dying in the hospital,
they don't become a medical examiner's case. The ones we
see are the stubborn ones. It's always the stubborn ones.
(03:21):
They don't want to go to the doctor, and they
end up dying at home and they come into the
medical examiner's office. And in these situations, they have vague
symptoms like a headache or a fever and maybe next stiffness,
but you don't know you're dealing with meningacccus. Usually with
these cases, I have autopsy dozens of cases of people
who have died of all types of meningitis, and I
have not had any consequences to this because I've always
(03:43):
had on my ppe. Except this one time it occurred
in Cook County in Chicago. I had my cases for
the day and I had started doing an autopsy. The
autopsy was of a thirty year old female that had
complained of a headache and fever and died at home. Externally,
she didn't have any fine on our skin, and we
had done the chestun abdominal portion of the autopsy, and
(04:04):
there was no fightings either, just some congestions along and
a full bladder. A friend of mine walked over while
we were finishing up the organza ab domo section. He
was a state trooper named Bob. He was at the
office that day observing another case that had just gotten done.
He walked over and started talking to me. Bob and
I had known each other for several years at this
point and had several common interests, and on my autopsy
(04:27):
days we'd often have a discussion about some topic. It
would rain from a variety of subjects. On that particular day,
we were talking about the TV show called Smallville. If
you're not familiar with Smallville, it's a show about Superman
in high school. It was kind of goofy, but it
had its fun moments, and both Bob and I enjoyed
watching it with our wives. The night before, the season
(04:48):
seven episode of Smallville had just premiered and it had
an appearance by Bizarro Superman, and we were talking about
the appearance of Bizarro Superman and joking around about how
Bizarro Superman says the opposite of what he is actually
thinking I had gotten blood on my master in the autopsy,
so I had decided to change it. I had taken
it off and was walking over to get a new
(05:09):
one and talking with Bob. In the meantime, the autopsy
tech had started the head and was sawing the skull open.
I turned around and saw the autopsy technician pulling the
skull cap off to expose the brain, and that's when
I saw it. The brain was covered in a bright
green yellow puss, and I instantly knew what I was
looking at, which was meninja caucus, and I didn't have
(05:31):
my mask on. I quickly put on my mask and
I told Bob to get out of there or get
a mask, but it was too late. At that point,
the sawing through the skull had probably aerosolized all the bacteria,
and Bob and I were exposed. I completed the autopsy,
and indeed the woman had died from niceria meningitis, so
her cause of death was meningitis manner natural. But the
(05:53):
bigger problem was Bob and I had been exposed to
meninta caucus. I told Bob that he was going to
have to go to the doctor and get a prescription
for a preventative medication, and I was going to go
do that too. That afternoon, we both went to our
separate doctors and got our prescriptions. Bob later told me
when he got home and told his wife what had occurred.
His wife made a joke about how Bob didn't have
(06:14):
a big enough brain for the bacteria to really find anything,
and they would have probably starved to death anyway. It
was a funny joke, but probably not appropriate for the time.
We both took our preventative medication, which was suprofloxin, and
neither one of us developmentingitis. We were both okay, so
CRISI is over. And later Bob purchased a Bizarro Superman
(06:35):
action figure and gave it to me as a remembrance
of that exposure. I still have that action figure in
my office to this day to remind me of the
good times I have with my friend Bob, and also
to remind me to always wear my ppe. The next
exposure was from a bacteria that is far more common,
known as Mycobacterium tuberculosis or TB. It causes the disease
(06:58):
tuberculosis micaelbac tie. Serium tuberculosis is believed to have originated
some one hundred and fifty million years ago in infected
early humans and has been killing humans ever since. It
has evolved with us over time, and again humans are
its only host. It is again transmitted by an infected
person coughing or sneezing, and the respiratory droplets in saliva
(07:19):
are inhaled by another individual and that gets the bacteria
into your lungs, and once in your lungs, the bacteria
form lesions. They are these large white to yellow soft
nodules that have necrotic siners. That is called casius necrosis.
Tuberculosis can get into your bloodstream when a lesion erodes
(07:40):
into your blood vessel, and the tuberculosis then can go
everywhere throughout your body, and that's called milliary tb. You'll
get into your lymph nodes, your kidneys, your spleen, even
into your bones, and at autopsy it's hazardous because when
you cut into one of these lesions or saw through one,
the tuberculosis in becomes aerosolized and you inhale it and
(08:00):
it can infect you if you're not wearing your ppe.
I was exposed to tuberculosis when I was a resident.
I had graduated from medical school to started my residency,
and my first rotation was to do autopsies at the
Medical Examiner's office. I was in my second month of
residency when a tuberculosis case came in to be autopsy.
It was a twenty five year old female who died
(08:21):
at home that was believed to have died from tuberculosis.
This was the first case of my career that had tuberculosis.
I knew about it from medical school, but I had
never seen it before. I prepared to do the autopsy
by doing a little reading and looking at some pictures
of tuberculosis to kind of get an idea of what
I was looking for. I was given ppe that day
that consisted of an old cloths surgical gown, two pairs
(08:44):
of gloves, of course in a plastic apron, and a
gas mask. The gas mask I was told by my
superiors would work just fine and not to worry about anything.
So I dutifully put on the gas mask, thinking everything
was going to be okay, But it wasn't. The gas
mask didn't have a proper filtration syce to take the
tuberculosis out of the air that I was breathing in,
so I was doomed from the start. I was going
(09:06):
to be exposed to tuberculosis. On that day, I was
working with a single autopsy technician who was also given
a gas masks, and the two of us performed the
autopsy together at the Medical Examiner's office in Memphis. At
that time, it was in an old ear nosen throat
hospital and the autopsy rooms were on the third floor,
which were the old surgical suites, And every day would
start by taking that body to the elevator and writing
(09:28):
up with it. And that's what we did that day.
We started the autopsy, and externally there was no findings
of significance, but internally it was something different. When we
made the wine decision and began dissecting the organs, the lungs,
the lymph nodes, a spleen, the liver all had these
large necrotic lesions. They seemed to be everywhere. I wasn't
sure if what I was looking at was actually tuberculosis.
(09:50):
Like I said, I'd never experienced it before, and I
had only really seen it in books, and I had
not had a lot of direction about what I was
getting into. In this medical examiners office, there were intercoms
that you could communicate with people on different floors. So
I stepped out of the morgue, went to the intercom
and called the doctor who was supervising me. She was
down on the second floor. I told her I needed
(10:13):
to ask her some questions about the autopsy, and she
quickly came up the stairs from the second floor and
stood in the opening of the autopsy room without any
ppe on, no mask or anything, and asked me how
could she help. At that moment, I was cutting the spleen,
and when I cut it in half, the spleen's usual
reddish purple soft tissue or prinkama was littered in these
(10:34):
little to large yellow, white necrotic lesions. I held this
cut portion of spleen up with the puffs and blood
dripping down my hand and arm, and I said to
my supervisor, Hey, is this TV? Is this what it
looks like or is it something else. The moment my
supervisor saw that spleen, she gasped and quickly ran out
of the room and came back holding a mask over
(10:55):
her face, and she said, yeah, yeah, that's TB and
she ran out of the room and I didn't see
her again for the rest of the day. Periodically she
would check in on me through the intercom. I would
be standing cutting more organs. I would hear the intercom
beep crackling with her voice. It would break the silence
of the autopsy and startle me, and she would ask, Hey,
(11:15):
are you okay. I would say yes, and I would
tell her what my progress was. She would encourage me
and tell me to let her know when I got
done or if I found anything else, and to take
a lot of pictures. I continued to work on the case.
It took me several hours. I was pretty new to
autopsies back then. Of course, I had been in tech
for several years, but now I was in charge of it,
(11:36):
and that's a much different matter, and I just wasn't
very efficient. The more gu I was working in, like
I said, was an old surgical suite, and it had
large windows along one wall, and these let the sun in,
so as the day progressed, it would make the morgue
heat up, and by about midday it was usually quite
hot and difficult to work in, and I was sweating
and hot in my gown and gas mask, and the
(11:59):
gas masks kept fogging over. The technician was having similar
problems we had to take multiple breaks. It was just miserable.
And after several hours the autopsy attack and I finally
completed the case. And when we finished up, I went
back to my office, wrote down my findings, dictated my reports,
and went about the rest of my day. I didn't
think much of it. Her cause of deaths was miliary tuberculosis.
(12:21):
Manner of death natural case closed. So fast forward to
a few months later. I was working at a hospital
on a surgical pathology rotation, and part of that rotation
I had to dissect or gross end curtical specimens, which
means I would take the specimens from the surgeries that
were occurring during the day or the day before, and
I would dissect them and cut out pieces of the
(12:41):
tissue to look at under the microscope with a pathologist.
So when I finished residency, I would know what to
do on that particular day in the grossing or dissecting room.
I was working at the hospital where actually Elvis had die,
Baptist Memorial Hospital, which has been demolished years ago. But anyway,
I was in the grosser room that day dissecting a
radical mastectomy specimen when I accidentally cut the palm of
(13:04):
my hand. I cleaned it up, bandaged it, and finished
out the rest of my cases for the day, and
then went to the employee health center at the hospital
I was working at. They looked at my wounds said
I didn't need stitches, thankfully, but the employee health nurse
said she would run an exposure panel. What's an exposure panel.
It's a test we usually use when someone gets exposed
to something or cut or inhaled. We do it a
(13:24):
lot for paramedics or emas workers or firefighters to deal
with the bodies at the scene, and a test for
things like hepatitis, HIV or other infectious diseases we can
get from the body. I've had a lot of exposure
panels run on me over the years, and you know this,
especially if you listen to episode one and they've all
been negative. On this particular day, they asked me about
(13:44):
the exposure panel, and I said it was fine if
they ran it. I wasn't really worried because that specimen
had been in formaldehyde for over twenty four hours, so
I figured everything that was in there that could have
been infectious was probably long since dead. The nurse also
asked if I wanted to get a test for TB
and I said, well, when I graduated from medical school
a few months ago, I had had to have one
(14:06):
done and it was negative. But sure, we could get
one done today. And she administered the tuberculosis skin test,
or PPD test. PPD stands for purified protein derivative test,
and that means they inject a small amount of purified
tuberculum protein from Mycobacterium tuberculosis under your skin, and if
you've been exposed or have a latent infection, you will
(14:28):
have an inflammatory reaction which causes a large raised area
on your arm. If you haven't been exposed, it doesn't
do anything. I had never experienced a positive test in
my life, and I had had several of these PPD
tests during my medical school. Every single time they were negative.
I didn't think much of it. After about a day,
the injection site started swelling and it got bigger and
(14:50):
bigger and more and more painful on my arm. When
I went back to the employee health area, the nurse
said that it was a positive test. They told me
I had been exposed to TV. Now I had to
go to the Shelby County Health Department and report to
public Health, and that's what I did. When I showed
up at Public Health. I walked into the building and
I asked the receptionist where was the tuberculosis clinic, and
(15:12):
she said I had to walk down the hall, hang
a left past the sexually Transmitted Disease clinic, past the
HIV clinic, and it was the third door on the right.
I headed down the hall. The walls were white and
the tile floor was kind of this greenish blue color.
I walked past the STD clinic, the HIV clinic, and
I went to the third door on the right like
I was told. And when I walked in, it was
(15:34):
kind of a big room, and it had a nurse
behind this glass window, kind of like at a bank.
And that window had a little slot in it, which
I learned the purpose of later. I said to her
through the window, you know, my name's Kendall Crowns. I'm
a resident of the University of Tennessee, and I've been
exposed to tuberculosis. And I was told to come over here,
and she told me okay, handed me some paperwork to
(15:54):
fill out and told me to have a seat and
the doctor would be with me shortly. So I sat
down in the waiting room, a very big waiting room,
had a lot of chairs with this black vinyl on them,
and a lot of people. There was a family who
didn't seem to speak English, and they were all sitting
and coughing and wheezing and talking amongst themselves. Sitting across
from them was a very angry, muscular man who was
(16:15):
cracking his knuckles and forming a fist and staring at
the family. I noticed that individual had scleeral ictriss, which
is a yellowing of the whites of your eyes, usually
associated with liver failure. I thought that was odd. There
was two more people sitting in the corner, coughing and wheezing,
sitting under this UV light that I learned later was
used for controlling airborne infections, especially tuberculosis. If you're ever
(16:36):
in a restaurant or grocery store and you notice this
kind of light bar with a UV light by the doorway,
that's what it's for. It's there to kill infectious disease.
I sat down, trying to stay as far away from
the other people as I could. And as I was
sitting there, I thought, well, if I didn't have TV,
I sure have it now and then a couple walked in,
a much older man and a fairly younger woman. They
(16:56):
sat down a few chairs away from me, and the
younger woman said, what is this TV saying anyway? And
the older man said, I don't know, but I think
it's some sort of bug that comes up some bites you,
which was highly inaccurate, but I didn't think it was
necessary to tell them that at the time. I just
kept to myself. Another person walked in and he said, Hey,
is this the SDD clinic, and the nurse said no,
(17:18):
it's down the hall on the right, and he left.
And then another person came in and said, hey, is
this the HIV clinic, and the nurse again said no,
it's down the hall on the right, next to the
SDD clinic. And so I waited, and after what seemed
like hours, which was probably only a few minutes, they
finally called my name and I went back and I
sat down at this kind of large desk, and a
nurse who was working there said, oh, don't put your
(17:39):
arms there. We just had the prisoners in here and
everything's all dirty. She sprayed the desk down with the
disinfectant and cleaned it, and later she took my blood
for testing and I got a chest X ray done
looking for active disease, and the doctor met with me
and he seemed very, very, very tired, and he said
to me, so, you think you've been exposed to TV,
do you? And I said, well, yes, sir, I'm pretty
(18:02):
sure I got exposed because they didn't have the proper PPE.
And he said to me, well, that's how all of
you pathologists end up. You all eventually get exposed to TB.
It's just how it goes. And I thought, well, I
guess it was just going to happen at some point,
just happened at the beginning. But the thing about it
is I work with a lot of pathologists. The majority
of my colleagues still have not had a positive tuberculosis
(18:25):
skin test. The doctor handed me some papers and told
me to fill them out and sign them. I read
through them, and when I was reading them, I realized
if I didn't show up to get my preventive medication
that they were going to have me arrested. And I
said to the doctor to wait, if I don't show
up to pick up the medication, I can be arrested.
And he said, oh, you don't have to worry about that.
(18:46):
That's only if you don't show up to get your medication,
and you'll show up, of course, But if you don't
show up, just give us a call and tell us
you'll be there within the next day or two. But
if you don't give us a call, well I have
you hunted down and arrested because we can't have TV
spread across this county. And I thought, wow, that sounds
(19:08):
incredibly extreme. And then he said, just sign it. Don't
worry about it. You don't have to worry. Just sign it.
And I thought, well, okay, there's not really much I
can do, and I signed the paper and handed it
back to him. He then left and the nurse came
in and she had with her the medication that I
(19:29):
was going to be taken as a preventative. It was
ionizing which is used to treat tuberculosis or to be
a preventative for tuberculosis, and the vitamin B six. Why
the vitamin it was given to me because ioniad causes
neurologic damage and the vitamin would help prevent that. Ionizad
also causes liver damage, and so they told me not
(19:50):
to drink alcohol for the next six months, which wasn't
really an issue, but it did explain why the gentleman
in the room had yellow eyes, because he probably had
liver failure. They handed me those two battles of pills,
placed in a brown paper bag that was stabled shut.
They also handed me a little card with my name
on it in the date I was supposed to come
back the next month to pick up my medication, and
(20:11):
that was it. I was told I could go. When
I came back the following a month, I handed the
nurse my card. She verified it and stamped it and
placed it in a file. She then handed me a
new card with the next month's date on it and
my bag of pills. And that's how it went for
the next several months, just like a banking transaction. I
never met the doctor again, and over the next five
(20:32):
months it was the sane, basic routine. Every time I
got there, there'd be a new group of people coughing,
hacking up along under that UV light. And towards the
end when people would come in and ask if it
was the HIV or SDD clinic, I knew where to
tell them to go, and I gave them directions. So
I learned quite a lot in my time. When that
last month finally came, there was a problem. My daughter
(20:52):
was born on the day I was supposed to come
and pick up my medication, and in the excitement of
that moment, I forgot to come and get my medication.
I also forgot to give them a call. Twenty four
hours went by, forty eight hours went by. I went
back to the house to pick some things up. I
noticed there was messages on the answering machine, and when
I pushed the button to listen to them, there were
several messages, excitedly congratulating us on the birth of our
(21:15):
new child. But then there was one message from the
nurse from the tuberculosis clinic, and she was calling looking
for me, and she left an ominous message stating if
I didn't report to the TB clinic in the next
twenty four hours, they would send the police to the
address to come and arrest me. And when I heard
this message, I panicked because it had been nearly forty
eight hours, and I quickly called the TB clinic and
(21:38):
I explained to them what had happened. How I forgot
because my daughter had been born, And the nurse said,
on the other end of the line. Oh, well, we're
glad you called. We were just putting together a delinquent
tuberculosis patientless to be arrested by the police, and you're
on it, so you will be coming today, correct? And
I said, yes, I'll be there this afternoon, and she said, well, wonderful,
you better be. And I showed up that afternoon, went
(21:59):
down there and picked up my medication, handed in my card.
But this time I asked if I could keep my
card because it had my daughter's birth date on it,
and I thought it'd be as fun souvenir, and they
did let me keep it, and I didn't get arrested,
and I finished my medication and that was the end
of it. And whenever there's a workplace tuberculosis test, which
we do every year, I get to opt out because
(22:20):
I already know I'm incredibly positive. And that brings us
to the end of the episode. I hope you learned
something like don't forget your pills or the pill police
will come to arrestue. And I hope you were entertained
until the next time.
Today's episode, I will be discussing the deaths of individuals.
If this sort of thing upsets you, may suggest you
read a book, maybe something like of Mice and Men Welcome.
You may have an imare with your host, Doctor kinder Crown.
(00:21):
Today's episode Exposure Part two TB or not TB. This
is the second episode of four in which I am
discussing the hazards of autopsies. If you didn't listen to
part one, I suggest you go back and listen to
part one before continuing. In the last episode, I mentioned
there are six hazards that can occur during an autopsy.
(00:43):
We previously discuss mechanical, sharp force, radiation, and electrical hazards.
Today we'll be discussing infectious diseases. Everybody can be carrying
an infectious disease, and just by looking at the body
you can't necessarily tell if a deadly bacteria or virus
is on the inside of them. Blood is the main
source of the infection. It can carry everything from viruses, bacteria, fungi,
(01:05):
or even parasites. And over the years I have been
exposed to a large number of different viruses, fungi and bacteria,
but not so much parasites. I myself am a carrier
of a particularly nasty strain of bacteria called Saphococcus aureus.
An X rays of my lungs light up like a
Christmas tree with the scars of a fungus called histoplasmosis.
When I'm doing an autopsy, I'm wearing my ppe, so
(01:28):
that means I'm pretty much protected from getting any diseases
from the body. And there's only been two times in
my career in which an exposure from an infectious disease
agent resulted in significant consequences, and both of these were
from bacteria. And today I'll be discussing these two particular exposures.
The first one we'll be talking about was an exposure
to Nicia meningitis or meningecaccus. It's a bacteria that causes meningitis,
(01:52):
which is an infection of the membranes of your brain.
Meningitis itself can be caused by different bacteria, viruses, fungi,
and less commonly again and parasites. But typically when I
think about meningitis, it's usually caused by a bacteria, specifically
Niceria meningitis or men ing Caucus meninguccus is a gram
negative bacteria that's been infecting people for thousands of years.
(02:13):
Humans are the only carrier of it, and they don't
really know where it exactly came from or when it
appeared in human history. Ten percent of us are carriers
of Meningoccus in our nasal passages or a pharyngeal region
of our mouth, and those people are asymptomatic, and they're
the ones that don't get meningitis from niceria meningitis, but
they can pass it on to the rest of the
population by coughing or sneezing and exposing people to their
(02:36):
saliva or respiratory droplets. Once meninjucaccus gets into your body,
it infects the linings of your brain and spinal cord
and causes the brain to swell, and this can result
in you dying. It can also get into your blood
stream and go widely throughout your body, causing sepsis or septicemia,
which is basically an infection of your entire body with
the bacteria, and this can cause damage to blood vessels,
(02:58):
which causes your limbs to become the chrotic and die,
and then you end up with multiple amputations. Menja caucus
is really not something you want to screw around with.
Most people make it to the hospital with this infection
and they get treated with antibiotics and they don't end
up dying. But if they end up dying in the hospital,
they don't become a medical examiner's case. The ones we
see are the stubborn ones. It's always the stubborn ones.
(03:21):
They don't want to go to the doctor, and they
end up dying at home and they come into the
medical examiner's office. And in these situations, they have vague
symptoms like a headache or a fever and maybe next stiffness,
but you don't know you're dealing with meningacccus. Usually with
these cases, I have autopsy dozens of cases of people
who have died of all types of meningitis, and I
have not had any consequences to this because I've always
(03:43):
had on my ppe. Except this one time it occurred
in Cook County in Chicago. I had my cases for
the day and I had started doing an autopsy. The
autopsy was of a thirty year old female that had
complained of a headache and fever and died at home. Externally,
she didn't have any fine on our skin, and we
had done the chestun abdominal portion of the autopsy, and
(04:04):
there was no fightings either, just some congestions along and
a full bladder. A friend of mine walked over while
we were finishing up the organza ab domo section. He
was a state trooper named Bob. He was at the
office that day observing another case that had just gotten done.
He walked over and started talking to me. Bob and
I had known each other for several years at this
point and had several common interests, and on my autopsy
(04:27):
days we'd often have a discussion about some topic. It
would rain from a variety of subjects. On that particular day,
we were talking about the TV show called Smallville. If
you're not familiar with Smallville, it's a show about Superman
in high school. It was kind of goofy, but it
had its fun moments, and both Bob and I enjoyed
watching it with our wives. The night before, the season
(04:48):
seven episode of Smallville had just premiered and it had
an appearance by Bizarro Superman, and we were talking about
the appearance of Bizarro Superman and joking around about how
Bizarro Superman says the opposite of what he is actually
thinking I had gotten blood on my master in the autopsy,
so I had decided to change it. I had taken
it off and was walking over to get a new
(05:09):
one and talking with Bob. In the meantime, the autopsy
tech had started the head and was sawing the skull open.
I turned around and saw the autopsy technician pulling the
skull cap off to expose the brain, and that's when
I saw it. The brain was covered in a bright
green yellow puss, and I instantly knew what I was
looking at, which was meninja caucus, and I didn't have
(05:31):
my mask on. I quickly put on my mask and
I told Bob to get out of there or get
a mask, but it was too late. At that point,
the sawing through the skull had probably aerosolized all the bacteria,
and Bob and I were exposed. I completed the autopsy,
and indeed the woman had died from niceria meningitis, so
her cause of death was meningitis manner natural. But the
(05:53):
bigger problem was Bob and I had been exposed to
meninta caucus. I told Bob that he was going to
have to go to the doctor and get a prescription
for a preventative medication, and I was going to go
do that too. That afternoon, we both went to our
separate doctors and got our prescriptions. Bob later told me
when he got home and told his wife what had occurred.
His wife made a joke about how Bob didn't have
(06:14):
a big enough brain for the bacteria to really find anything,
and they would have probably starved to death anyway. It
was a funny joke, but probably not appropriate for the time.
We both took our preventative medication, which was suprofloxin, and
neither one of us developmentingitis. We were both okay, so
CRISI is over. And later Bob purchased a Bizarro Superman
(06:35):
action figure and gave it to me as a remembrance
of that exposure. I still have that action figure in
my office to this day to remind me of the
good times I have with my friend Bob, and also
to remind me to always wear my ppe. The next
exposure was from a bacteria that is far more common,
known as Mycobacterium tuberculosis or TB. It causes the disease
(06:58):
tuberculosis micaelbac tie. Serium tuberculosis is believed to have originated
some one hundred and fifty million years ago in infected
early humans and has been killing humans ever since. It
has evolved with us over time, and again humans are
its only host. It is again transmitted by an infected
person coughing or sneezing, and the respiratory droplets in saliva
(07:19):
are inhaled by another individual and that gets the bacteria
into your lungs, and once in your lungs, the bacteria
form lesions. They are these large white to yellow soft
nodules that have necrotic siners. That is called casius necrosis.
Tuberculosis can get into your bloodstream when a lesion erodes
(07:40):
into your blood vessel, and the tuberculosis then can go
everywhere throughout your body, and that's called milliary tb. You'll
get into your lymph nodes, your kidneys, your spleen, even
into your bones, and at autopsy it's hazardous because when
you cut into one of these lesions or saw through one,
the tuberculosis in becomes aerosolized and you inhale it and
(08:00):
it can infect you if you're not wearing your ppe.
I was exposed to tuberculosis when I was a resident.
I had graduated from medical school to started my residency,
and my first rotation was to do autopsies at the
Medical Examiner's office. I was in my second month of
residency when a tuberculosis case came in to be autopsy.
It was a twenty five year old female who died
(08:21):
at home that was believed to have died from tuberculosis.
This was the first case of my career that had tuberculosis.
I knew about it from medical school, but I had
never seen it before. I prepared to do the autopsy
by doing a little reading and looking at some pictures
of tuberculosis to kind of get an idea of what
I was looking for. I was given ppe that day
that consisted of an old cloths surgical gown, two pairs
(08:44):
of gloves, of course in a plastic apron, and a
gas mask. The gas mask I was told by my
superiors would work just fine and not to worry about anything.
So I dutifully put on the gas mask, thinking everything
was going to be okay, But it wasn't. The gas
mask didn't have a proper filtration syce to take the
tuberculosis out of the air that I was breathing in,
so I was doomed from the start. I was going
(09:06):
to be exposed to tuberculosis. On that day, I was
working with a single autopsy technician who was also given
a gas masks, and the two of us performed the
autopsy together at the Medical Examiner's office in Memphis. At
that time, it was in an old ear nosen throat
hospital and the autopsy rooms were on the third floor,
which were the old surgical suites, And every day would
start by taking that body to the elevator and writing
(09:28):
up with it. And that's what we did that day.
We started the autopsy, and externally there was no findings
of significance, but internally it was something different. When we
made the wine decision and began dissecting the organs, the lungs,
the lymph nodes, a spleen, the liver all had these
large necrotic lesions. They seemed to be everywhere. I wasn't
sure if what I was looking at was actually tuberculosis.
(09:50):
Like I said, I'd never experienced it before, and I
had only really seen it in books, and I had
not had a lot of direction about what I was
getting into. In this medical examiners office, there were intercoms
that you could communicate with people on different floors. So
I stepped out of the morgue, went to the intercom
and called the doctor who was supervising me. She was
down on the second floor. I told her I needed
(10:13):
to ask her some questions about the autopsy, and she
quickly came up the stairs from the second floor and
stood in the opening of the autopsy room without any
ppe on, no mask or anything, and asked me how
could she help. At that moment, I was cutting the spleen,
and when I cut it in half, the spleen's usual
reddish purple soft tissue or prinkama was littered in these
(10:34):
little to large yellow, white necrotic lesions. I held this
cut portion of spleen up with the puffs and blood
dripping down my hand and arm, and I said to
my supervisor, Hey, is this TV? Is this what it
looks like or is it something else. The moment my
supervisor saw that spleen, she gasped and quickly ran out
of the room and came back holding a mask over
(10:55):
her face, and she said, yeah, yeah, that's TB and
she ran out of the room and I didn't see
her again for the rest of the day. Periodically she
would check in on me through the intercom. I would
be standing cutting more organs. I would hear the intercom
beep crackling with her voice. It would break the silence
of the autopsy and startle me, and she would ask, Hey,
(11:15):
are you okay. I would say yes, and I would
tell her what my progress was. She would encourage me
and tell me to let her know when I got
done or if I found anything else, and to take
a lot of pictures. I continued to work on the case.
It took me several hours. I was pretty new to
autopsies back then. Of course, I had been in tech
for several years, but now I was in charge of it,
(11:36):
and that's a much different matter, and I just wasn't
very efficient. The more gu I was working in, like
I said, was an old surgical suite, and it had
large windows along one wall, and these let the sun in,
so as the day progressed, it would make the morgue
heat up, and by about midday it was usually quite
hot and difficult to work in, and I was sweating
and hot in my gown and gas mask, and the
(11:59):
gas masks kept fogging over. The technician was having similar
problems we had to take multiple breaks. It was just miserable.
And after several hours the autopsy attack and I finally
completed the case. And when we finished up, I went
back to my office, wrote down my findings, dictated my reports,
and went about the rest of my day. I didn't
think much of it. Her cause of deaths was miliary tuberculosis.
(12:21):
Manner of death natural case closed. So fast forward to
a few months later. I was working at a hospital
on a surgical pathology rotation, and part of that rotation
I had to dissect or gross end curtical specimens, which
means I would take the specimens from the surgeries that
were occurring during the day or the day before, and
I would dissect them and cut out pieces of the
(12:41):
tissue to look at under the microscope with a pathologist.
So when I finished residency, I would know what to
do on that particular day in the grossing or dissecting room.
I was working at the hospital where actually Elvis had die,
Baptist Memorial Hospital, which has been demolished years ago. But anyway,
I was in the grosser room that day dissecting a
radical mastectomy specimen when I accidentally cut the palm of
(13:04):
my hand. I cleaned it up, bandaged it, and finished
out the rest of my cases for the day, and
then went to the employee health center at the hospital
I was working at. They looked at my wounds said
I didn't need stitches, thankfully, but the employee health nurse
said she would run an exposure panel. What's an exposure panel.
It's a test we usually use when someone gets exposed
to something or cut or inhaled. We do it a
(13:24):
lot for paramedics or emas workers or firefighters to deal
with the bodies at the scene, and a test for
things like hepatitis, HIV or other infectious diseases we can
get from the body. I've had a lot of exposure
panels run on me over the years, and you know this,
especially if you listen to episode one and they've all
been negative. On this particular day, they asked me about
(13:44):
the exposure panel, and I said it was fine if
they ran it. I wasn't really worried because that specimen
had been in formaldehyde for over twenty four hours, so
I figured everything that was in there that could have
been infectious was probably long since dead. The nurse also
asked if I wanted to get a test for TB
and I said, well, when I graduated from medical school
a few months ago, I had had to have one
(14:06):
done and it was negative. But sure, we could get
one done today. And she administered the tuberculosis skin test,
or PPD test. PPD stands for purified protein derivative test,
and that means they inject a small amount of purified
tuberculum protein from Mycobacterium tuberculosis under your skin, and if
you've been exposed or have a latent infection, you will
(14:28):
have an inflammatory reaction which causes a large raised area
on your arm. If you haven't been exposed, it doesn't
do anything. I had never experienced a positive test in
my life, and I had had several of these PPD
tests during my medical school. Every single time they were negative.
I didn't think much of it. After about a day,
the injection site started swelling and it got bigger and
(14:50):
bigger and more and more painful on my arm. When
I went back to the employee health area, the nurse
said that it was a positive test. They told me
I had been exposed to TV. Now I had to
go to the Shelby County Health Department and report to
public Health, and that's what I did. When I showed
up at Public Health. I walked into the building and
I asked the receptionist where was the tuberculosis clinic, and
(15:12):
she said I had to walk down the hall, hang
a left past the sexually Transmitted Disease clinic, past the
HIV clinic, and it was the third door on the right.
I headed down the hall. The walls were white and
the tile floor was kind of this greenish blue color.
I walked past the STD clinic, the HIV clinic, and
I went to the third door on the right like
I was told. And when I walked in, it was
(15:34):
kind of a big room, and it had a nurse
behind this glass window, kind of like at a bank.
And that window had a little slot in it, which
I learned the purpose of later. I said to her
through the window, you know, my name's Kendall Crowns. I'm
a resident of the University of Tennessee, and I've been
exposed to tuberculosis. And I was told to come over here,
and she told me okay, handed me some paperwork to
(15:54):
fill out and told me to have a seat and
the doctor would be with me shortly. So I sat
down in the waiting room, a very big waiting room,
had a lot of chairs with this black vinyl on them,
and a lot of people. There was a family who
didn't seem to speak English, and they were all sitting
and coughing and wheezing and talking amongst themselves. Sitting across
from them was a very angry, muscular man who was
(16:15):
cracking his knuckles and forming a fist and staring at
the family. I noticed that individual had scleeral ictriss, which
is a yellowing of the whites of your eyes, usually
associated with liver failure. I thought that was odd. There
was two more people sitting in the corner, coughing and wheezing,
sitting under this UV light that I learned later was
used for controlling airborne infections, especially tuberculosis. If you're ever
(16:36):
in a restaurant or grocery store and you notice this
kind of light bar with a UV light by the doorway,
that's what it's for. It's there to kill infectious disease.
I sat down, trying to stay as far away from
the other people as I could. And as I was
sitting there, I thought, well, if I didn't have TV,
I sure have it now and then a couple walked in,
a much older man and a fairly younger woman. They
(16:56):
sat down a few chairs away from me, and the
younger woman said, what is this TV saying anyway? And
the older man said, I don't know, but I think
it's some sort of bug that comes up some bites you,
which was highly inaccurate, but I didn't think it was
necessary to tell them that at the time. I just
kept to myself. Another person walked in and he said, Hey,
is this the SDD clinic, and the nurse said no,
(17:18):
it's down the hall on the right, and he left.
And then another person came in and said, hey, is
this the HIV clinic, and the nurse again said no,
it's down the hall on the right, next to the
SDD clinic. And so I waited, and after what seemed
like hours, which was probably only a few minutes, they
finally called my name and I went back and I
sat down at this kind of large desk, and a
nurse who was working there said, oh, don't put your
(17:39):
arms there. We just had the prisoners in here and
everything's all dirty. She sprayed the desk down with the
disinfectant and cleaned it, and later she took my blood
for testing and I got a chest X ray done
looking for active disease, and the doctor met with me
and he seemed very, very, very tired, and he said
to me, so, you think you've been exposed to TV,
do you? And I said, well, yes, sir, I'm pretty
(18:02):
sure I got exposed because they didn't have the proper PPE.
And he said to me, well, that's how all of
you pathologists end up. You all eventually get exposed to TB.
It's just how it goes. And I thought, well, I
guess it was just going to happen at some point,
just happened at the beginning. But the thing about it
is I work with a lot of pathologists. The majority
of my colleagues still have not had a positive tuberculosis
(18:25):
skin test. The doctor handed me some papers and told
me to fill them out and sign them. I read
through them, and when I was reading them, I realized
if I didn't show up to get my preventive medication
that they were going to have me arrested. And I
said to the doctor to wait, if I don't show
up to pick up the medication, I can be arrested.
And he said, oh, you don't have to worry about that.
(18:46):
That's only if you don't show up to get your medication,
and you'll show up, of course, But if you don't
show up, just give us a call and tell us
you'll be there within the next day or two. But
if you don't give us a call, well I have
you hunted down and arrested because we can't have TV
spread across this county. And I thought, wow, that sounds
(19:08):
incredibly extreme. And then he said, just sign it. Don't
worry about it. You don't have to worry. Just sign it.
And I thought, well, okay, there's not really much I
can do, and I signed the paper and handed it
back to him. He then left and the nurse came
in and she had with her the medication that I
(19:29):
was going to be taken as a preventative. It was
ionizing which is used to treat tuberculosis or to be
a preventative for tuberculosis, and the vitamin B six. Why
the vitamin it was given to me because ioniad causes
neurologic damage and the vitamin would help prevent that. Ionizad
also causes liver damage, and so they told me not
(19:50):
to drink alcohol for the next six months, which wasn't
really an issue, but it did explain why the gentleman
in the room had yellow eyes, because he probably had
liver failure. They handed me those two battles of pills,
placed in a brown paper bag that was stabled shut.
They also handed me a little card with my name
on it in the date I was supposed to come
back the next month to pick up my medication, and
(20:11):
that was it. I was told I could go. When
I came back the following a month, I handed the
nurse my card. She verified it and stamped it and
placed it in a file. She then handed me a
new card with the next month's date on it and
my bag of pills. And that's how it went for
the next several months, just like a banking transaction. I
never met the doctor again, and over the next five
(20:32):
months it was the sane, basic routine. Every time I
got there, there'd be a new group of people coughing,
hacking up along under that UV light. And towards the
end when people would come in and ask if it
was the HIV or SDD clinic, I knew where to
tell them to go, and I gave them directions. So
I learned quite a lot in my time. When that
last month finally came, there was a problem. My daughter
(20:52):
was born on the day I was supposed to come
and pick up my medication, and in the excitement of
that moment, I forgot to come and get my medication.
I also forgot to give them a call. Twenty four
hours went by, forty eight hours went by. I went
back to the house to pick some things up. I
noticed there was messages on the answering machine, and when
I pushed the button to listen to them, there were
several messages, excitedly congratulating us on the birth of our
(21:15):
new child. But then there was one message from the
nurse from the tuberculosis clinic, and she was calling looking
for me, and she left an ominous message stating if
I didn't report to the TB clinic in the next
twenty four hours, they would send the police to the
address to come and arrest me. And when I heard
this message, I panicked because it had been nearly forty
eight hours, and I quickly called the TB clinic and
(21:38):
I explained to them what had happened. How I forgot
because my daughter had been born, And the nurse said,
on the other end of the line. Oh, well, we're
glad you called. We were just putting together a delinquent
tuberculosis patientless to be arrested by the police, and you're
on it, so you will be coming today, correct? And
I said, yes, I'll be there this afternoon, and she said, well, wonderful,
you better be. And I showed up that afternoon, went
(21:59):
down there and picked up my medication, handed in my card.
But this time I asked if I could keep my
card because it had my daughter's birth date on it,
and I thought it'd be as fun souvenir, and they
did let me keep it, and I didn't get arrested,
and I finished my medication and that was the end
of it. And whenever there's a workplace tuberculosis test, which
we do every year, I get to opt out because
(22:20):
I already know I'm incredibly positive. And that brings us
to the end of the episode. I hope you learned
something like don't forget your pills or the pill police
will come to arrestue. And I hope you were entertained
until the next time.
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