August 4, 2025 • 37 mins
For Dr. Priya, the autopsy is just the beginning. What happens next can change everything for the families left behind.
In this episode, Dr. Priya Banerjee joins Sheryl McCollum, to examine a side of autopsies that rarely makes headlines: the profound responsibility of communicating with families. Dr. Priya reflects on the power of empathy in the autopsy suite, the deep importance of walking families through trauma with care, and the surprising ways postmortem findings can protect the living.
She shares raw personal experiences—from the loss of her own parents to advocating for grieving families left behind during COVID—and the critical role of cultural awareness, front-line staff, and honest conversations. Listeners will also learn how autopsies sometimes uncover hereditary conditions that can lead to lifesaving interventions for surviving loved ones.
This is forensic pathology not just as a science, but as a service.
Highlights:
- (0:00) The emotional weight of entering the medical examiner’s office
- (1:30) Debunking the ‘grim reaper’ myth of pathology
- (3:00) Personal loss and professional insight: How Dr. Priya’s grief reshaped her work
- (5:45) The unsung heroes of the ME office—investigators and admin staff
- (6:45) Why Dr. Priya insists on calling families directly
- (9:00) Launching a private autopsy service in response to COVID-era needs
- (13:00) Managing expectations: What autopsies reveal and what they can’t
- (15:00) Working with families and finding closure
- (16:30) Cultural and religious barriers to autopsy
- (24:00) Why refusing an autopsy can hurt future legal or health outcomes
- (27:00) The hidden legacy of genetic disease
- (30:00) Dr. Priya’s pet and power of early intervention
About the Hosts
Dr. Priya Banerjee is a board-certified forensic pathologist with extensive experience in death investigation, clinical forensics, and courtroom testimony. A graduate of Johns Hopkins, she served for over a decade as Rhode Island’s state medical examiner and now runs a private forensic pathology practice. Her work includes military deaths, NSA cases, and high-profile investigations. Dr. Priya has also been featured as a forensic expert on platforms such as CrimeOnline and Crime Stories with Nancy Grace. She is a dedicated educator, animal lover, and proud mom.
Website: anchorforensicpathology.com
Twitter/X: @Autopsy_MD
Sheryl McCollum is an Emmy Award–winning CSI, a writer for CrimeOnline, and the Forensic and Crime Scene Expert for Crime Stories with Nancy Grace. She works as a CSI for a metro Atlanta Police Department and is the co-author of the textbook Cold Case: Pathways to Justice. Sheryl is also the founder and director of the Cold Case Investigative Research Institute (CCIRI), a nationally recognized nonprofit that brings together universities, law enforcement, and experts to help solve unsolved homicides, missing persons cases, and kidnappings.
Email: coldcase2004@gmail.com
Twitter/X: @ColdCaseTips
Facebook: @sheryl.mccollum
Instagram: @officialzone7podcast
📣 If this episode gave you a new understanding of the human side of forensic science, follow the show, share it with someone who needs to hear it, and leave us a review.
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 (00:08):
Y'all, welcome back to pathology with doctor Pria. Let me
tell you something, doctor, it is just one of those
things every single time that I've got to go to
the Medical Examiner's office, whether it's to participate in the
autopsy process, pick up evidence, or go and just have
(00:32):
a conversation about what we think is going on with
an investigation. The lobby, I mean it is just awful.
It's like sterile and the walls are just barn and
maybe have a photograph of you know, something just generic.
I don't know, and you just think these poor families
(00:54):
that are coming there and they're already suffering with trauma,
they're scared to they don't understand what's going on. They're
trying to process the worst information that they've only been
given a very short time ago, and now it's just
this I don't know, heartbreaking process that everybody is now
(01:16):
involved in. So I here's what I would love to
happen today with your expertise, just talk about general family
communication and how that relates to the autopsy process.
Speaker 2 (01:31):
Wow, well that's a big one, okay. And I can
only speak for myself obviously. This is our sort of
you know, off the beaten path experience, but and not
everybody's meat. You know, some people don't like interacting with families.
And you know, it's funny because the overarching impression of
medical examiners and even pathologists are that we're some sort
(01:54):
of like grim reaper, basement dweller, right, that all we
like to do is, you know, look at the dead.
But we are isolated and we don't interact with anybody,
which is the farthest thing from the truth. You know,
we're always talking to law enforcement, right. That goes about
saying my investigators and I are communicating all the time
(02:15):
about a case. But then you know, external to that,
you have to think about it. We're talking to families
to get history. We're talking to other treating physicians, doctors, nurses, anybody, neighbors, right,
like anybody that potentially knew about this, you know, individual
who's passed. And so that to me is really like
(02:39):
the one of the key misconceptions. You know, It's like
you go into it, everybody you know said, oh, there's
no way you're going to be a pathologist, you are
so outgoing, And I said, now, you know, I really
like doing this work. This is my calling. And then
you know, I think my other strength is being able
to like talk to people at their worst times. Like,
(03:01):
you know, no one goes to the medical examiner for
fun usually, right, it's always families are interacting with me
at their worst possible moment, you know. And personally, I've
been there over the last few years. My mom died
and prior to that, my dad died unexpectedly in India
while on vacation. So I have been through the personal
(03:23):
ringer of Okay, they don't care that I'm an emmy
in America, you know what I mean that in India,
I'm not their emmy, and I had to go through
all this rigamar role State Department. I don't even want
to get into that, but you know, I've been on
the other side, very personally. And then you know, of course,
(03:44):
my mother in law died not that long ago, so
again our family has been through it. So and it's
hard to be on that side, okay, And I don't
know if it's you know, I don't want to make
like one upmanship, like it's harder for me than you,
but it is. You know, doctors make the worst patience, Well,
I make the worst customer because normally I'm the one
(04:05):
in charge right signing the papers, you know, and when
I'm now the customer, if you will, the family where
I don't have the power but I'm heartbroken and need
things done. That's the hardest place to be in because
you see it from both sides. And I think I
try to carry that with me, like what did I
(04:25):
want to know? What did I you know, what answers
did I want? What did I need done to make
me feel better? You know, my daughter went to school
seeing my mom, you know, basically passing away, and how
shocking that was to her. She was much younger obviously,
and so like you know, you have to think about
(04:46):
you know, we are very medical, We're very procedural. We're
very calculated, right because evidence and documentation and you know.
But that's how I think we have to be in
the more right to make make sure that cases are
handled properly, step by step, thoroughly. But I think it
(05:06):
also helps us cope, right, Like when you emotionally remove
yourself and you know you're not connected to that individual
that you're autopsying in an emotional way, right, That's why
doctors don't treat their own family, right, It's the same thing.
Speaker 1 (05:23):
Yeah, I think you definitely have to protect yourself, there's
no question, right.
Speaker 2 (05:27):
But I had a very close friend pass away in
a car accident and I remember seeing her and I
had talked to her Monday, and it was a Wednesday.
We rode the Peloton bikes together and we would video
each other before we rode, and we would high five
each other throughout the ride. So two days I talked
to her and then she was dead and I remember
bursting out into tears. I had to leave the beating,
(05:49):
and like, her card's still in my office to this day,
her funeral card. So like, you know, obviously you can't
be removed. You know, you can't be as independent when
your emotions are in play, and I think that's easy
to forget. And that's where sometimes I think we I
don't want to say fail families, but we're not as
(06:12):
communicative as possible. I really do think though, like the
old office I used to work with, and multiple offices
that I've worked with, you know, throughout New England and
Vegas and whatnot, I think the front staff, like the
you know, people facing staff, the secretaries, the investigators, they
don't get enough credit because they're often the ones who
(06:36):
are interacting the most. What's that you know, and they
are really I remember my now you know, at my
old office. This guy has become an investigator, but he
started as a front office staff and you know, we
would listen to him and I'm like, you should have
become a therapist. You know how patient he was, how understanding.
We said, Jason, this is like a hidden talent you have,
(07:00):
you know, and so it is you know, really important.
And this may be my soapbox in a way of
how I operate, but you know, I often that my
secretary would say do you want me to call the family,
and I say no, I want to do it. You know.
It's not that she couldn't do it, but I think
for me, it was very important to show that I cared.
(07:20):
You know, I did the exam. There's no nothing lost
like the game and operator, you know where he goes
around and then things change because lost in translation. I
really wanted to say I saw these you know, saw
this with my own eyes. This is what it means.
And you know we might say, oh, he died of
a heart attack. No, I don't want to say, no
(07:41):
big deal, because that's what my dad died. Of you know,
but we know that it's not a homicide. We know
it's not an accident, right, it's not a drug overdose
like we you know, you know, case closed for us,
right from an investigative standpoint or for a complexity. But
to that family, that's devastating, you know, and I think
having in there, both of my parents died of natural diseases.
(08:02):
It wasn't anything harmful, even though my dad was abroad,
you know, so obviously they were life altering events for me.
But again, you know, from a police standpoint, they're like, yeah,
her parents died, Okay, cool, you know, like it wasn't
this huge ditch to do. So what I believe is
(08:25):
first and foremost is the communication. Now I have a
unique perspective where I'm now working for myself, so I
run a private autopsy service, and so I'm no longer
the road, you know, working for the State of Rhode Island,
and I'm in transition. I might be working elsewhere well
you know, I don't know where that's going, but part time,
(08:45):
of course. But regardless, you know, when my primary role
in this private pathology sector is that families call me.
And the whole reason this even started as part of
my practice was that during COVID I had families. I
had three different calls, three different families crying to me
(09:08):
on the phone that during COVID their loved ones could
not get autopsies and that no one would touch them.
And one of them was a thirty one year old
guy found on the hospital floor, you know, and I'm
just like shocked that these people aren't going to be autopsy.
They had examinations, but they didn't have the full work up,
if you will. And you know, as a parent, as
(09:30):
a loved one, it's you know, whether your wife is
seventy four, eighty four or your son's thirty one. Everybody
wants to know, right. So it was like, after three
separate calls of saying, no, I don't do this, I
realized these people like I'm their last hope, really, you know,
last outlet, because there's not even that many pathologists. I mean,
(09:51):
there's not that many forensic pathologists, but on top of that,
there's not that many forensic pathologists that do private autopsies,
and so it's really hard to find someone. And this
is in the backdrop of both you know, emmy offices
being overburdened and hospitals now really cutting back on their
autopsy service. You know, my two cents are because it's
(10:13):
not a financial gain, like insurances don't pay for an autopsy.
And you know, most hospital pathologists are sort of a divide,
if you will. The ones that like doing autopsies become
forensic pathologists and the ones that don't like doing autopsies
are usually hospital or laboratory based pathologists.
Speaker 1 (10:30):
So but you know, that leads me to a question
because as you're talking, I have heard that there are
some insurances that won't pay if it's a suicide. That's right,
So the family's gonna need you to say it was
medical or natural or right.
Speaker 2 (10:47):
Right. So it's a huge deal. Oh. I mean I
can talk hours about this because in my career I've
dealt with so much of this. You know. Part of
it is I think I look at it as what's
the first step. The first step is to just, you know,
understand where the family's coming from and this autopsy. I mean,
ninety nine point nine percent of the people have never
(11:07):
even I would say doctors that are my colleagues, who
are non pathologists don't know what a true autopsy is.
They may have never seen one. You know, they know
of it, that it exists, but what does it entail?
What can you know we tell from it? They have
no idea. So like you know, with that being said,
they you know, are in a state of shock. As
(11:29):
you said, they come to me, doctor, I need you
to do this. You know. Obviously I have to charge
them because of you know, the cost of doing it.
I don't have a I usually do it out of
a funeral home. I don't have a set up myself,
and I have to have help, so you know, there's
an overhead cost and what an uncomfortable time to talk
about money, right, But you know, after that sorted out,
(11:51):
one of the basic questions is can I have a
funeral for my loved one? You know? And I go
through this and say, you know, we the utmost care
that whether it's going to be an open casket or
you know, cremation, I still treat the body the same way.
And an autopsy and an you know, intact non decomposed
(12:15):
body does not prevent an open casket funeral. You know.
The you know, they we do it in a way
that the funeral directors can embomb the body, they can
dress it up. They have you know, full suits under
the like sort of plastic I don't know, like almost
like a partial partial like TIEVEK type suit where they
(12:36):
you know, zip up the body, everything's contained and then
they're you know, beautifully dressed in their final clothes. And
there's nothing that interferes with that because I want to
gather this information and give them closure. But obviously I
would never want to hinder the final you know, respects
of that person, right, I would never want to alter
(12:59):
their funeral, you know, So in any case, like that's
probably probably one of the biggest questions that I get,
you know, and then there's like what can you tell me?
And and really, you know, unfortunately what is oftentimes what
they want is not possible. I mean I spend a
lot of time, what I would say, counseling families that
(13:19):
I'm not here to take your money. I'm here for
to ride a service if it's useful. So I spend
a lot of time counseling them about like what's the
question you want to answer? What are you looking for
me to help you with? Because I am doing a
medical procedure, you know, and we can get into that,
we will get into the difference. But you know, they
grant me permission, but they don't really know exactly what
(13:42):
I'm doing, you know, and so you need to understand
the limitations of that as well. Sometimes it's a very
valid question and I'm like, yes, let's do this, And
those are the most satisfying autopsies. Like I'm a pretty
strict like screener, if you will, and believe or not,
I'm the one that talks to families. I don't have
(14:03):
a secretary, I don't have anybody doing the filtering, you know,
I'm the one that has because I think, you know,
even if someone takes the initial call, these kind of
difficult medical conversations, the nuances are really something that I
need to explain to the family and have that difficult
conversation because is this even the right way to proceed,
(14:25):
you know. And I've told families, hey, it's better for
you to wait on the initial autopsy and then have
me look at the report as an expert pathologist later.
You know, maybe I can't do a second autopsy because
it's not going to add anything, but you need to
wait for the results for the medical examiner and then
we can look at it. Because oftentimes litigation, you know,
(14:46):
or other questions. I mean a lady had hired me
just to even sit down with her on another you know,
offices autopsy, to go through it with her husband and
her you know, mentally challenged son because he was very
distraught by not understanding what the autops he meant. And
I could provide just interpretation closure to them. So I
sat at their dining room, you know, going over it
(15:08):
with them, just because I was like, why didn't the
doctor talk to you? They should have done this for you.
You know that that's how you get closure. Handing them
a medical report doesn't tell the layperson what happened? What
is all this jargon? Meat?
Speaker 1 (15:28):
Well, you know, you and I have talked about that.
I've got two sisters that are trauma nurses. They know terminology.
I don't know. And usually if there's a medical issue
within the family or friendship circle, they are ahead of
me like six or seven steps, where I'm like, Okay,
(15:49):
what are we going to do? How can we help
them get better? They may already know they're not going
to get better. I'm not there yet.
Speaker 2 (15:56):
Right, they're fund of knowledge or they're bad and experience
is different.
Speaker 1 (16:00):
Right, So when you took the time to sit down
with that family. That's that's more than communication. That to
me is so critical just as a human you're giving
them a gift to so that they can't accept it.
Speaker 2 (16:15):
Yes, and you know, it was very I don't want
to say strange, but it is very personal to be
in someone's home, right, Like if you think about it,
and I actually say that as someone who did crime
scene work, like you know, as any I used to
go to scenes when it was suspicious and I was
on call, and I found those personal effects personal you know,
(16:38):
scenarios where it was in their house to be the
most different, emotionally challenging, difficult to handle scenes because you're
in their lives right and you know, being in this
family's dining room where they used to have dinner every night,
you know, family photos, et cetera. That really like I
(17:01):
you know, I guess I was like, oh, it's an
hour on my life, you know day. Why didn't the
other emmy sit with them? But I was like, you
know what, at least I can do this for them.
And I felt so much better after leaving because I
felt like the sun really you know, was able to
grasp it. You know, obviously the dad's not there anymore.
But I think the why he had a lot of
(17:21):
basic questions and you know, no he didn't suffer, No,
he didn't, you know, those kinds of things he did receive.
You know, they tried to save him, just basic things,
you know, or the fact that they tried to save him,
but that it wouldn't have worked, you know, that they
didn't feel like they were missing something. Does that make
(17:42):
sense that their loved one they did enough or they
couldn't have done anything else that, because I think there's
a lot of regret or what if you know, that
kind of thing. And I actually played that out with
my dad too, Like he died of a heart attack,
Well what if like I had sent him to a
cardiologist months before? What if I had done this? You
know it just even that what if plays out in
(18:05):
my mind because now I'm the daughter with you know,
a doctorate, right, like an MD who does this for
a living. How did I miss it? Like? And I
don't think I missed anything, honestly. I think it was
you know, bad luck. But you know, it just happened,
you know, it's like it does. But I think when
it's so shocking, you know, and the family doesn't know,
(18:27):
they've read the report twenty times, but they don't know
what it means. That doesn't help anybody.
Speaker 1 (18:32):
Right, But like your dad, there was a whole process.
You didn't know about it. You didn't know who to call,
or where to go or how to get things done.
Speaker 2 (18:41):
I was in Calcutta with my mom, like, we schlept
all over. I've never been to a US embassy abroad.
I had to go to the police state. I mean,
you know, we almost felt like criminals, you know, and
I hate to say it that way, but they were like, well,
who are you. You have to prove this is your dad.
(19:01):
You have to. My mom had to take her wedding
marriage certificate from nineteen seventy from her lock box, Like
she had to dig that out before we were going
on an emergency flight to India. She was like, I
don't even know if I have something you know that's
fifty sixty years old. You know, just think about it, right, Yeah,
(19:22):
She's like, who keeps this stuff where? You know, we're
in our sixties. You know, my dad was sixty nine,
my mom was sixty eighth. It's not like, you know,
they were together forty years. It's not like they questioned it.
So she was like, and they wanted all this paperwork.
It's so overwhelming. I mean, that was one of the
most humbling experiences of my life. And I could talk,
(19:46):
you know, out of my teeth. Okay, I know the process.
He had an autopsy, but that doesn't prove in their
eyes that I'm legit right, that this is the wife,
this is the daughter, like to claim the body, you know. Yeah,
And that was and they had him because he was
a US citizen and died like an act and working
for the government. This was like even more rig up,
(20:07):
like more coops to jump through. It was hard, you know.
And I can only imagine if someone's in a different state,
doesn't speak the language. I mean, there's so many potential
difficulties that just you know. That's why any any communication
is so good. And I remember once in my career
(20:27):
there was a there was a running it became a
running joke in a way because I had a terribly
unfortunate case where a young girl from Guatemala died while
coming to camp in America. It was just a terrible accident.
Her parents flew over the next day. I met with
the parents and the consulate, like the Chief of the
(20:51):
Consulate of Guatemala in Providence, Rhode Island, Like they came
to the office, and since that day, I got invited
to every Guatemala Day festival, every every celebration in the
Guatemalan embassy. I got called single handedly from the embassy
that you know, they want to invite me. And I
(21:12):
was pregnant. I remember that I was, you know, first
I was not pregnant, and I was pregnant. She you know,
they were so thrilled that I was going to have
a baby. But it was funny how they accepted me,
you know, just because how I treated the family and
I can't even imagine losing a kid. You know. They
wanted to see pictures, and I actually took her aside
and said, I'm not comfortable showing. You know, this is
(21:34):
not how parents want to remember their child autopsy. You know,
I'm very hesitant to show autopsy pictures of any relative,
but especially a child. And then they were forcing me,
and I finally told, you know, the ambassador, I was like,
I don't feel like this is okay. You know, I'm
not personally comfortable. And I took her aside and I
(21:57):
shoulder and then she said yeah, this is not good,
you know, like they can't have this image in their head,
and so like, you know, it was so interesting how
you know, I sort of got connected with a different community.
And can you imagine internationally going and getting like the
worst news of your life basically, So you don't know
(22:18):
where people are coming from. They could be local, they
could be international, but it's always an unfortunate time. You know.
The other thing I sort of say is you know,
walking them through the process, you know, getting a funeral home.
We often because there's a lot of international families here.
We have a lot of Guatemalan, we have Cambodian families.
(22:40):
I'm just talking about Rhode Island, you know, the populations
and that varies throughout I mean Atlanta talk about like
a mixing bowl, right, I mean I grew up in DC.
That was the same thing in Maryland, DC area. So
you know, people are often cremated and sent abroad or
embombed and then sent you know, broad for burial whatnot.
(23:01):
So we're working with all avenues of people, you know,
and so I think the cultural awareness, even if you
don't know what to do, just the empathy can really help.
They know that you're trying to help them. You know,
you're not a man them. Ye you know, it's like
I don't speak your language, you know, but at least
I can try to help you. And you know, I
(23:21):
have to say that, like that was the best part
probably of the staff I worked with, as I was
always impressed and in various offices, I've always been impressed
how collegial it is and how you know we've gotten
people from. You know, they'll call the Department of Health
and say, does anybody speak Filipino because you know the
(23:43):
families here and no one in our office did you
know that kind of thing? Or Indian or you know,
there was a family that lost a baby and they
were Indian. I was like, let me tell you, and
they did not want to have an autopsy, so I
know that, you know, Hindu religious duties. I called them
and I said, look, you know, I'm of the same background.
I know how devastating this is. You know, those kinds
(24:06):
of things. So when you can reach beyond the cultural
sort of differences, it helps you understand, like it's not
that they were trying to be difficult. They religiously didn't
want an autopsy, you know, on this.
Speaker 1 (24:20):
Baby and all of that is communication, right.
Speaker 2 (24:24):
And I do want to say and we could this
will probably go into many other like episodes. But the
other thing that I take away from autopsy and the
communication part is like, you know, why do you have
to cut into my loved one? Well, God, for you know,
how will I know why they died? I need to
be able to stand up in quarter or to the police,
(24:44):
or even to look you in the face and say,
this is what proves how they died, right, And it
may not just be a toxicology issue that I can
do externally, right, And so that's a reason. And I
know it's invading the body, but this is the only
chance I'm going to get, you know. And then I
have had cases myself, but also I've handled as an
(25:07):
expert witness. You know, I do a lot of court
work where they didn't want an autopsy, and two years
later they want to file a lawsuit and then they're like,
oh man, we should have had an autopsy. You know,
we're sort of doing a work around what do you
think they died of? And I'm like, well, you know,
I can look at medical records and look at injury
patterns or whatnot. But obviously an autopsy speaks for itself,
(25:29):
you know, and to really communicate with that, and that
finally brings me to very interesting medical cases I've had.
You know, we know when it's like, you know, you
get that gut feeling at scene or as you're doing
the case, like, oh, this is not adding up. This
is not kosher, right, this is something bad happened. But
I think the stuff that people miss or don't communicate
(25:54):
to families as much, or I hope they do, are
like genetic conditions, you know. Now I have seen very
interesting things happen. I remember all the way back to
when I was training in Baltimore, this African American man
had blood in his urine and they never knew why.
And I did his autopsy and said, he has this
(26:14):
genetic kidney condition. No one detected. It was called polycystic
kidney disease. So I don't know why the other doctors didn't.
If they did a CT scan or you know, even
an ultrasound of his kidneys, they should have seen it.
And that means it's important because that can be a
reason someone goes to kidney failure and on dialysis because
(26:34):
it's genetic. So I called the family and I said, look,
you know you were you told me he had this
blood in his urine. You thought he may have had
a kidney infection. But indeed, now everybody should go to
their doctor and get screened for this. You know. And
probably the most telling things I've had really are centered
in the heart, you know, where the more genetic DNA
(26:55):
studies are done, the more we know about diseases of
the heart that's inherited. I have seen so many things,
you know, that are just crazy. I had a kid
who died and it was a very high profile case here,
and it turns out he probably had an arrhythmia. And
(27:17):
I called the mom and I said, look, you know,
there's all this other stuff, but I really am very suspicious.
Please get any surviving children worked up. And the sister
went to another hospital in the region, another academic center,
you know, where they're very specialized, and she got put
I think a pacemaker in because she had the same
arrhythmia that no one would have ever discovered otherwise.
Speaker 1 (27:44):
Doctor, this is blowing my mind. I'm going to tell
you something I have often told young detectives and rookies
that medical examiners are the reason we had things in
place like.
Speaker 2 (27:57):
Seat belts, yep, yep, ye very much.
Speaker 1 (28:00):
So I have never thought about you discovering something and
then been able to call the family to say, hey,
some more y'all probably have it well.
Speaker 2 (28:11):
Probably the most heartbreaking case that stands out was a
thirty eight year old African American man and he was
a big dude. But I mean, everybody's bigger than me
because I'm only five to one, you know, But like,
you know, but when I look at him, like, oh,
he's a strapping young man, but for thirty eight, you know,
six ft something, he wasn't that heavy, do you know
(28:31):
what I mean? Like he's a strapping young man. He
may have been okay, ten twenty pounds over a week,
but he's by no means unhealthy, right, And he's totally active.
And he drops dead and I get his heart and
his heart is humongous, like I can't hold it in
my hands, it is so big. And I was like,
this is really weird, Like this doesn't make sense to me.
(28:53):
And I sent it to a heart pathologist because I
had to basically advocate this needs a special study. I'm
not comfortable with this. This is unexplained and it turns
out that he had a genetic condition called dilated cardiomopathy,
where his heart got so big and so it became
sort of like this loose balloon, if you will. It
(29:15):
wasn't an effective pumping mechanism. Then I called his relative,
I think it was his aunt or sister, a female,
and they were driving to his funeral, and I said, look,
I'm really concerned that this is, you know, something that
running in the family. Does this guy have any children?
He goes, yeah, he has a two year old. And
(29:36):
I said, okay, and has anybody you know and your family,
extended family, you know, died at the same age. And
he's like, oh yeah, we had an uncle, a cousin.
They both dropped dead. And I was like, oh my god, Like,
you know, it was like bone chilling to me that like,
can we prevent any more debts? You know, there's obviously
(29:58):
something going on that it didn't strike them. They just said, okay,
the men, some men in our family die young, you know.
And that's what shocks me, you know, that, Oh my god.
And so and I'll have to throw in like a
pet story this week because it's like totally affected me, right,
(30:18):
But you know, I love my pets. Right, that's oh everybody,
anybody that knows me or follows me and like online
it's basically pictures of my kid and my pets. Okay,
Well I have Sphinx cats, right, So like think about
this in a way where I am now the consumer, right,
I'm now on the patient side. So Monday I took
(30:41):
two of my special cat Sphinx cats. So if anybody
listening to this ever saw Austin Powers, mister Bigglesworth was
one of those cats. No hair, okay, and that is
a genetic condition. That's why they have no hair. But
close to that, these cats off and inherit a gene
that affects their heart. It's a genetic heart condition. And
(31:04):
I mean, if anybody knows me, they know how much
I love my cats and how spoiled they are. Okay,
they don't want for anything. But Monday I had to
take them for what I thought was just screening. They're
not sick, they're not anything. And believe it or not,
my younger cat has some mild heart changes due to
(31:25):
her genetics. So now I am. I cried in the
doctor's office and now I'm like, there's a medicine that
just came out like a month or two ago, that
she's going to start on that hopefully makes some changes
to her heart to protect it, you know, from her
passing away. So like, think about it. Not only am
I you know, obviously it's my cat, and a lot
(31:46):
of people are like, oh, it's just a cat. But
you know it's the same sort of parallel, right, it's
recognizing it and communicating it, screening for it, and then
allowing families to maybe prevent whether it be future cancers. Right,
Like if we have like the breast cancer, sure, early
heart attacks, some people have like cholesterol problems. We can
(32:09):
see changes in their skin, you know. And and sometimes
I've seen people die in like a car crash, even
a twenty year old. But if they have something, I
know it's scary because I've seen you know, heart disease,
narrowing of the arteries in someone who's twenty or thirty,
and I'm like, that's really strange. Like if it's so prominent,
(32:31):
I might give the family a call and say, hey,
you know, I know this was hard, and he died
unrelay he or she died of unrelated issues. But we
always document everything, right, I say that in court all
the time. I document every little scratch, every finding on
the body, not just the trauma or not just the
drug overdose, every single thing. And so it's like, huh,
(32:53):
look at this this person has you know why at
at twenty five is this person having heart disease? Maybe
there's something genetic that's unknown and that they should get screened.
You know, I just think, am I doing the screening? No?
All I'm doing is sort of referring them. And the
other sort of thing is I can only do so
(33:16):
much lab work on a deceased person. Right, most of
genetic screening is only covered by insurance and living individuals, right,
because it's prevention treatment. Right, They're not going to cover
someone who's dead, and they don't treat anymore. But so
I'm not even really doing the treatment for me. It's
more like, hey, and I don't even know the result,
you know what I mean. Like, and some people may
(33:38):
blow me off saying, oh, she's crazy. I'm not going
to go to the doctor. Well that's up to you.
You know, I can't make you do anything. But if
there's someone who listens to me and maybe they can
get an intervention, you know, it may help them or
their loved one. You know, when you go to the doctor,
they always ask you, hey, what problems run in the family. Right,
That's what I'm getting at. Right if you have if
(33:59):
you're mind had a stroke, your dad had a heart attack.
That's why they doctors write these things down because they know,
oh it runs in the family. So I'm seeing it
unfortunately at you know, at the other end. But maybe
we can backtrack by communicating with the families to then say, hey,
you know the insurance will cover you guys. Right if
(34:19):
you say my brother died of you know, this really
rare heart condition. Can you send me to a cardiologist
and get an ultrasound of the heart or imaging of
the heart. Yeah, that's that should be covered, right, because
they want to prevent death. And so sure, I think
where I feel like I'm making a difference. You know,
it's not just giving closure, but I think there's actually
(34:41):
clinical benefit to.
Speaker 1 (34:43):
It, doctor Pria. I have never in my life thought, hey,
the medical examiner could save your life.
Speaker 2 (34:52):
Yeah you know, but that's what you did for the thing.
Speaker 1 (34:55):
But that's what you're doing with the unusual kidney is
she and the heart issue? Wow?
Speaker 2 (35:02):
And I mean I will document it too and say,
you know, this result was communicated with the family and
you know needs cardiology work, you know, or is suggested.
I can't say you must get it right because that's
not my place, but I really do think it's it's
part of our follow through. Right. If a doctor orders
a lab test and the result is abnormal, they call you, right,
(35:26):
you have an abnormal lab test. You need to get
XYZ done. And so to me, that's what it is. Yes,
I'm there to figure out why John Smith died, and
he died of a car accident, but if there's still
something you know, out and left field, it may not
have had anything to do with the death, but I'm
the only one that's going to look inside of him,
(35:47):
and you know, God forbid it could cause death in
someone else, right, or they didn't know that this you know,
weird thing could happen, like oh my god, what if
you know even think about like an aneurysm in the
brain or something that is silent until it's not. And
those are the big things that you want to you know.
I really do make it a point to call the families,
(36:10):
and sometimes they're like, why are you calling me? They
do get almost weirded out, you know, in a way.
Speaker 1 (36:17):
I think if the medical examiner calls you to say
I found I located. I noticed something really unusual that
genetically you may not be aware of, that you may
also carry. That is vital communication. So again, you know,
everybody listening, that's just one more level that I did
(36:41):
not even know was part of the service. I didn't
never cross my mind, Doctor Pria. I cannot thank you
enough because again, I mean, I've witnessed how you operate,
and it is from your heart. You just naturally have empathy,
and I just appreciate what you're doing here on Mondays.
Speaker 2 (37:03):
Well, thank you for the avenue you know to really
you know, these are my soapboxes or I mean, you
have to realize this is my view, right. Not everybody's
like me, but definitely you know, this is how I
practiced before and I continue to practice.
Speaker 1 (37:18):
Y'all. I'm Cheryl McCollum and I'm joined with doctor Priab Energy.
Do not miss Pathology with Doctor Pria Monday's on Zone
seven
Y'all, welcome back to pathology with doctor Pria. Let me
tell you something, doctor, it is just one of those
things every single time that I've got to go to
the Medical Examiner's office, whether it's to participate in the
autopsy process, pick up evidence, or go and just have
(00:32):
a conversation about what we think is going on with
an investigation. The lobby, I mean it is just awful.
It's like sterile and the walls are just barn and
maybe have a photograph of you know, something just generic.
I don't know, and you just think these poor families
(00:54):
that are coming there and they're already suffering with trauma,
they're scared to they don't understand what's going on. They're
trying to process the worst information that they've only been
given a very short time ago, and now it's just
this I don't know, heartbreaking process that everybody is now
(01:16):
involved in. So I here's what I would love to
happen today with your expertise, just talk about general family
communication and how that relates to the autopsy process.
Speaker 2 (01:31):
Wow, well that's a big one, okay. And I can
only speak for myself obviously. This is our sort of
you know, off the beaten path experience, but and not
everybody's meat. You know, some people don't like interacting with families.
And you know, it's funny because the overarching impression of
medical examiners and even pathologists are that we're some sort
(01:54):
of like grim reaper, basement dweller, right, that all we
like to do is, you know, look at the dead.
But we are isolated and we don't interact with anybody,
which is the farthest thing from the truth. You know,
we're always talking to law enforcement, right. That goes about
saying my investigators and I are communicating all the time
(02:15):
about a case. But then you know, external to that,
you have to think about it. We're talking to families
to get history. We're talking to other treating physicians, doctors, nurses, anybody, neighbors, right,
like anybody that potentially knew about this, you know, individual
who's passed. And so that to me is really like
(02:39):
the one of the key misconceptions. You know, It's like
you go into it, everybody you know said, oh, there's
no way you're going to be a pathologist, you are
so outgoing, And I said, now, you know, I really
like doing this work. This is my calling. And then
you know, I think my other strength is being able
to like talk to people at their worst times. Like,
(03:01):
you know, no one goes to the medical examiner for
fun usually, right, it's always families are interacting with me
at their worst possible moment, you know. And personally, I've
been there over the last few years. My mom died
and prior to that, my dad died unexpectedly in India
while on vacation. So I have been through the personal
(03:23):
ringer of Okay, they don't care that I'm an emmy
in America, you know what I mean that in India,
I'm not their emmy, and I had to go through
all this rigamar role State Department. I don't even want
to get into that, but you know, I've been on
the other side, very personally. And then you know, of course,
(03:44):
my mother in law died not that long ago, so
again our family has been through it. So and it's
hard to be on that side, okay, And I don't
know if it's you know, I don't want to make
like one upmanship, like it's harder for me than you,
but it is. You know, doctors make the worst patience, Well,
I make the worst customer because normally I'm the one
(04:05):
in charge right signing the papers, you know, and when
I'm now the customer, if you will, the family where
I don't have the power but I'm heartbroken and need
things done. That's the hardest place to be in because
you see it from both sides. And I think I
try to carry that with me, like what did I
(04:25):
want to know? What did I you know, what answers
did I want? What did I need done to make
me feel better? You know, my daughter went to school
seeing my mom, you know, basically passing away, and how
shocking that was to her. She was much younger obviously,
and so like you know, you have to think about
(04:46):
you know, we are very medical, We're very procedural. We're
very calculated, right because evidence and documentation and you know.
But that's how I think we have to be in
the more right to make make sure that cases are
handled properly, step by step, thoroughly. But I think it
(05:06):
also helps us cope, right, Like when you emotionally remove
yourself and you know you're not connected to that individual
that you're autopsying in an emotional way, right, That's why
doctors don't treat their own family, right, It's the same thing.
Speaker 1 (05:23):
Yeah, I think you definitely have to protect yourself, there's
no question, right.
Speaker 2 (05:27):
But I had a very close friend pass away in
a car accident and I remember seeing her and I
had talked to her Monday, and it was a Wednesday.
We rode the Peloton bikes together and we would video
each other before we rode, and we would high five
each other throughout the ride. So two days I talked
to her and then she was dead and I remember
bursting out into tears. I had to leave the beating,
(05:49):
and like, her card's still in my office to this day,
her funeral card. So like, you know, obviously you can't
be removed. You know, you can't be as independent when
your emotions are in play, and I think that's easy
to forget. And that's where sometimes I think we I
don't want to say fail families, but we're not as
(06:12):
communicative as possible. I really do think though, like the
old office I used to work with, and multiple offices
that I've worked with, you know, throughout New England and
Vegas and whatnot, I think the front staff, like the
you know, people facing staff, the secretaries, the investigators, they
don't get enough credit because they're often the ones who
(06:36):
are interacting the most. What's that you know, and they
are really I remember my now you know, at my
old office. This guy has become an investigator, but he
started as a front office staff and you know, we
would listen to him and I'm like, you should have
become a therapist. You know how patient he was, how understanding.
We said, Jason, this is like a hidden talent you have,
(07:00):
you know, and so it is you know, really important.
And this may be my soapbox in a way of
how I operate, but you know, I often that my
secretary would say do you want me to call the family,
and I say no, I want to do it. You know.
It's not that she couldn't do it, but I think
for me, it was very important to show that I cared.
(07:20):
You know, I did the exam. There's no nothing lost
like the game and operator, you know where he goes
around and then things change because lost in translation. I
really wanted to say I saw these you know, saw
this with my own eyes. This is what it means.
And you know we might say, oh, he died of
a heart attack. No, I don't want to say, no
(07:41):
big deal, because that's what my dad died. Of you know,
but we know that it's not a homicide. We know
it's not an accident, right, it's not a drug overdose
like we you know, you know, case closed for us,
right from an investigative standpoint or for a complexity. But
to that family, that's devastating, you know, and I think
having in there, both of my parents died of natural diseases.
(08:02):
It wasn't anything harmful, even though my dad was abroad,
you know, so obviously they were life altering events for me.
But again, you know, from a police standpoint, they're like, yeah,
her parents died, Okay, cool, you know, like it wasn't
this huge ditch to do. So what I believe is
(08:25):
first and foremost is the communication. Now I have a
unique perspective where I'm now working for myself, so I
run a private autopsy service, and so I'm no longer
the road, you know, working for the State of Rhode Island,
and I'm in transition. I might be working elsewhere well
you know, I don't know where that's going, but part time,
(08:45):
of course. But regardless, you know, when my primary role
in this private pathology sector is that families call me.
And the whole reason this even started as part of
my practice was that during COVID I had families. I
had three different calls, three different families crying to me
(09:08):
on the phone that during COVID their loved ones could
not get autopsies and that no one would touch them.
And one of them was a thirty one year old
guy found on the hospital floor, you know, and I'm
just like shocked that these people aren't going to be autopsy.
They had examinations, but they didn't have the full work up,
if you will. And you know, as a parent, as
(09:30):
a loved one, it's you know, whether your wife is
seventy four, eighty four or your son's thirty one. Everybody
wants to know, right. So it was like, after three
separate calls of saying, no, I don't do this, I
realized these people like I'm their last hope, really, you know,
last outlet, because there's not even that many pathologists. I mean,
(09:51):
there's not that many forensic pathologists, but on top of that,
there's not that many forensic pathologists that do private autopsies,
and so it's really hard to find someone. And this
is in the backdrop of both you know, emmy offices
being overburdened and hospitals now really cutting back on their
autopsy service. You know, my two cents are because it's
(10:13):
not a financial gain, like insurances don't pay for an autopsy.
And you know, most hospital pathologists are sort of a divide,
if you will. The ones that like doing autopsies become
forensic pathologists and the ones that don't like doing autopsies
are usually hospital or laboratory based pathologists.
Speaker 1 (10:30):
So but you know, that leads me to a question
because as you're talking, I have heard that there are
some insurances that won't pay if it's a suicide. That's right,
So the family's gonna need you to say it was
medical or natural or right.
Speaker 2 (10:47):
Right. So it's a huge deal. Oh. I mean I
can talk hours about this because in my career I've
dealt with so much of this. You know. Part of
it is I think I look at it as what's
the first step. The first step is to just, you know,
understand where the family's coming from and this autopsy. I mean,
ninety nine point nine percent of the people have never
(11:07):
even I would say doctors that are my colleagues, who
are non pathologists don't know what a true autopsy is.
They may have never seen one. You know, they know
of it, that it exists, but what does it entail?
What can you know we tell from it? They have
no idea. So like you know, with that being said,
they you know, are in a state of shock. As
(11:29):
you said, they come to me, doctor, I need you
to do this. You know. Obviously I have to charge
them because of you know, the cost of doing it.
I don't have a I usually do it out of
a funeral home. I don't have a set up myself,
and I have to have help, so you know, there's
an overhead cost and what an uncomfortable time to talk
about money, right, But you know, after that sorted out,
(11:51):
one of the basic questions is can I have a
funeral for my loved one? You know? And I go
through this and say, you know, we the utmost care
that whether it's going to be an open casket or
you know, cremation, I still treat the body the same way.
And an autopsy and an you know, intact non decomposed
(12:15):
body does not prevent an open casket funeral. You know.
The you know, they we do it in a way
that the funeral directors can embomb the body, they can
dress it up. They have you know, full suits under
the like sort of plastic I don't know, like almost
like a partial partial like TIEVEK type suit where they
(12:36):
you know, zip up the body, everything's contained and then
they're you know, beautifully dressed in their final clothes. And
there's nothing that interferes with that because I want to
gather this information and give them closure. But obviously I
would never want to hinder the final you know, respects
of that person, right, I would never want to alter
(12:59):
their funeral, you know, So in any case, like that's
probably probably one of the biggest questions that I get,
you know, and then there's like what can you tell me?
And and really, you know, unfortunately what is oftentimes what
they want is not possible. I mean I spend a
lot of time, what I would say, counseling families that
(13:19):
I'm not here to take your money. I'm here for
to ride a service if it's useful. So I spend
a lot of time counseling them about like what's the
question you want to answer? What are you looking for
me to help you with? Because I am doing a
medical procedure, you know, and we can get into that,
we will get into the difference. But you know, they
grant me permission, but they don't really know exactly what
(13:42):
I'm doing, you know, and so you need to understand
the limitations of that as well. Sometimes it's a very
valid question and I'm like, yes, let's do this, And
those are the most satisfying autopsies. Like I'm a pretty
strict like screener, if you will, and believe or not,
I'm the one that talks to families. I don't have
(14:03):
a secretary, I don't have anybody doing the filtering, you know,
I'm the one that has because I think, you know,
even if someone takes the initial call, these kind of
difficult medical conversations, the nuances are really something that I
need to explain to the family and have that difficult
conversation because is this even the right way to proceed,
(14:25):
you know. And I've told families, hey, it's better for
you to wait on the initial autopsy and then have
me look at the report as an expert pathologist later.
You know, maybe I can't do a second autopsy because
it's not going to add anything, but you need to
wait for the results for the medical examiner and then
we can look at it. Because oftentimes litigation, you know,
(14:46):
or other questions. I mean a lady had hired me
just to even sit down with her on another you know,
offices autopsy, to go through it with her husband and
her you know, mentally challenged son because he was very
distraught by not understanding what the autops he meant. And
I could provide just interpretation closure to them. So I
sat at their dining room, you know, going over it
(15:08):
with them, just because I was like, why didn't the
doctor talk to you? They should have done this for you.
You know that that's how you get closure. Handing them
a medical report doesn't tell the layperson what happened? What
is all this jargon? Meat?
Speaker 1 (15:28):
Well, you know, you and I have talked about that.
I've got two sisters that are trauma nurses. They know terminology.
I don't know. And usually if there's a medical issue
within the family or friendship circle, they are ahead of
me like six or seven steps, where I'm like, Okay,
(15:49):
what are we going to do? How can we help
them get better? They may already know they're not going
to get better. I'm not there yet.
Speaker 2 (15:56):
Right, they're fund of knowledge or they're bad and experience
is different.
Speaker 1 (16:00):
Right, So when you took the time to sit down
with that family. That's that's more than communication. That to
me is so critical just as a human you're giving
them a gift to so that they can't accept it.
Speaker 2 (16:15):
Yes, and you know, it was very I don't want
to say strange, but it is very personal to be
in someone's home, right, Like if you think about it,
and I actually say that as someone who did crime
scene work, like you know, as any I used to
go to scenes when it was suspicious and I was
on call, and I found those personal effects personal you know,
(16:38):
scenarios where it was in their house to be the
most different, emotionally challenging, difficult to handle scenes because you're
in their lives right and you know, being in this
family's dining room where they used to have dinner every night,
you know, family photos, et cetera. That really like I
(17:01):
you know, I guess I was like, oh, it's an
hour on my life, you know day. Why didn't the
other emmy sit with them? But I was like, you
know what, at least I can do this for them.
And I felt so much better after leaving because I
felt like the sun really you know, was able to
grasp it. You know, obviously the dad's not there anymore.
But I think the why he had a lot of
(17:21):
basic questions and you know, no he didn't suffer, No,
he didn't, you know, those kinds of things he did receive.
You know, they tried to save him, just basic things,
you know, or the fact that they tried to save him,
but that it wouldn't have worked, you know, that they
didn't feel like they were missing something. Does that make
(17:42):
sense that their loved one they did enough or they
couldn't have done anything else that, because I think there's
a lot of regret or what if you know, that
kind of thing. And I actually played that out with
my dad too, Like he died of a heart attack,
Well what if like I had sent him to a
cardiologist months before? What if I had done this? You
know it just even that what if plays out in
(18:05):
my mind because now I'm the daughter with you know,
a doctorate, right, like an MD who does this for
a living. How did I miss it? Like? And I
don't think I missed anything, honestly. I think it was
you know, bad luck. But you know, it just happened,
you know, it's like it does. But I think when
it's so shocking, you know, and the family doesn't know,
(18:27):
they've read the report twenty times, but they don't know
what it means. That doesn't help anybody.
Speaker 1 (18:32):
Right, But like your dad, there was a whole process.
You didn't know about it. You didn't know who to call,
or where to go or how to get things done.
Speaker 2 (18:41):
I was in Calcutta with my mom, like, we schlept
all over. I've never been to a US embassy abroad.
I had to go to the police state. I mean,
you know, we almost felt like criminals, you know, and
I hate to say it that way, but they were like, well,
who are you. You have to prove this is your dad.
(19:01):
You have to. My mom had to take her wedding
marriage certificate from nineteen seventy from her lock box, Like
she had to dig that out before we were going
on an emergency flight to India. She was like, I
don't even know if I have something you know that's
fifty sixty years old. You know, just think about it, right, Yeah,
(19:22):
She's like, who keeps this stuff where? You know, we're
in our sixties. You know, my dad was sixty nine,
my mom was sixty eighth. It's not like, you know,
they were together forty years. It's not like they questioned it.
So she was like, and they wanted all this paperwork.
It's so overwhelming. I mean, that was one of the
most humbling experiences of my life. And I could talk,
(19:46):
you know, out of my teeth. Okay, I know the process.
He had an autopsy, but that doesn't prove in their
eyes that I'm legit right, that this is the wife,
this is the daughter, like to claim the body, you know. Yeah,
And that was and they had him because he was
a US citizen and died like an act and working
for the government. This was like even more rig up,
(20:07):
like more coops to jump through. It was hard, you know.
And I can only imagine if someone's in a different state,
doesn't speak the language. I mean, there's so many potential
difficulties that just you know. That's why any any communication
is so good. And I remember once in my career
(20:27):
there was a there was a running it became a
running joke in a way because I had a terribly
unfortunate case where a young girl from Guatemala died while
coming to camp in America. It was just a terrible accident.
Her parents flew over the next day. I met with
the parents and the consulate, like the Chief of the
(20:51):
Consulate of Guatemala in Providence, Rhode Island, Like they came
to the office, and since that day, I got invited
to every Guatemala Day festival, every every celebration in the
Guatemalan embassy. I got called single handedly from the embassy
that you know, they want to invite me. And I
(21:12):
was pregnant. I remember that I was, you know, first
I was not pregnant, and I was pregnant. She you know,
they were so thrilled that I was going to have
a baby. But it was funny how they accepted me,
you know, just because how I treated the family and
I can't even imagine losing a kid. You know. They
wanted to see pictures, and I actually took her aside
and said, I'm not comfortable showing. You know, this is
(21:34):
not how parents want to remember their child autopsy. You know,
I'm very hesitant to show autopsy pictures of any relative,
but especially a child. And then they were forcing me,
and I finally told, you know, the ambassador, I was like,
I don't feel like this is okay. You know, I'm
not personally comfortable. And I took her aside and I
(21:57):
shoulder and then she said yeah, this is not good,
you know, like they can't have this image in their head,
and so like, you know, it was so interesting how
you know, I sort of got connected with a different community.
And can you imagine internationally going and getting like the
worst news of your life basically, So you don't know
(22:18):
where people are coming from. They could be local, they
could be international, but it's always an unfortunate time. You know.
The other thing I sort of say is you know,
walking them through the process, you know, getting a funeral home.
We often because there's a lot of international families here.
We have a lot of Guatemalan, we have Cambodian families.
(22:40):
I'm just talking about Rhode Island, you know, the populations
and that varies throughout I mean Atlanta talk about like
a mixing bowl, right, I mean I grew up in DC.
That was the same thing in Maryland, DC area. So
you know, people are often cremated and sent abroad or
embombed and then sent you know, broad for burial whatnot.
(23:01):
So we're working with all avenues of people, you know,
and so I think the cultural awareness, even if you
don't know what to do, just the empathy can really help.
They know that you're trying to help them. You know,
you're not a man them. Ye you know, it's like
I don't speak your language, you know, but at least
I can try to help you. And you know, I
(23:21):
have to say that, like that was the best part
probably of the staff I worked with, as I was
always impressed and in various offices, I've always been impressed
how collegial it is and how you know we've gotten
people from. You know, they'll call the Department of Health
and say, does anybody speak Filipino because you know the
(23:43):
families here and no one in our office did you
know that kind of thing? Or Indian or you know,
there was a family that lost a baby and they
were Indian. I was like, let me tell you, and
they did not want to have an autopsy, so I
know that, you know, Hindu religious duties. I called them
and I said, look, you know, I'm of the same background.
I know how devastating this is. You know, those kinds
(24:06):
of things. So when you can reach beyond the cultural
sort of differences, it helps you understand, like it's not
that they were trying to be difficult. They religiously didn't
want an autopsy, you know, on this.
Speaker 1 (24:20):
Baby and all of that is communication, right.
Speaker 2 (24:24):
And I do want to say and we could this
will probably go into many other like episodes. But the
other thing that I take away from autopsy and the
communication part is like, you know, why do you have
to cut into my loved one? Well, God, for you know,
how will I know why they died? I need to
be able to stand up in quarter or to the police,
(24:44):
or even to look you in the face and say,
this is what proves how they died, right, And it
may not just be a toxicology issue that I can
do externally, right, And so that's a reason. And I
know it's invading the body, but this is the only
chance I'm going to get, you know. And then I
have had cases myself, but also I've handled as an
(25:07):
expert witness. You know, I do a lot of court
work where they didn't want an autopsy, and two years
later they want to file a lawsuit and then they're like,
oh man, we should have had an autopsy. You know,
we're sort of doing a work around what do you
think they died of? And I'm like, well, you know,
I can look at medical records and look at injury
patterns or whatnot. But obviously an autopsy speaks for itself,
(25:29):
you know, and to really communicate with that, and that
finally brings me to very interesting medical cases I've had.
You know, we know when it's like, you know, you
get that gut feeling at scene or as you're doing
the case, like, oh, this is not adding up. This
is not kosher, right, this is something bad happened. But
I think the stuff that people miss or don't communicate
(25:54):
to families as much, or I hope they do, are
like genetic conditions, you know. Now I have seen very
interesting things happen. I remember all the way back to
when I was training in Baltimore, this African American man
had blood in his urine and they never knew why.
And I did his autopsy and said, he has this
(26:14):
genetic kidney condition. No one detected. It was called polycystic
kidney disease. So I don't know why the other doctors didn't.
If they did a CT scan or you know, even
an ultrasound of his kidneys, they should have seen it.
And that means it's important because that can be a
reason someone goes to kidney failure and on dialysis because
(26:34):
it's genetic. So I called the family and I said, look,
you know you were you told me he had this
blood in his urine. You thought he may have had
a kidney infection. But indeed, now everybody should go to
their doctor and get screened for this. You know. And
probably the most telling things I've had really are centered
in the heart, you know, where the more genetic DNA
(26:55):
studies are done, the more we know about diseases of
the heart that's inherited. I have seen so many things,
you know, that are just crazy. I had a kid
who died and it was a very high profile case here,
and it turns out he probably had an arrhythmia. And
(27:17):
I called the mom and I said, look, you know,
there's all this other stuff, but I really am very suspicious.
Please get any surviving children worked up. And the sister
went to another hospital in the region, another academic center,
you know, where they're very specialized, and she got put
I think a pacemaker in because she had the same
arrhythmia that no one would have ever discovered otherwise.
Speaker 1 (27:44):
Doctor, this is blowing my mind. I'm going to tell
you something I have often told young detectives and rookies
that medical examiners are the reason we had things in
place like.
Speaker 2 (27:57):
Seat belts, yep, yep, ye very much.
Speaker 1 (28:00):
So I have never thought about you discovering something and
then been able to call the family to say, hey,
some more y'all probably have it well.
Speaker 2 (28:11):
Probably the most heartbreaking case that stands out was a
thirty eight year old African American man and he was
a big dude. But I mean, everybody's bigger than me
because I'm only five to one, you know, But like,
you know, but when I look at him, like, oh,
he's a strapping young man, but for thirty eight, you know,
six ft something, he wasn't that heavy, do you know
(28:31):
what I mean? Like he's a strapping young man. He
may have been okay, ten twenty pounds over a week,
but he's by no means unhealthy, right, And he's totally active.
And he drops dead and I get his heart and
his heart is humongous, like I can't hold it in
my hands, it is so big. And I was like,
this is really weird, Like this doesn't make sense to me.
(28:53):
And I sent it to a heart pathologist because I
had to basically advocate this needs a special study. I'm
not comfortable with this. This is unexplained and it turns
out that he had a genetic condition called dilated cardiomopathy,
where his heart got so big and so it became
sort of like this loose balloon, if you will. It
(29:15):
wasn't an effective pumping mechanism. Then I called his relative,
I think it was his aunt or sister, a female,
and they were driving to his funeral, and I said, look,
I'm really concerned that this is, you know, something that
running in the family. Does this guy have any children?
He goes, yeah, he has a two year old. And
(29:36):
I said, okay, and has anybody you know and your family,
extended family, you know, died at the same age. And
he's like, oh yeah, we had an uncle, a cousin.
They both dropped dead. And I was like, oh my god, Like,
you know, it was like bone chilling to me that like,
can we prevent any more debts? You know, there's obviously
(29:58):
something going on that it didn't strike them. They just said, okay,
the men, some men in our family die young, you know.
And that's what shocks me, you know, that, Oh my god.
And so and I'll have to throw in like a
pet story this week because it's like totally affected me, right,
(30:18):
But you know, I love my pets. Right, that's oh everybody,
anybody that knows me or follows me and like online
it's basically pictures of my kid and my pets. Okay,
Well I have Sphinx cats, right, So like think about
this in a way where I am now the consumer, right,
I'm now on the patient side. So Monday I took
(30:41):
two of my special cat Sphinx cats. So if anybody
listening to this ever saw Austin Powers, mister Bigglesworth was
one of those cats. No hair, okay, and that is
a genetic condition. That's why they have no hair. But
close to that, these cats off and inherit a gene
that affects their heart. It's a genetic heart condition. And
(31:04):
I mean, if anybody knows me, they know how much
I love my cats and how spoiled they are. Okay,
they don't want for anything. But Monday I had to
take them for what I thought was just screening. They're
not sick, they're not anything. And believe it or not,
my younger cat has some mild heart changes due to
(31:25):
her genetics. So now I am. I cried in the
doctor's office and now I'm like, there's a medicine that
just came out like a month or two ago, that
she's going to start on that hopefully makes some changes
to her heart to protect it, you know, from her
passing away. So like, think about it. Not only am
I you know, obviously it's my cat, and a lot
(31:46):
of people are like, oh, it's just a cat. But
you know it's the same sort of parallel, right, it's
recognizing it and communicating it, screening for it, and then
allowing families to maybe prevent whether it be future cancers. Right,
Like if we have like the breast cancer, sure, early
heart attacks, some people have like cholesterol problems. We can
(32:09):
see changes in their skin, you know. And and sometimes
I've seen people die in like a car crash, even
a twenty year old. But if they have something, I
know it's scary because I've seen you know, heart disease,
narrowing of the arteries in someone who's twenty or thirty,
and I'm like, that's really strange. Like if it's so prominent,
(32:31):
I might give the family a call and say, hey,
you know, I know this was hard, and he died
unrelay he or she died of unrelated issues. But we
always document everything, right, I say that in court all
the time. I document every little scratch, every finding on
the body, not just the trauma or not just the
drug overdose, every single thing. And so it's like, huh,
(32:53):
look at this this person has you know why at
at twenty five is this person having heart disease? Maybe
there's something genetic that's unknown and that they should get screened.
You know, I just think, am I doing the screening? No?
All I'm doing is sort of referring them. And the
other sort of thing is I can only do so
(33:16):
much lab work on a deceased person. Right, most of
genetic screening is only covered by insurance and living individuals, right,
because it's prevention treatment. Right, They're not going to cover
someone who's dead, and they don't treat anymore. But so
I'm not even really doing the treatment for me. It's
more like, hey, and I don't even know the result,
you know what I mean. Like, and some people may
(33:38):
blow me off saying, oh, she's crazy. I'm not going
to go to the doctor. Well that's up to you.
You know, I can't make you do anything. But if
there's someone who listens to me and maybe they can
get an intervention, you know, it may help them or
their loved one. You know, when you go to the doctor,
they always ask you, hey, what problems run in the family. Right,
That's what I'm getting at. Right if you have if
(33:59):
you're mind had a stroke, your dad had a heart attack.
That's why they doctors write these things down because they know,
oh it runs in the family. So I'm seeing it
unfortunately at you know, at the other end. But maybe
we can backtrack by communicating with the families to then say, hey,
you know the insurance will cover you guys. Right if
(34:19):
you say my brother died of you know, this really
rare heart condition. Can you send me to a cardiologist
and get an ultrasound of the heart or imaging of
the heart. Yeah, that's that should be covered, right, because
they want to prevent death. And so sure, I think
where I feel like I'm making a difference. You know,
it's not just giving closure, but I think there's actually
(34:41):
clinical benefit to.
Speaker 1 (34:43):
It, doctor Pria. I have never in my life thought, hey,
the medical examiner could save your life.
Speaker 2 (34:52):
Yeah you know, but that's what you did for the thing.
Speaker 1 (34:55):
But that's what you're doing with the unusual kidney is
she and the heart issue? Wow?
Speaker 2 (35:02):
And I mean I will document it too and say,
you know, this result was communicated with the family and
you know needs cardiology work, you know, or is suggested.
I can't say you must get it right because that's
not my place, but I really do think it's it's
part of our follow through. Right. If a doctor orders
a lab test and the result is abnormal, they call you, right,
(35:26):
you have an abnormal lab test. You need to get
XYZ done. And so to me, that's what it is. Yes,
I'm there to figure out why John Smith died, and
he died of a car accident, but if there's still
something you know, out and left field, it may not
have had anything to do with the death, but I'm
the only one that's going to look inside of him,
(35:47):
and you know, God forbid it could cause death in
someone else, right, or they didn't know that this you know,
weird thing could happen, like oh my god, what if
you know even think about like an aneurysm in the
brain or something that is silent until it's not. And
those are the big things that you want to you know.
I really do make it a point to call the families,
(36:10):
and sometimes they're like, why are you calling me? They
do get almost weirded out, you know, in a way.
Speaker 1 (36:17):
I think if the medical examiner calls you to say
I found I located. I noticed something really unusual that
genetically you may not be aware of, that you may
also carry. That is vital communication. So again, you know,
everybody listening, that's just one more level that I did
(36:41):
not even know was part of the service. I didn't
never cross my mind, Doctor Pria. I cannot thank you
enough because again, I mean, I've witnessed how you operate,
and it is from your heart. You just naturally have empathy,
and I just appreciate what you're doing here on Mondays.
Speaker 2 (37:03):
Well, thank you for the avenue you know to really
you know, these are my soapboxes or I mean, you
have to realize this is my view, right. Not everybody's
like me, but definitely you know, this is how I
practiced before and I continue to practice.
Speaker 1 (37:18):
Y'all. I'm Cheryl McCollum and I'm joined with doctor Priab Energy.
Do not miss Pathology with Doctor Pria Monday's on Zone
seven
Host
Sheryl McCollum
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