August 25, 2025 • 27 mins
Content Warning: This episode contains graphic descriptions of internal autopsy procedures, causes of death, and discussions of trauma, drug use, and infectious diseases. Listener discretion is advised.
In this episode, Dr. Priya and Sheryl McCollum go beneath the skin to examine what internal findings reveal about how someone lived and what ultimately caused their death. From the first incision to the final look at the neck, Dr. Priya walks through each step of the internal autopsy, showing how the lungs, liver, stomach contents and brain tissue all contribute to a complete forensic picture. It's an unfiltered look at the science behind suspicious deaths and the small but critical findings that can change the course of a case. Whether it's an undiagnosed disease or unexpected toxins, nothing gets past a thorough autopsy.
Highlights
- (0:00) Welcome to Pathology with Dr. Priya | A Zone 7 Series
- (0:30) Honoring the legacy of Judge Frank Caprio
- (3:00) Making the first cut: the Y-incision and what it reveals
- (6:30) The process of removing weighing and inspecting organs
- (8:30) Clues in the lungs: smoking damage, silent infections, and signs of COVID
- (10:30) Why every case includes drug testing, no matter the age
- (11:30) What stomach contents can us about timing and intent
- (12:45) Reading the liver and spleen for signs of alcohol hepatitis in cancer
- (16:00) STDs beneath the surface: infections that quietly destroy
- (18:00) Detecting undiagnosed disease and hidden internal trauma
- (23:00) Inside the brain: swelling, strokes, and oxygen-starved tissue
- (25:15) The final step of the autopsy: what the neck can reveal
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
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Welcome to Pathology with Doctor Pria. Doc so good to
talk to you. How are you, honey, I'm doing well.
Speaker 2 (00:15):
Thank you.
Speaker 1 (00:16):
You know you and I talked off air yesterday. We
lost a great judge and a better man, and you
know you had such wonderful things to say. I'm just
gonna give you the mic so you can honor him.
Speaker 2 (00:31):
Well, it's hard. I'm gonna try not to shed some tears.
So you know. The one thing is I didn't know
him personally. I knew him more professionally, just like the
rest of the world did. I'm talking about the honorable
Judge Frank Caprio who passed away, and you know, as
a doctor, he asked for prayers the night before and
(00:55):
I hate to say it, I was worried then that
he seemed weak, you know, but he's meant, he was
so strong. I was just hoping and praying that it,
you know, wasn't the end for him. But pancreatic cancer
is just an evil, evil disease. And you know, I
think with so much negativity and you know, whatever's going
(01:18):
on in our lives around us, he just saw the
light and the pure joy in life and people, and
I think that's what I always took away from him.
You know, he was locally known from a very prestigious
family because of his work, and then you know, he
became a national superstar really because of his generosity as
(01:41):
a judge, which just you know, uncommon to see, you know,
right on the bench, the soft, kind hearted understanding. He
was a municipal judge, so he dealt with people who
were really hard up in life. And I think people
come with excuses sometimes to court, but he really saw
(02:03):
the best in people. And that's what I want to
like remember him for, and what we can learn from
him is just to try to be positive despite all challenges.
I mean, there's nothing like pancreatic cancer. And so I
just want to honor him and send my sincere condolences
to his family and his loved ones, his colleagues and friends.
(02:26):
But you know, we're such a small state here in
Rhode Island, but it sent ripples around the country because
so many people knew him from his work that as
soon as he passed and we were all just, I
don't know, sort of speechless. What you know, how do
you honor such an honorable man.
Speaker 1 (02:46):
That was beautiful and you're absolutely right, all right, So listen. Now,
last week we talked about the external exam when you're
looking at clothes and tattoos and jewelry and staying and
et cetera. Tonight we're going to talk about the internal.
So y'all know what it starts with? That why shaped incision?
(03:11):
So dot take it away?
Speaker 2 (03:13):
Yeah, so you know, we sort of describe it separately,
but they're really everything is connected. Right, So we left
off looking at the outside of the body, any markings, right,
tattoo scars, but really that's sort of a stamp or
a glimpse of what I'm going to find inside. Right,
(03:34):
Sometimes we have you know, surgery scars, we have maybe
genetic developmental changes, and then of course we're trauma and
so and remember it's not they're not mutually exclusive, right,
normal people can have multiple things. And so I want to,
(03:55):
you know, say that this is where the two worlds
sort of meat. And we started started gathering like the
rest of the data of the autopsy. So when we
talked about it last week, I just want to say,
we sort of talked about a variety of things, but nonetheless,
this is a medical procedure and it's I do it,
(04:18):
and I teach it in a very like systematic way.
So like when we're living and we go to the doctor, right,
they take our height and wait, and then they check
our blood pressure, and they listen to our heart and
lungs and then press on our belly. It's basically the
same thing in an autopsy.
Speaker 1 (04:34):
Right.
Speaker 2 (04:35):
So anytime I'm doing the outside of a person, I'm
looking top to bottom. I always do the right side,
then the left side, and then I do the back,
you know, And so it's the same thing for the inside,
which means I start with this famous wy decision. Now
it's exactly done in that shape. So what I do
is I use my scalpel blade to cut through the
(04:57):
skin and the soft tissues from schol to shoulder, and
I bring it down like I'm painting the top of
a y on the body, right to the middle of
the chest, and then I cut all the way down
to the pelvic area and the pubic bone. And then
that's the stem of the Why that is like unlocking
(05:21):
the body. Okay, I just entered it. Now I have
to pull all that back, which you know, I think
the beauty of it all is we're all built the same,
no matter what our skin color, no matter how heavy
or light we are. Really it's skin and fat, okay,
(05:41):
and some muscle. And then once those are removed, I'm
looking at the chest plate. So you imagine it like
a body of armor. Okay, and I take that off
and believe it or not. I hate to be very
crude about it, but there's not a lot of fancy tools.
We use an autopsy and some people use like a
(06:01):
surgical type saw, but most of the time I was trained,
we use tree cutting shears from a hardware store, so
they can cut through limbs, they can cut through bone
like ribs, and we remove the chest plate. And it's
sort of the ultimate look inside. Right, I'm looking at
everything from the collar bones to the pelvic bone. I
(06:24):
see the heart, it's in its sack. I see the
lungs right, and then that's the chest. So I do
it very systematically, in an orderly fashion. I first take
out I open the sack around the heart, make sure
that is not punctured or filled with fluid. I look
at the heart itself. I remove the heart, make sure
(06:47):
there's not a clot between the lungs and the heart,
and then go from there. We weigh each organ, So
the heart gets weighed and then each lung is separated.
Now all this time looking at are these in the
right position? Is there any fluid around them that shouldn't
be there? Is there any blood infection? So every step,
(07:09):
you know, like I said, I'm not gonna talk about
every single thing in my mental checklist, but it's there,
you know, And that's how I train my junior doctors.
You know, you think I'm not. I'm just going through
the motions, but really my eyes and brain are constantly
communicating what do I have here? Okay? Is the heart enlarged?
(07:31):
Is the heart in the normal connection? Is their heart
surgery in the past, right? There may have been clues
to that on the skin on the outside or the
chest plate, if there's heart surgery in the past, and
now I'm going to see it on the inside, like
what was done? You know, I don't often have the
full story and medical records when I'm doing an autopsy,
(07:52):
and they may come in later, you know, and the
family may know that, oh he had heart surgery. But
you know, you can't always expect detailed medical record when
you're going in. So sometimes I am learning as I go,
and I just have to be very careful with the
dissection that you know, I document everything and also sort
(08:13):
of disconnect things gently and systematically, so I can see, Okay,
this artery was you know, routed to the heart because
this person had a bypass in the past. Oh that
means they might have had a heart attack or some
sort of hurt problems. Right, Like these are all this
is how my mind works as I'm doing it. Like
(08:34):
what clues are revealed and what does that represent? You know,
were they a smoker?
Speaker 1 (08:40):
Right?
Speaker 2 (08:40):
I can tell by looking at the lungs or did
they have a lung cancer? Or is there are the
lungs so discolored and heavy that there might be an
infection like a pneumonia? And I think, you know, we
just went through the cod we can't forget about COVID, right,
So that was really injurious to the lungs. Right, The
(09:02):
lungs were not working for many people who are dying
from COVID. So I could just see, oh my gosh,
these lungs are dense. They're not filling with air, They're
filled with fluid and infection. So I mean that's gonna
send me down, you know, almost like a different pathway meaning, Okay,
I need to figure out what infection this is. I
(09:24):
might send microbiology studies, you know, infection studies from the
lung tissue or usually both. I'll also take tissue samples
to look under the microscope. Right. So this is where like,
it's not one one recipe for everybody, right, because depending
(09:45):
on what I'm finding, depending on the case, you know,
case by case, just like every crime scene isn't that
isn't handled the same, right, It just depends depends on
the crime, depends on the flavor of the scene. Well,
what's the flavor of the autopsy. Right. If it's a young,
healthy person who drops dead, well then I think drugs,
maybe something genetic more often drugs, trauma, maybe a heart condition,
(10:12):
you know. But unfortunately, drugs being the most you know,
common in our daily lives, I need to make sure
I get every dang you know, toxicology sample I need, right,
And that's true with everybody. I mean, I was I
had an interview for a different program and I was
joking with the casting director. I'm like, what's the oldest
(10:36):
you know, drug abuser that I've handled case? And she
said eighty five. I said, no, nineties, you know, so
I run toxicology on everybody. Okay, so like even Grandma
who may not be able to walk. Well, I've had
those cases where they have meth amphetamine in their system
and I'm like, how is Granny getting meth But that's
(10:58):
not my pro that's not my role to find, right,
It's it's the fact that that may impact her heart
condition and could lead to her death. Right, So I
don't pass judgment. I just sort of have it that,
you know, toxicology is so important that you know, I
need to test it on everybody and then I you know,
(11:18):
so that's sort of jumping ahead. But because we get
blood samples from the heart and the leg and sometimes
the stomach contents if I think someone has eaten, like
ingested a lot of medication or some chemical purposefully. Right,
so we're looking at all these sort of issues.
Speaker 1 (11:38):
Well, cannot jump in here a second, because the stomach
contents are always fascinating to me and critical. A lot
of times. It'll give us a starting point. I know
with John B. Nay Ramsay, it was the pineapple, you know,
and that goes away so quick, so that means she
ate right before she was killed just about and then
(11:59):
other people have a steak dinner and they're supposed to
be poor or you know, you see the red wine
whatever it might be.
Speaker 2 (12:05):
Yeah, it tells a lot and it's hard sometimes to
tell visually because it may not look like the food
you know that was chewed up and swallowed, because it's
not all mixed together. But it's really important, like even
in something like drowning, did they swallow water? You know,
is there water that sort of separates out in their
(12:28):
stomach that kit that can be a sign of drowning.
It's not exclusively, but it's something that I like to
look at, you know, so you know, everything is done
sort of in context right of what the background is.
But you know, we're continuing from the heart, lungs. Now
we're in the stomach. Then we look at the liver.
(12:48):
The liver is is so resilient but tell so much
of a story in in US, you know, it's the
detoxifying center. It can have cancers, but usually if there's
an infection like a hepatitis or drug abuse, you can
see scarring, you know, alcoholism, that's probably the number one
(13:11):
thing I see, you know in the liver. The changes right,
so you know, then I go to the spleen, which
is this sort of bag of blood that sits on
the side, but you can have you know, I've had
undiagnosed blood cancers because I'm like, Wow, this spleen's really big.
(13:34):
What's going on with it? You know? And I've looked
at it and then suddenly I'm like, hey, there's this
blood cancer that no one knew about, you know, So
that's really important that you know. The spleen is sort
of this the blood cleaning system, and it'll get bigger,
it'll react. So if anybody's had mononucleosis or epstein bar
(13:56):
infection EBV, sometimes you know, the spleen gets big and inflamed,
and that's when kids aren't allowed to play contact sports
because the screen can burst. It's so thin from you know,
from a hit, and so when it's enlarge, you can
imagine the balloon stretched even more. So. Like you know, obviously,
(14:16):
in any kind of trauma, I'm always looking for breaks
or tears in these organs. Is there blood tracking anywhere
that gives me an idea where the injury started?
Speaker 1 (14:29):
And you know, Doc, you mentioned an STD and I
want to ask you two things. Get ready to make
fun of me, but when I was you know, young
and first starting you know, twenty twenty one, I thought
STDs were only owned sex organs, so well I know
now I know then and like, there was somebody that
(14:51):
I was dealing with that was a regular in court
and he would get arrested all the time. Well he
had these sores on his hands, and I was like, oh,
you know, poor thing, because he's homeless. I mean, it
could be ants whatever. I had no idea that.
Speaker 2 (15:03):
Was syphilis, Dallas syphilis.
Speaker 1 (15:05):
Right. So again I have heard sometimes with the internal
exam some of the STDs are so rampant.
Speaker 2 (15:16):
Right if they can get really you know extin bar mono.
They call it a kissing disease, but there are other
ways to get it, so I don't necessarily call it
in the STD. But it's very contagious. Does that make sense,
meningitis because these are just like little saliva droplets breathing
on people can even give you know, transfer the highly
(15:40):
contagious infection. You know, that's when we see it in
young people sharings, you know, glasses, drinking from the same glass, kissing,
whatever it may be. But I think, you know, sometimes
people have other issues going on that go undetected, and
I've definitely seen it, like whether it be like something
(16:00):
like gonorrhea, chlamydia inside especially I hate to say it,
and a female, you know, women's organs that carries up
and into the pelvis, and I've seen horrible abscesses, pockets
of infection. You know, things just get destroyed inside and
it may not be as a parent on the outside.
(16:22):
So you know, men and women both get it, but
it really reeks havoc in a very destructive fashion if
it's not treated. Of course, antibiotics, you know, if you
do get detected or it's easy to treat. But so
you know, that's the sort of takeaway from this is
if we can teach the living, go see your doctor
and practice safe sex.
Speaker 1 (16:43):
Right.
Speaker 2 (16:43):
But you know, and I mean when we talk about
hepatitis C, HIV, I mean all of these can be
blood borne but also sexually transmitted. So you know, all
of these are so important to think about that I think,
not to say complacency, but I think people are now
(17:03):
less afraid of them in a way because there's treatments
or preventions. But I don't think anything is is totally gone.
Speaker 1 (17:12):
Right, Well, the plague, what the heck what.
Speaker 2 (17:16):
The heck, right, We're seeing that pop up every now
and then. But you know, a historical thing is when
talk about like back in the day, when families would meet,
like a dad would meet a daughter's, you know, possible spouse,
they would shake hands and would feel the elbow region
(17:38):
because there's lymph nodes there that can get enlarged and syphilis,
so that was like one of the tests for it,
you know. And if you hear that, yeah, yep, and
then you know, you sometimes have to get syphilis testing
antiquated for marriage licenses, you know, because that those laws
were set so far back. And then there's even things
(18:00):
like well I didn't talk about in the external, but
there's a nodule like if someone has cancer brewing on
the inside, sometimes a lymph node right above the belly
button can pop up as a sign of cancer. And
so you know, if I see something like that and
I'm looking inside, I want to know, it's usually a
gi cancer like a gut cancer, and I'm like, I
(18:21):
want to know where this, you know, is it colon cancer,
some bowel cancer, stomach cancer that I'm missing. So there
could be a lot of like subtle signs and the
hard part is I again, I can't talk to the
person and say, have you had belly pain? Right, or
you know, some sort of discharge for a month, right, Like,
so I'm taking inside looking for things, right, That's.
Speaker 1 (18:45):
Really what it is. I'm just you know why I'm laughing.
Remember our dinner in Atlanta when I was like, you
are going to be no fun because there was a
man at the next table. You were like, oh, he
don't need any of that, Like, yeah, now you got
people out there grabbing people's elbows, and ah.
Speaker 2 (19:12):
Kids stand out very differently, so you know, a lot
of what I'm describing, And I mean I still approach
child autopsies the same way, like top to bottom, going
from you know, I think I left off at the kidneys,
right describing the kidneys. The biggest thing we often see
is like high blood pressure changes in the kidney's, diabetic
(19:34):
changes in the kidneys where the kidneys are scarred. Maybe
someone's had a kidney transplant that can put them at
risk for infection, you know, maybe a cancer. So there's
a lot of those things, you know, And so I'm
looking at every organ after the kidneys, I'm looking at
the at either the female organs, the uterus, bladder, ovaries,
(19:55):
fallopian tubes, or I'm looking at the testicles along with
the bladder and prostate in a man. So you can
see how we just worked our way down from the
top to the bottom. Right, And remember everything is not
just looked at in its place inside the body. I'm
handling it, and then I'm looking, you know, taking it
(20:16):
out of its place, and then I'm weighing it. And
then once I take everything out of the body, I
actually step aside and dissect everything, you know, very carefully.
When I say carefully, it's you know, a few millimeter
slices through the coronary arteries, you know, which are the
large vessels to the heart. Like you slice through the heart,
(20:38):
you slice through the lungs. Everything is looked at. And
why we slice through it is because you don't want
to just look at the outside of something. You want
to really look at it inside and get as much
of a look as you can. So it's very detailed
in that sense where if you cut it, like just
think about a loaf of bread, right, if you look
at the crust, only you're not seeing the inside of
(21:00):
the crumb. Is it crunchy, is it soft? Is it dry,
Is it bubbly? Right? Is there cheese inside of it?
Or their herbs? You have no idea just looking at
the outside. So that's why we slice it right, just
like a loaf of bread. And you're really getting all
these looks, all these slices to look at front and back,
if you will, throughout any organ that's sort of the
(21:23):
big chunk of it. But we haven't looked at the
brain and the neck yet. And would you know this?
Why why I go back to the brain and then
the neck. Do you have any recollection from your training, Cheryl?
Speaker 1 (21:39):
Well, I mean probably to see if somebody's been strangled.
Speaker 2 (21:42):
Or right, But do you know why there's sort of
strategy to do that?
Speaker 1 (21:46):
No?
Speaker 2 (21:47):
No, okay, So we then look at the brain. After
the you know, the torso the main body cavities are done. Okay,
So I go back and I cut into the skin
out and then we look at the skull make sure
there's no abnormal bruising or fractures. I'm looking at every step,
(22:07):
so I'm looking at the scalp. I want to make
sure I feel around the hair because hair can hide
so much. But fear not, because if I didn't even
you know, if the hair's hiding so much dreadlocks. I mean,
sometimes people have so much hair it's very hard to see.
But the beauty is when I cut through the scalp
and I flip it, I'm getting to see the entire
underside of the scalp. So if there's any bruising that
(22:31):
was hidden, if you will, on the outside, it becomes
super visible on the underside, Okay. And so usually, unfortunately,
if it's a massive head trauma case, especially in a homicide,
I usually have to shave a portion of their head,
if not the whole head. But I try to be
(22:54):
as respectful as possible and do my work, you know,
without necessarily changing their appearance, you know, as much as
can be preserved. At the same time, it's a very
delicate balance. I need to get my information, and especially
if there's wounds to the head, they need to be photographed,
(23:14):
measured and documented. So, you know, sometimes it does come
into shaving the whole head. And then we're going deeper.
We're going to take the skull cap off and look
at the brain. The brain's going to be sitting there.
And again what I'm doing, layer by layer is looking
at the covering of the head, so the skull, the scalp,
(23:38):
the skull. Then I'm going to look at the dura,
which is that thick sort of I describe it like tievek,
like this thick opaque covering over the brain, the dura
moter that's like a protective layer over the brain. And
then we're looking at the brain itself. Now I want
to see if there's infection, meningitis, if there's a stroke,
(24:04):
if there's bleeding in and around the brain. Right, all
of these have been you know, they're so important in
the brain. And then I actually look at the brain.
Oftentimes we see swelling of the brain that can be
either part of the brain or the whole brain. Okay,
And sometimes we see the swelling just because as someone
(24:27):
is dying from a lack of oxygen, the brain is
the most sensitive to that and it will start swelling.
So it's not the primary cause, like even in a
drug overdose or something where or a you know, heart attack,
where someone may be dying slowly. If they drop dead,
you're not going to see the brain swelling. But if
they're resuscitated on a ventilator, all sorts of things like that,
(24:48):
we see swelling of the brain. So you know that
may be sort of what is irreversible, especially in a
drug overdose or something of that nature. That's where the
really bad injury occurs from not breathing, having a lack
of oxygen, and then going from there. Hell, it looks
(25:10):
like I've talked a lot, but I do want to
come back to the very essential point is after we've
taken the brain out, made sure that's evaluated. Remember, I
have the neck left, and the neck is such a
vulnerable part in the body. We cannot forget it. So
why I've now saved the best for last, if you will,
is because by taking the brain away and cutting it
(25:33):
out and then cutting the organs out, what I've done
is drain the blood away from top and bottom, Okay,
and that really clears the field, which you know is
sort of a medical way of saying. The blood drains
out from the muscles and the structures. There's so much
going on in the neck. I want to get a
very detailed look at it. And so then I'm going
(25:54):
to go in and do a layer by layer dissection.
And really what I'm looking at is not just you know,
the muscles, the airway, the thyroid. I want to make
sure there's no injury there. Okay, that's the big thing.
We have the hyoid bone, we have the airway, the larynx,
the voice box, and we really need to make sure
(26:17):
that everything's intact there or if it's not, really hone
in on that.
Speaker 1 (26:23):
That is amazing. Now, y'all listen, we've done external and internal.
Next week, doctor Priya is gonna be talking about things
that she has found in bodies that ain't supposed to
be there.
Speaker 2 (26:37):
Oh, there's so much on that. That may be two episodes.
Speaker 1 (26:40):
You never know, it needs to be two episodes, so
y'all get ready. Doctor. Thank you so much to Judge
and being with us and just teaching us so much.
Speaker 2 (26:51):
Thank you for having me. Till next time.
Welcome to Pathology with Doctor Pria. Doc so good to
talk to you. How are you, honey, I'm doing well.
Speaker 2 (00:15):
Thank you.
Speaker 1 (00:16):
You know you and I talked off air yesterday. We
lost a great judge and a better man, and you
know you had such wonderful things to say. I'm just
gonna give you the mic so you can honor him.
Speaker 2 (00:31):
Well, it's hard. I'm gonna try not to shed some tears.
So you know. The one thing is I didn't know
him personally. I knew him more professionally, just like the
rest of the world did. I'm talking about the honorable
Judge Frank Caprio who passed away, and you know, as
a doctor, he asked for prayers the night before and
(00:55):
I hate to say it, I was worried then that
he seemed weak, you know, but he's meant, he was
so strong. I was just hoping and praying that it,
you know, wasn't the end for him. But pancreatic cancer
is just an evil, evil disease. And you know, I
think with so much negativity and you know, whatever's going
(01:18):
on in our lives around us, he just saw the
light and the pure joy in life and people, and
I think that's what I always took away from him.
You know, he was locally known from a very prestigious
family because of his work, and then you know, he
became a national superstar really because of his generosity as
(01:41):
a judge, which just you know, uncommon to see, you know,
right on the bench, the soft, kind hearted understanding. He
was a municipal judge, so he dealt with people who
were really hard up in life. And I think people
come with excuses sometimes to court, but he really saw
(02:03):
the best in people. And that's what I want to
like remember him for, and what we can learn from
him is just to try to be positive despite all challenges.
I mean, there's nothing like pancreatic cancer. And so I
just want to honor him and send my sincere condolences
to his family and his loved ones, his colleagues and friends.
(02:26):
But you know, we're such a small state here in
Rhode Island, but it sent ripples around the country because
so many people knew him from his work that as
soon as he passed and we were all just, I
don't know, sort of speechless. What you know, how do
you honor such an honorable man.
Speaker 1 (02:46):
That was beautiful and you're absolutely right, all right, So listen. Now,
last week we talked about the external exam when you're
looking at clothes and tattoos and jewelry and staying and
et cetera. Tonight we're going to talk about the internal.
So y'all know what it starts with? That why shaped incision?
(03:11):
So dot take it away?
Speaker 2 (03:13):
Yeah, so you know, we sort of describe it separately,
but they're really everything is connected. Right, So we left
off looking at the outside of the body, any markings, right,
tattoo scars, but really that's sort of a stamp or
a glimpse of what I'm going to find inside. Right,
(03:34):
Sometimes we have you know, surgery scars, we have maybe
genetic developmental changes, and then of course we're trauma and
so and remember it's not they're not mutually exclusive, right,
normal people can have multiple things. And so I want to,
(03:55):
you know, say that this is where the two worlds
sort of meat. And we started started gathering like the
rest of the data of the autopsy. So when we
talked about it last week, I just want to say,
we sort of talked about a variety of things, but nonetheless,
this is a medical procedure and it's I do it,
(04:18):
and I teach it in a very like systematic way.
So like when we're living and we go to the doctor, right,
they take our height and wait, and then they check
our blood pressure, and they listen to our heart and
lungs and then press on our belly. It's basically the
same thing in an autopsy.
Speaker 1 (04:34):
Right.
Speaker 2 (04:35):
So anytime I'm doing the outside of a person, I'm
looking top to bottom. I always do the right side,
then the left side, and then I do the back,
you know, And so it's the same thing for the inside,
which means I start with this famous wy decision. Now
it's exactly done in that shape. So what I do
is I use my scalpel blade to cut through the
(04:57):
skin and the soft tissues from schol to shoulder, and
I bring it down like I'm painting the top of
a y on the body, right to the middle of
the chest, and then I cut all the way down
to the pelvic area and the pubic bone. And then
that's the stem of the Why that is like unlocking
(05:21):
the body. Okay, I just entered it. Now I have
to pull all that back, which you know, I think
the beauty of it all is we're all built the same,
no matter what our skin color, no matter how heavy
or light we are. Really it's skin and fat, okay,
(05:41):
and some muscle. And then once those are removed, I'm
looking at the chest plate. So you imagine it like
a body of armor. Okay, and I take that off
and believe it or not. I hate to be very
crude about it, but there's not a lot of fancy tools.
We use an autopsy and some people use like a
(06:01):
surgical type saw, but most of the time I was trained,
we use tree cutting shears from a hardware store, so
they can cut through limbs, they can cut through bone
like ribs, and we remove the chest plate. And it's
sort of the ultimate look inside. Right, I'm looking at
everything from the collar bones to the pelvic bone. I
(06:24):
see the heart, it's in its sack. I see the
lungs right, and then that's the chest. So I do
it very systematically, in an orderly fashion. I first take
out I open the sack around the heart, make sure
that is not punctured or filled with fluid. I look
at the heart itself. I remove the heart, make sure
(06:47):
there's not a clot between the lungs and the heart,
and then go from there. We weigh each organ, So
the heart gets weighed and then each lung is separated.
Now all this time looking at are these in the
right position? Is there any fluid around them that shouldn't
be there? Is there any blood infection? So every step,
(07:09):
you know, like I said, I'm not gonna talk about
every single thing in my mental checklist, but it's there,
you know, And that's how I train my junior doctors.
You know, you think I'm not. I'm just going through
the motions, but really my eyes and brain are constantly
communicating what do I have here? Okay? Is the heart enlarged?
(07:31):
Is the heart in the normal connection? Is their heart
surgery in the past, right? There may have been clues
to that on the skin on the outside or the
chest plate, if there's heart surgery in the past, and
now I'm going to see it on the inside, like
what was done? You know, I don't often have the
full story and medical records when I'm doing an autopsy,
(07:52):
and they may come in later, you know, and the
family may know that, oh he had heart surgery. But
you know, you can't always expect detailed medical record when
you're going in. So sometimes I am learning as I go,
and I just have to be very careful with the
dissection that you know, I document everything and also sort
(08:13):
of disconnect things gently and systematically, so I can see, Okay,
this artery was you know, routed to the heart because
this person had a bypass in the past. Oh that
means they might have had a heart attack or some
sort of hurt problems. Right, Like these are all this
is how my mind works as I'm doing it. Like
(08:34):
what clues are revealed and what does that represent? You know,
were they a smoker?
Speaker 1 (08:40):
Right?
Speaker 2 (08:40):
I can tell by looking at the lungs or did
they have a lung cancer? Or is there are the
lungs so discolored and heavy that there might be an
infection like a pneumonia? And I think, you know, we
just went through the cod we can't forget about COVID, right,
So that was really injurious to the lungs. Right, The
(09:02):
lungs were not working for many people who are dying
from COVID. So I could just see, oh my gosh,
these lungs are dense. They're not filling with air, They're
filled with fluid and infection. So I mean that's gonna
send me down, you know, almost like a different pathway meaning, Okay,
I need to figure out what infection this is. I
(09:24):
might send microbiology studies, you know, infection studies from the
lung tissue or usually both. I'll also take tissue samples
to look under the microscope. Right. So this is where like,
it's not one one recipe for everybody, right, because depending
(09:45):
on what I'm finding, depending on the case, you know,
case by case, just like every crime scene isn't that
isn't handled the same, right, It just depends depends on
the crime, depends on the flavor of the scene. Well,
what's the flavor of the autopsy. Right. If it's a young,
healthy person who drops dead, well then I think drugs,
maybe something genetic more often drugs, trauma, maybe a heart condition,
(10:12):
you know. But unfortunately, drugs being the most you know,
common in our daily lives, I need to make sure
I get every dang you know, toxicology sample I need, right,
And that's true with everybody. I mean, I was I
had an interview for a different program and I was
joking with the casting director. I'm like, what's the oldest
(10:36):
you know, drug abuser that I've handled case? And she
said eighty five. I said, no, nineties, you know, so
I run toxicology on everybody. Okay, so like even Grandma
who may not be able to walk. Well, I've had
those cases where they have meth amphetamine in their system
and I'm like, how is Granny getting meth But that's
(10:58):
not my pro that's not my role to find, right,
It's it's the fact that that may impact her heart
condition and could lead to her death. Right, So I
don't pass judgment. I just sort of have it that,
you know, toxicology is so important that you know, I
need to test it on everybody and then I you know,
(11:18):
so that's sort of jumping ahead. But because we get
blood samples from the heart and the leg and sometimes
the stomach contents if I think someone has eaten, like
ingested a lot of medication or some chemical purposefully. Right,
so we're looking at all these sort of issues.
Speaker 1 (11:38):
Well, cannot jump in here a second, because the stomach
contents are always fascinating to me and critical. A lot
of times. It'll give us a starting point. I know
with John B. Nay Ramsay, it was the pineapple, you know,
and that goes away so quick, so that means she
ate right before she was killed just about and then
(11:59):
other people have a steak dinner and they're supposed to
be poor or you know, you see the red wine
whatever it might be.
Speaker 2 (12:05):
Yeah, it tells a lot and it's hard sometimes to
tell visually because it may not look like the food
you know that was chewed up and swallowed, because it's
not all mixed together. But it's really important, like even
in something like drowning, did they swallow water? You know,
is there water that sort of separates out in their
(12:28):
stomach that kit that can be a sign of drowning.
It's not exclusively, but it's something that I like to
look at, you know, so you know, everything is done
sort of in context right of what the background is.
But you know, we're continuing from the heart, lungs. Now
we're in the stomach. Then we look at the liver.
(12:48):
The liver is is so resilient but tell so much
of a story in in US, you know, it's the
detoxifying center. It can have cancers, but usually if there's
an infection like a hepatitis or drug abuse, you can
see scarring, you know, alcoholism, that's probably the number one
(13:11):
thing I see, you know in the liver. The changes right,
so you know, then I go to the spleen, which
is this sort of bag of blood that sits on
the side, but you can have you know, I've had
undiagnosed blood cancers because I'm like, Wow, this spleen's really big.
(13:34):
What's going on with it? You know? And I've looked
at it and then suddenly I'm like, hey, there's this
blood cancer that no one knew about, you know, So
that's really important that you know. The spleen is sort
of this the blood cleaning system, and it'll get bigger,
it'll react. So if anybody's had mononucleosis or epstein bar
(13:56):
infection EBV, sometimes you know, the spleen gets big and inflamed,
and that's when kids aren't allowed to play contact sports
because the screen can burst. It's so thin from you know,
from a hit, and so when it's enlarge, you can
imagine the balloon stretched even more. So. Like you know, obviously,
(14:16):
in any kind of trauma, I'm always looking for breaks
or tears in these organs. Is there blood tracking anywhere
that gives me an idea where the injury started?
Speaker 1 (14:29):
And you know, Doc, you mentioned an STD and I
want to ask you two things. Get ready to make
fun of me, but when I was you know, young
and first starting you know, twenty twenty one, I thought
STDs were only owned sex organs, so well I know
now I know then and like, there was somebody that
(14:51):
I was dealing with that was a regular in court
and he would get arrested all the time. Well he
had these sores on his hands, and I was like, oh,
you know, poor thing, because he's homeless. I mean, it
could be ants whatever. I had no idea that.
Speaker 2 (15:03):
Was syphilis, Dallas syphilis.
Speaker 1 (15:05):
Right. So again I have heard sometimes with the internal
exam some of the STDs are so rampant.
Speaker 2 (15:16):
Right if they can get really you know extin bar mono.
They call it a kissing disease, but there are other
ways to get it, so I don't necessarily call it
in the STD. But it's very contagious. Does that make sense,
meningitis because these are just like little saliva droplets breathing
on people can even give you know, transfer the highly
(15:40):
contagious infection. You know, that's when we see it in
young people sharings, you know, glasses, drinking from the same glass, kissing,
whatever it may be. But I think, you know, sometimes
people have other issues going on that go undetected, and
I've definitely seen it, like whether it be like something
(16:00):
like gonorrhea, chlamydia inside especially I hate to say it,
and a female, you know, women's organs that carries up
and into the pelvis, and I've seen horrible abscesses, pockets
of infection. You know, things just get destroyed inside and
it may not be as a parent on the outside.
(16:22):
So you know, men and women both get it, but
it really reeks havoc in a very destructive fashion if
it's not treated. Of course, antibiotics, you know, if you
do get detected or it's easy to treat. But so
you know, that's the sort of takeaway from this is
if we can teach the living, go see your doctor
and practice safe sex.
Speaker 1 (16:43):
Right.
Speaker 2 (16:43):
But you know, and I mean when we talk about
hepatitis C, HIV, I mean all of these can be
blood borne but also sexually transmitted. So you know, all
of these are so important to think about that I think,
not to say complacency, but I think people are now
(17:03):
less afraid of them in a way because there's treatments
or preventions. But I don't think anything is is totally gone.
Speaker 1 (17:12):
Right, Well, the plague, what the heck what.
Speaker 2 (17:16):
The heck, right, We're seeing that pop up every now
and then. But you know, a historical thing is when
talk about like back in the day, when families would meet,
like a dad would meet a daughter's, you know, possible spouse,
they would shake hands and would feel the elbow region
(17:38):
because there's lymph nodes there that can get enlarged and syphilis,
so that was like one of the tests for it,
you know. And if you hear that, yeah, yep, and
then you know, you sometimes have to get syphilis testing
antiquated for marriage licenses, you know, because that those laws
were set so far back. And then there's even things
(18:00):
like well I didn't talk about in the external, but
there's a nodule like if someone has cancer brewing on
the inside, sometimes a lymph node right above the belly
button can pop up as a sign of cancer. And
so you know, if I see something like that and
I'm looking inside, I want to know, it's usually a
gi cancer like a gut cancer, and I'm like, I
(18:21):
want to know where this, you know, is it colon cancer,
some bowel cancer, stomach cancer that I'm missing. So there
could be a lot of like subtle signs and the
hard part is I again, I can't talk to the
person and say, have you had belly pain? Right, or
you know, some sort of discharge for a month, right, Like,
so I'm taking inside looking for things, right, That's.
Speaker 1 (18:45):
Really what it is. I'm just you know why I'm laughing.
Remember our dinner in Atlanta when I was like, you
are going to be no fun because there was a
man at the next table. You were like, oh, he
don't need any of that, Like, yeah, now you got
people out there grabbing people's elbows, and ah.
Speaker 2 (19:12):
Kids stand out very differently, so you know, a lot
of what I'm describing, And I mean I still approach
child autopsies the same way, like top to bottom, going
from you know, I think I left off at the kidneys,
right describing the kidneys. The biggest thing we often see
is like high blood pressure changes in the kidney's, diabetic
(19:34):
changes in the kidneys where the kidneys are scarred. Maybe
someone's had a kidney transplant that can put them at
risk for infection, you know, maybe a cancer. So there's
a lot of those things, you know, And so I'm
looking at every organ after the kidneys, I'm looking at
the at either the female organs, the uterus, bladder, ovaries,
(19:55):
fallopian tubes, or I'm looking at the testicles along with
the bladder and prostate in a man. So you can
see how we just worked our way down from the
top to the bottom. Right, And remember everything is not
just looked at in its place inside the body. I'm
handling it, and then I'm looking, you know, taking it
(20:16):
out of its place, and then I'm weighing it. And
then once I take everything out of the body, I
actually step aside and dissect everything, you know, very carefully.
When I say carefully, it's you know, a few millimeter
slices through the coronary arteries, you know, which are the
large vessels to the heart. Like you slice through the heart,
(20:38):
you slice through the lungs. Everything is looked at. And
why we slice through it is because you don't want
to just look at the outside of something. You want
to really look at it inside and get as much
of a look as you can. So it's very detailed
in that sense where if you cut it, like just
think about a loaf of bread, right, if you look
at the crust, only you're not seeing the inside of
(21:00):
the crumb. Is it crunchy, is it soft? Is it dry,
Is it bubbly? Right? Is there cheese inside of it?
Or their herbs? You have no idea just looking at
the outside. So that's why we slice it right, just
like a loaf of bread. And you're really getting all
these looks, all these slices to look at front and back,
if you will, throughout any organ that's sort of the
(21:23):
big chunk of it. But we haven't looked at the
brain and the neck yet. And would you know this?
Why why I go back to the brain and then
the neck. Do you have any recollection from your training, Cheryl?
Speaker 1 (21:39):
Well, I mean probably to see if somebody's been strangled.
Speaker 2 (21:42):
Or right, But do you know why there's sort of
strategy to do that?
Speaker 1 (21:46):
No?
Speaker 2 (21:47):
No, okay, So we then look at the brain. After
the you know, the torso the main body cavities are done. Okay,
So I go back and I cut into the skin
out and then we look at the skull make sure
there's no abnormal bruising or fractures. I'm looking at every step,
(22:07):
so I'm looking at the scalp. I want to make
sure I feel around the hair because hair can hide
so much. But fear not, because if I didn't even
you know, if the hair's hiding so much dreadlocks. I mean,
sometimes people have so much hair it's very hard to see.
But the beauty is when I cut through the scalp
and I flip it, I'm getting to see the entire
underside of the scalp. So if there's any bruising that
(22:31):
was hidden, if you will, on the outside, it becomes
super visible on the underside, Okay. And so usually, unfortunately,
if it's a massive head trauma case, especially in a homicide,
I usually have to shave a portion of their head,
if not the whole head. But I try to be
(22:54):
as respectful as possible and do my work, you know,
without necessarily changing their appearance, you know, as much as
can be preserved. At the same time, it's a very
delicate balance. I need to get my information, and especially
if there's wounds to the head, they need to be photographed,
(23:14):
measured and documented. So, you know, sometimes it does come
into shaving the whole head. And then we're going deeper.
We're going to take the skull cap off and look
at the brain. The brain's going to be sitting there.
And again what I'm doing, layer by layer is looking
at the covering of the head, so the skull, the scalp,
(23:38):
the skull. Then I'm going to look at the dura,
which is that thick sort of I describe it like tievek,
like this thick opaque covering over the brain, the dura
moter that's like a protective layer over the brain. And
then we're looking at the brain itself. Now I want
to see if there's infection, meningitis, if there's a stroke,
(24:04):
if there's bleeding in and around the brain. Right, all
of these have been you know, they're so important in
the brain. And then I actually look at the brain.
Oftentimes we see swelling of the brain that can be
either part of the brain or the whole brain. Okay,
And sometimes we see the swelling just because as someone
(24:27):
is dying from a lack of oxygen, the brain is
the most sensitive to that and it will start swelling.
So it's not the primary cause, like even in a
drug overdose or something where or a you know, heart attack,
where someone may be dying slowly. If they drop dead,
you're not going to see the brain swelling. But if
they're resuscitated on a ventilator, all sorts of things like that,
(24:48):
we see swelling of the brain. So you know that
may be sort of what is irreversible, especially in a
drug overdose or something of that nature. That's where the
really bad injury occurs from not breathing, having a lack
of oxygen, and then going from there. Hell, it looks
(25:10):
like I've talked a lot, but I do want to
come back to the very essential point is after we've
taken the brain out, made sure that's evaluated. Remember, I
have the neck left, and the neck is such a
vulnerable part in the body. We cannot forget it. So
why I've now saved the best for last, if you will,
is because by taking the brain away and cutting it
(25:33):
out and then cutting the organs out, what I've done
is drain the blood away from top and bottom, Okay,
and that really clears the field, which you know is
sort of a medical way of saying. The blood drains
out from the muscles and the structures. There's so much
going on in the neck. I want to get a
very detailed look at it. And so then I'm going
(25:54):
to go in and do a layer by layer dissection.
And really what I'm looking at is not just you know,
the muscles, the airway, the thyroid. I want to make
sure there's no injury there. Okay, that's the big thing.
We have the hyoid bone, we have the airway, the larynx,
the voice box, and we really need to make sure
(26:17):
that everything's intact there or if it's not, really hone
in on that.
Speaker 1 (26:23):
That is amazing. Now, y'all listen, we've done external and internal.
Next week, doctor Priya is gonna be talking about things
that she has found in bodies that ain't supposed to
be there.
Speaker 2 (26:37):
Oh, there's so much on that. That may be two episodes.
Speaker 1 (26:40):
You never know, it needs to be two episodes, so
y'all get ready. Doctor. Thank you so much to Judge
and being with us and just teaching us so much.
Speaker 2 (26:51):
Thank you for having me. Till next time.
Host
Sheryl McCollum
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