How Much Evidence?

I'm so excited to host forensic specialist Amryn Cross as a new guest blogger to Redwood's Medical Edge. To welcome her properly I asked my Facebook peeps what forensic questions they might have.

This was the first one:

How much forensic evidence does the court need to declare a missing person dead without a body?

Welcome, Amryn!!

Great question. The short answer is, it depends.

Any question involving the court itself has the potential to be highly variable. Different states have different laws, and some judges may allow things that others would not. That being said, I’ll answer this based on the most common occurrences in the U.S.

In most states, common law indicates a missing person may be declared dead after seven years with no evidence to indicate they may be alive. That means if a missing person’s bank account still gets regular deposits and withdrawals, if their name shows up on a deed in another state, or if they contact anyone this would be sufficient evidence that the person is alive (or their identity has been stolen, in which case this would be investigated).

If, after seven consecutive years of absence and a diligent but unsuccessful search for this person, there may be a court order issued to the registrar, instructing them to issue a death certificate.

As far as forensic evidence goes, a person may be declared dead sooner than seven years based on “sufficient evidence”. What constitutes sufficient evidence may be up to a judge in that jurisdiction.

One example includes finding a large pool of the victim’s blood provided it is a volume large enough that a person couldn’t have survived a loss that significant.

The other caveat is a person may be presumed dead because they were in imminent peril. This happens following plane crashes or mass disasters or even war. The passengers of the Titanic who did not arrive aboard the Carpathia in New York were declared dead in a matter of days and weeks. A similar thing happened after September 11.

Courts don’t automatically grant the order for a death certificate, even after the seven years. If a petition is made for a death certificate, the following criteria may be considered as reasons to deny the petition:

·         the absent person was a fugitive from justice

·         the absent person had a bad relationship

·         the absent person was having money troubles

·         the absent person had no family ties or connection to the community

Again, this is highly dependent on individual courts/judges. It always pays to check the laws in your particular jurisdiction.

Here’s a good article on the basics of declaring death and what happens when that person turns out to be very much alive. 

http://www.straightdope.com/columns/read/2253/what-happens-when-someone-legally-dead-shows-up-alive

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Amryn Cross is a full-time forensic scientist and author of romantic suspense novels. Her first novel, Learning to Die, will be released in September. In her spare time, she enjoys college football, reading, watching movies, and researching her next novel. You can connect with Amryn via her website, Twitter and Facebook.

 

Up and Coming

When this posts I'll actually be driving back from Oklahoma with my two children (age 9 and 11) and my father. Hopefully, my life will feel as carefree as the photo but somehow (in already surviving past trips) it may feel more like the second photo-- zombies attacking.

Road Trip Possibility A

As you know I'm also a pediatric nurse. I am more of a strict, I-will-do-as-I-say parent. So if I make a threat (and they can be pretty inventive) it is going to happen. Many years ago, my husband and I were driving from Colorado to Ft. Wayne, Indiana. There is a lot of road between here and there. The girls were maybe 4 and 7 at the time at they were fighting, fighting, fighting.

We kept saying if you can't be calm in the car then you can't be in the car!

It didn't really change much. So finally, I said to my youngest who was the biggest instigator of the fighting. "If you can't stop fighting and screaming I'm going to pull over and you'll sit in the field until you can be quiet."

Fighting ensued.

Road Trip Possibility B

Next exit ramp-- car is over and my husband takes her from the car and marches her to the middle of a field and sits her down and stands about two feet away.

I can't hear the conversation but I can see the body language. Both are with arms crossed just flat out sizing the other one up. It was chilly-- with sleet falling.

It took about five minutes before she felt like the car might be warmer and more comfortable than the middle of the field.

There's something about road trips that bring out the good and bad. Hopefully this one will be ALL good.

This week I'll be hosting a Facebook Party for Peril's release and giving away over $500.00 worth of prizes. Hope you'll join the fun.

For you this week:

Tuesday: I am so excited to be hosting new guest blogger, Amory Cannon, a forensic scientist. She'll be blogging about exactly what evidence (or lack of) the courts need to declare someone dead.

Thursday: Author Richard Mabry stops by to give some background into his latest and greatest medical thriller, Heart Failure. I know I'm excited to check this book out.

Have a GREAT week.

Jordyn

Author Question: Antibiotic Usage

Amanda Asks:

I thought it would be good conflict to give my nurse protagonist TWO patients with rival needs. The fast facts:

A) Fugitives from the law.
B) No access to medical treatment.
C) The nurse does have some Amoxicillin but just enough for about another week for Patient #1 (the man she loves), who has been on it for almost five days now (fever broke, lucid now, still sick though.) He has bacterial pneumonia, rib fractures, and malnourishment.

They're running for their freedom if not their lives. In comes Patient #2, who dug a tracking device out of his body with a non-sterile instrument and now has cellulitis (red streaks from the wound, low-grade fever, awesomeness.)

My nurse has to give him antibiotics or he could die.

But if she gives them to Patient #2, Patient #1 could relapse. And die.

So . . . Nurse Jordyn . . . which patient truly needs the medicine the most? Is there any use whatsoever in giving each of them half of it?

If she gives the whole dose left to Patient #2, will Patient #1 necessarily relapse? Is it unrealistic if he doesn't?

If she gives the whole dose left to Patient #1 will Patient #2 necessarily die?

And now for the big question: as a nurse, what would YOU do?

Thank you, you are awesomely awesome.

Jordyn Says:

Wow, Amanda. This is a very intense question and not as hard an answer as you might think.

The issue you've given these two patients . . . Patient #1 has presumed bacterial pneumonia because I'm assuming no chest film was taken (which would be a definitive diagnosis) since they are running from the law. Patient #2 has cellulitis. 

The reason this is an easy answer is that Amoxicillin is typically not used to treat skin infections. What is generally used is an antibiotic called Keflex. This uber-smart nurse would know that and continue to give the Amoxicillin to the man with the pneumonia-- particularly if he was improving. If the patient improves it can be a logical assumption that the antibiotic had something to do with it and he should finish the course of treatment.

That being said--- let's consider your questions.

Is there a benefit in giving each half the dose? Yes and no. This could be effective and also dangerous. Under dosing an antibiotic could lead to partial treatment and some bacteria still being left alive. Now, the bacteria have been exposed to the antibiotic and may mutate leading to a resistant strain which could ultimately put them both in danger.

Would patient #1 die if treatment stopped half-way through? Again, yes and no. He could survive and be fine but also develop a more resistant infection later on.

Would patient #2 die without treatment? Yes, this is probable with a bad cellulitis. Likely, what would happen eventually, is the bacteria gets into his blood and he dies from blood-borne sepsis or blood poisoning as it is sometimes called.

I do hope one of these fine gents lives.

In My Arms: A Tale of Special Need

I'm pleased to host friend and author Gillian Marchenko as she guest posts to give a brief glimpse of taking care of her special needs daughter.

Many of you know that I'm a pediatric ER nurse and I come into contact with special needs kids and their families often. What you don't know his how tough as nails and compassionate these caregivers are. Truly, some of the most special people on earth. Today, Gillian blogs about something so simple-- holding her daughter in her arms.

Gillian, I am honored to have you here. Welcome.


“Mom!” Polly yells out in her sleep. Her body thrashes to and fro on our queen sized bed. Her legs kick the covers off. Sweat glistens her forehead.
 

The house is quiet. My husband and two older girls went out for the night. My youngest has been asleep for an hour in her room. I bedded Polly in next to me, thinking that my husband would move her when he got home, and that her slight of breath, up and down, methodical, musical, may inspire me as I grab a few last minutes in the day to write with our fuzzy white dog at my feet.

“Honey, what’s wrong. Tell Mama what’s wrong.”

She doesn’t respond but continues to fuss and squirm.

“Shh, there, there,” I attempt to settle her back into her dream cycle. This part isn’t new to me, a seasoned mother of four. There have been countless nights in the last twelve years where I’ve brushed wet hair off a forehead, hummed a melody, and lulled a child back to sleep.

But my coaxing doesn’t work.

“What’s wrong, Polly? Does something hurt?”

My daughter nods, and a shot of electricity zaps my extremities.

When Polly was born at 37 weeks, she wasn’t breathing. The doctors resuscitated her, and she spent the first three weeks of her life in an incubator fighting for her life.

By the time I felt the weight of her tiny, five-pound body in my arms, I had already been informed of her diagnosis of Down syndrome.

I wrote about that time in my recently published memoir Sun Shine Down. Polly too weak to leave her plastic dome and me, too weak to fathom the curve ball of Down syndrome. 

Sometimes my arms ache to hold Polly the baby. What I wouldn’t give to scoop her up, to hell with my fear of the unknown, to hell with sickness, and to hell with stigmas hidden within, stigmas I didn’t know existed in me until I heard the words Down syndrome. 

“Show me where it hurts.”

Polly gestures towards her head.

“Your head hurts?”

She nods yes again. I pull her up onto my chest. It is not an easy task because she is now seven years old. 

But we don’t screw around with headaches in this family.

Three years ago, Polly had a catastrophic stroke which resulted in the diagnosis of Moyamoya, a disease that thins the arteries in the brain to the point of strokes and seizures. Unbeknownst to us, this disastrous disease had been causing mild strokes in her body throughout her short little life.

Polly underwent two brain surgeries that diminished the chances of recurrent strokes and seizures from 67% to 7%. She rocked the surgeries, actually running circles around me after the second one, just days after her neurosurgeon cut through skin, skull, and brain to create new blood flow for our girl.

“Here, honey, let me see.” I force Polly’s face towards mine and examine her for signs of stroke. No twitching, no loss of motor control. The fearful moment releases into the air around us. I hold her to my heart like I longed to do after her birth. She settles, and sinks into me. My body is quicksand. I engulf her.

We’ve danced around death too often.

Polly is here tonight, in my arms. I don’t take it for granted.  

She’s here. I feel her weight. She is happy. She loves her life. Her life overflows with joy, so much so that she splashes her joy on those around her, and continually plugs up my heart, so that I can be filled too.

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Gillian Marchenko is an author and national speaker who lives in Chicago with her husband Sergei and four daughters. Her book, Sun Shine Down, a memoir, published with T. S. Poetry Press in the fall of 2013. She writes and speaks about parenting kids with Down syndrome, faith, depression, imperfection, and adoption. Her work has appeared in numerous publications, including Chicago Parent, Thriving Family, Gifted for Leadership, Literary Mama, Today's Christian Woman, MomSense Magazine, Charlottesville Family, EFCA Today, and the Tri-City Record. Gillian says the world is full of people who seem to have it all together. She speaks for the rest of us. You can connect with Gillian on her website, on Facebook and Twitter.