Bad Falls and Bad Calls: Speculation on Bob Saget's Death

[pbmus]

https://www.medpagetoday.com/opinion/working-stiff/97330


Part of my training as a forensic pathologist at the New York City Office of Chief Medical Examiner included forensic neuropathology, which meant I was given the opportunity to attend a course on brain diseases at the U.S. Armed Forces Institute of Pathology. I was privileged to join doctors from all over the country in Bethesda, boning up on our understanding of all the things that can go wrong with the brain and spinal cord. There were lectures on tumors, neurodegenerative conditions like Alzheimer's disease, and head trauma. Most everyone there was an experienced resident physician in their final years of training. Over 90% of those in the room were neurosurgeons; neuropathology is an important part of the neurosurgery board examinations. Only a handful of attendees were pathologists.

When the instructor in the forensic neuropathology course projected onto the lecture hall's screen a series of autopsy photos in vivid color, a collective, horrified gasp rose in the packed auditorium. I was puzzled. What was wrong with these guys? They were experienced physicians. Sure, pictures of shotgun wounds to the face and comminuted skull fractures from suicidal jumpers can be unpleasant, but how could it be they were so revolted that some of them were averting their gaze? This is medicine -- they've seen it before, right?

And then it occurred to me: No, they hadn't. Neurosurgeons never see patients with injuries as devastating as these, injuries that are, in our parlance, not compatible with life. These are the patients who never make it to the hospital. They get declared dead at the scene, and then they come to us forensic pathologists in the morgue. So does every death that happens unattended at home, including simple falls from standing.

This is why I was not surprised that a recent New York Times article on the death of actor and comedian Bob Saget reported that "some neurosurgeons said that it would be unusual for a typical fall to cause Mr. Saget's set of fractures -- to the back, the right side and the front of his skull. Those doctors said that the injuries appeared more reminiscent of ones suffered by people who fall from a considerable height or get thrown from their seat in a car crash." The Times quotes commentary from Houston neurosurgeon Gavin Britz, MD, saying, "'This is significant trauma. This is something I find with someone with a baseball bat to the head, or who has fallen from 20 or 30 feet.'"

No, it's not. Blunt trauma from swung baseball bats and falls from 20 or 30 feet cause much more serious injuries than Saget's. The injuries in Saget's autopsy are common in patients found dead at a scene after they have had a simple fall from standing height. By asking neurosurgeons to review an autopsy report prepared by a forensic pathologist, the New York Times chose to rely on interviews with doctors who are opining way outside their realm of expertise. In doing so, the paper has fed those reckons to a pack of social media conspiracy theorists who have, predictably, amplified doubts about a celebrity's manner of death as clickbait for profit.

[intrepidity]

1. The devil is in the details

Makes sense that neurosurgeons--and physicians in general--would have less exposure than pathologists to certain kinds of injuries that result in a direct trip to the morgue.

[Tanuki]

2. Fascinating...thanks for posting!

[blogslug]

3. Did any of the neurosurgeons consulted by the NYT suggest contacting a forensic neuropathologist?

I wonder.

[viva la]

4. A relative of mine fell and hit her head on a curb-

She was about 5 feet tall, so she didn't fall very far.

She went into a coma and died a few hours later.
Another older person, the father of a friend, had a similar fall, hit his head on the pavement. He seemed okay immediately after, but the son kept watch on him, and when he seemed "out of it" got him to the ER. Only brain surgery saved him. If he'd been alone, he would have died.

The skull is hard, but the right type of impact can shatter it.

I thought it was rather rude of some of those neurosurgeons to speculate that it must have been "something else", implying that he was murdered. The family didn't need to hear that when it was rank speculation.