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Mayhem in the Morgue : Grapes of Death · Crime Stories with Nancy Grace

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  Speaker 1: This episode includes information about the death of individuals as
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  Speaker 1: well as children. If this sort of thing upsets you,
• 0:07
  Speaker 1: this is not the episode for you. Welcome it may
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  Speaker 1: have in the more with their host, doctor Kender Crowns
• 0:22
  Speaker 1: today's episode Grapes of Death. Today, I'm going to be
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  Speaker 1: talking about a fairly common type of case. I see
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  Speaker 1: these several times a year, and these are individuals dying
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  Speaker 1: of choking. Choking is not just caused by food, but
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  Speaker 1: it can also be caused by objects as well. It
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  Speaker 1: causes greater than five five hundred fatalities every year, making
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  Speaker 1: it the fourth leading cause of death in the United States.
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  Speaker 1: In almost half of these cases occur at home. It
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  Speaker 1: can affect every age group, but most commonly affects people
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  Speaker 1: over the age of sixty five, also known as the elderly,
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  Speaker 1: and children actually under the age of five. It can
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  Speaker 1: also affect adults as well, and is often seen in
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  Speaker 1: individuals who are intoxicated and in people with mental disorders.
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  Speaker 1: Choking occurs when a foreign object lodges in the back
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  Speaker 1: of your throat, blocking the larynx and trachia. The object
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  Speaker 1: can also forcibly close the epiglottis, which is the cartilaginous
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  Speaker 1: flap that closes over your airway when you swallow, so
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  Speaker 1: you don't inhale food or fluids. If your airway is
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  Speaker 1: completely blocked, you can't breathe, speak, or even cough, and
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  Speaker 1: you can feel the object stuck in the back of
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  Speaker 1: your throat. You'll keep trying to swallow and trying to
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  Speaker 1: make it move, but eventually your brain realizes you aren't
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  Speaker 1: getting air in and the clock is now ticking for consciousness.
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  Speaker 1: Panic sets in. You grab at your throat with both hands,
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  Speaker 1: singling those around you that something is wrong, trying to
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  Speaker 1: get help. Your face, lips, and skin begin to turn
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  Speaker 1: blue due to lack of oxygen, and in about seven
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  Speaker 1: to ten seconds you go unconscious, and in about another
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  Speaker 1: four to five minutes brain death occurs. If the object
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  Speaker 1: can be cleared, breathing can be restored, and the main
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  Speaker 1: way to do this is through the use of the
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  Speaker 1: Heimlich maneuver, which is a maneuver that was developed in
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  Speaker 1: nineteen seventy two by an American thoracic surgeon, doctor Henry Heimlich.
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  Speaker 1: It's a life save and technique using abdominal thrust to
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  Speaker 1: expel the obstruction, and it has saved millions of lives.
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  Speaker 1: Seventy five percent of choking cases actually occur in the elderly.
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  Speaker 1: The risk increases after the age of seventy one, making
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  Speaker 1: the elderly more likely to choke than any other group
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  Speaker 1: in the population. The main culprit is food, usually meat,
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  Speaker 1: including the deadly hot dogs. Other things commonly choked on
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  Speaker 1: are grapes, nuts, popcorn, hard candy, fruits, vegetables, and sticky food,
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  Speaker 1: especially peanut butter. The elderly can even choke to death
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  Speaker 1: on water. The main reasons for them choking is swallowing difficulties,
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  Speaker 1: also known as dysphagia, less saliva and absence of tea.
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  Speaker 1: Dysphasia effects up to one third of adults and is
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  Speaker 1: caused by age related muscle weakness or underlying diseases like strokes, dementia,
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  Speaker 1: or Parkinson's disease. Less saliva is a combination of aging
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  Speaker 1: and medication side effects, and this can cause difficulty chewing
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  Speaker 1: and swallowing. The lack of saliva can make the food
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  Speaker 1: more dry and sticky, hard to manage in the mouth
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  Speaker 1: and throat. Fewer teeth is also a very common one,
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  Speaker 1: and less teeth means bigger bites, often swallowing things whole,
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  Speaker 1: and this is the risk factor I see the most
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  Speaker 1: in combination with tough overcooked steaks, resulting in large pieces
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  Speaker 1: of meat, including the airways. One case I had was
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  Speaker 1: an individual who had no teeth at all. He actually
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  Speaker 1: died of a heart attack, not choking, but he had
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  Speaker 1: a very interesting finding. The stomach felt like it had
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  Speaker 1: hard lumps in it, and upon opening, contained unhewed artichoke
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  Speaker 1: hearts about two point five inches wide. I was surprised
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  Speaker 1: he didn't choke on these and he was able to
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  Speaker 1: swallow them whole, but I guess anything is possible. A
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  Speaker 1: syndrome seen commonly in the elderly and the middle age
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  Speaker 1: associated with choking is a cafe coronary syndrome. This syndrome
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  Speaker 1: occurs where an otherwise healthy individual collapses during a meal
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  Speaker 1: in the absence of any signs of choking or asphyxia
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  Speaker 1: or respiratory distress or neurological symptoms. The person just basically
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  Speaker 1: stands up and collapses. People think it's a heart attack
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  Speaker 1: and it results in the wrong emergency treatment being administered,
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  Speaker 1: meaning the obstruction the airway is completely missed and the
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  Speaker 1: person dies when they could have probably been saved. Typically,
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  Speaker 1: the food involved in the cafe coronary syndrome is poorly
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  Speaker 1: chewed steak that gets further wedged in the airway as
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  Speaker 1: people try and restore breathing. Cafe coronary syndrome is also
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  Speaker 1: often seen in the middle age por dentician taking big
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  Speaker 1: bites of food while talking, and they are often intoxicated,
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  Speaker 1: typically with alcohol. And this also brings us to another
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  Speaker 1: installment of everybody's favorite true crime game show. Is it Methamphetamine,
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  Speaker 1: Women or Alcohol? So let's get started. The case was
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  Speaker 1: that of a twenty two year old male found unresponsive,
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  Speaker 1: partially lying in his bed at his residence. His residence
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  Speaker 1: was in disarray, Lamps were broken, things were thrown around,
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  Speaker 1: stuff was torn up. His residence was trashed, but not
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  Speaker 1: in a way that suggested he had been in a fight.
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  Speaker 1: At autopsy, he was well developed and well nourished, appeared
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  Speaker 1: the reported age. He had abrasions and lacerations about his head,
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  Speaker 1: chest in upper and lower extremities, but again he had
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  Speaker 1: been found in a secured residence, so there was no
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  Speaker 1: thought of foul play. He exhibited small, particular hemorrhages about
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  Speaker 1: his face, which are the little pinpoint hemorrhages that are
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  Speaker 1: often seen with strangulation, hangings and things of that nature,
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  Speaker 1: but they can also be associated with wretching and hard
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  Speaker 1: gagging Internally, it was found that he had peace, a
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  Speaker 1: credit card and other debris blocking his airway. These had
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  Speaker 1: actually been pressed down on his epiglottis and closed his
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  Speaker 1: trachee off. He had basically choked on a credit card.
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  Speaker 1: He also had in his stomach multiple foreign bodies including
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  Speaker 1: cell phone parts, wires, earphones, paper and other bits and
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  Speaker 1: pieces of credit card, and in his intestines there was
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  Speaker 1: an unfired bullet. He was basically a human goat. He
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  Speaker 1: exhibited palmary congestion as well, so this credit card and
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  Speaker 1: other debris had caused them to choke, wretch violently, resulting
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  Speaker 1: in the particular hemorrhages and eventually dying from asphyxia. And
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  Speaker 1: why did he do this? Were there women about? No?
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  Speaker 1: Was he drinking? Was it meth What the toxicology showed
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  Speaker 1: was he had methamphetamine on board and no alcohol and
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  Speaker 1: no other drugs, So the answer is meth amphetamine. The
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  Speaker 1: finding of methamphetamine made sense. Sometimes when a person is
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  Speaker 1: on methamfetamine, they get itch, which would account for all
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  Speaker 1: his abrasions, and it makes people do erratic things. I
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  Speaker 1: always think, when it doesn't make sense, it's probably methen fetamine.
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  Speaker 1: And eating your credit cards just didn't make sense. So
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  Speaker 1: his cause of death was choking with a contributing factor
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  Speaker 1: of methanfetamine. This case is a little unusual, not just
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  Speaker 1: because of the credit card, but usually with the intoxication
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  Speaker 1: choking cases, it's typically alcohol. Alcohol impairs a gag reflex,
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  Speaker 1: relaxes muscles, and reduces the body's ability to react to choking.
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  Speaker 1: Other factors in adult choking include laughing and talking with
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  Speaker 1: food in your mouth and yes, your mom was right
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  Speaker 1: when she advised you not to talk with food in
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  Speaker 1: your mouth. Another factor in adult chokings is mental conditions.
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  Speaker 1: A case of one of my colleagues was that of
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  Speaker 1: a forty year old woman who was found unresponsive in
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  Speaker 1: her secured residence. She was fully clothed laying in her
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  Speaker 1: bedroom on the floor during a well being check. There
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  Speaker 1: was no signs of foul play. The house was secured
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  Speaker 1: and she was brought in for autopsy and autopsy she
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  Speaker 1: was a well developed OBEs female and there was no
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  Speaker 1: external evidence of injury. Internally, she had no findings except
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  Speaker 1: when her throat was examined, they found four latex gloves
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  Speaker 1: stuck in the back of her throat. These gloves blocked
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  Speaker 1: her airway and caused her to die. But why rubber gloves.
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  Speaker 1: The reason why, well, she had a condition called pika,
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  Speaker 1: and let's discuss pika. Pika is a scientific term for
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  Speaker 1: craving and subsequent consumption of non food items. It's not
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  Speaker 1: an acronym or an abbreviation of a famous physician's last name.
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  Speaker 1: Pica is actually the genus and species of the common magpie.
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  Speaker 1: Magpies are frequently seen with all sorts of items in
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  Speaker 1: their beaks, from chewing gum wrappers to wire hangers. Because
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  Speaker 1: of their attraction to sparkly objects, they were thought to
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  Speaker 1: be birds with an indiscriminate appetite, and as it turns out,
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  Speaker 1: they don't swallow these items, they build their nests with them.
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  Speaker 1: But the human condition of desiring non food items was
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  Speaker 1: given the name pica in the sixth century because they
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  Speaker 1: believe the birds were eating all of these odd items.
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  Speaker 1: The exact cause of pika is unknown, but it is
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  Speaker 1: often linked to nutritional deficiencies, pregnancies, developmental disabilities, mental health conditions,
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  Speaker 1: and cultural practices. The list of substances consumed by individuals
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  Speaker 1: with PIKA is very long, but earth or dirt is
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  Speaker 1: the most commonly consumed substance, and out of all these substances,
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  Speaker 1: with the exception of ice, they are usually dry, powdery,
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  Speaker 1: and absorptive, and most of them are rather crunchy. The
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  Speaker 1: American Psychiatric Association defines PIKA with four criteria. First, there
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  Speaker 1: must be persistent eating of a non nutritive substance for
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  Speaker 1: at least a month. Second, this behavior is inappropriate to
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  Speaker 1: the person's developmental level. Third, the behavior is not a
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  Speaker 1: culturally normative or socially so supported practice. And finally, if
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  Speaker 1: the behavior occurs at the same time as another DSM
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  Speaker 1: diagnosis or a medical disorder, it must be sufficient to
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  Speaker 1: require additional attention. The clinical forms of PIKA share at
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  Speaker 1: least four features, and these are the person with PIKA
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  Speaker 1: appears or reports to be obsessed with eating certain substances. Second,
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  Speaker 1: certain physical or sensory properties of the PIKA items are
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  Speaker 1: highly important to the person. Third, in the general population,
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  Speaker 1: in those with autism spectrum disorder, PIKA appears to be
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  Speaker 1: very powerfully, positively reinforcing for a range of PIKA related behavior.
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  Speaker 1: And finally, both groups of people engage in pika for
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  Speaker 1: its short term benefits despite its long term harms. Some
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  Speaker 1: segments of the population are more likely to engage in
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  Speaker 1: PIKA than others. Pregnant women easily comprise the largest proportion
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  Speaker 1: of consumers, while children form the second largest group. Children
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  Speaker 1: most active seek out clay, paper, chalk, dirt, termite hills,
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  Speaker 1: et cetera. For this reason, PIKA cannot possibly occur until
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  Speaker 1: after the children are over two years of age. The
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  Speaker 1: exact cause in any group is again unknown, but it
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  Speaker 1: is believed to be triggered by a nutritional deficiency, mental
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  Speaker 1: health conditions, and developmental factors. I have seen other examples
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  Speaker 1: of pike o over the years, and some rather unusual
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  Speaker 1: things have been eaten. But the most unusual one was
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  Speaker 1: an individual who ate ballpoint pins, and on the day
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  Speaker 1: he died, he had consumed over thirty ballpoint pins. They
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  Speaker 1: filled his entire stomach and they were beginning to be
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  Speaker 1: pushed into his intestines when one perforated his duodenum, which
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  Speaker 1: is the beginning of the small intestine after the stomach,
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  Speaker 1: and this resulted in fecal material bacteria, et cetera pouring
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  Speaker 1: into his abdominal cavity and that resulted in paronitis, also
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  Speaker 1: known as inflammation of the abdominal cavity. This eventually got
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  Speaker 1: into his bloodstream, resulting in sepsis, which is bacteria getting
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  Speaker 1: widespread throughout the body with an inflammatory response by the body,
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  Speaker 1: and that results in septic shock which can cause tissue damage,
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  Speaker 1: organ failure, and death, which is what happened in this case.
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  Speaker 1: He didn't choke, but instead died from the perforation of
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  Speaker 1: his bowel on the resultant paronitis and sepsis. I don't
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  Speaker 1: think he meant to die from consuming the pins, and
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  Speaker 1: he had probably done it before. As an aside, the
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  Speaker 1: pins that were recovered actually still worked even though they
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  Speaker 1: had been in the stomach for a period of time. Wow. So,
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  Speaker 1: now that we've covered the elderly and adults, that brings
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  Speaker 1: us to the other large group of choking victims, which
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  Speaker 1: as children. Choking is the leading cause of death and children,
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  Speaker 1: with one child dying every five days in the United States,
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  Speaker 1: and seventy five percent of these occur in children under
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  Speaker 1: the age of three. The most common case of pediatric
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  Speaker 1: choking is food, with hard candy being the most common culprit.
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  Speaker 1: Other common food items are grapes, hot dogs, and bones.
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  Speaker 1: It suggested that all grapes be peeled in all hot dogs,
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  Speaker 1: especially the tip of the hot dog, be cut into small,
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  Speaker 1: bite sized pieces. The most common non food item that
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  Speaker 1: causes choking are balloons, especially latex balloons, and coins. Coins
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  Speaker 1: account for more choking incidents, but balloons cause more choking deaths,
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  Speaker 1: and that is because of the way balloons can easily
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  Speaker 1: stretch and mold to the child's airway, making it impossible
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  Speaker 1: to breathe. They are also harder removed from the airway
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  Speaker 1: due to their smooth, slippery texture, which thwarts typical rescue methods.
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  Speaker 1: Foods and objects can easily block a child's airway because
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  Speaker 1: their airway is significantly smaller, shorter, and more pliable than
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  Speaker 1: an adult. A child's airway measures between six to eight
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  Speaker 1: millimeters depending on the age, whereas an adult airway is
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  Speaker 1: twenty to twenty six millimeters in males and fifteen to
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  Speaker 1: twenty two millimeters in females. Other factors include the child's
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  Speaker 1: airways funnel shaped, the tongue is proportionately bigger and the
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  Speaker 1: epiglottis is floppy. One example I have of a child
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  Speaker 1: choking on food is a five month old mail On
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  Speaker 1: the day he died, he had been crawling and scooting
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  Speaker 1: around on the floor like he usually did. He had
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  Speaker 1: older siblings, and one of them earlier in the day,
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  Speaker 1: had knocked over a number of items in the kitchen.
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  Speaker 1: The mother and the child had diligently cleaned it all
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  Speaker 1: up and thought they had gotten everything off the floor,
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  Speaker 1: but they hadn't. Something had rolled under the stove and
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  Speaker 1: the five month old found it. When he was found
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  Speaker 1: by the mother, he was unresponsive on the floor in
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  Speaker 1: the kitchen in the mid afternoon. She started CPR. The
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  Speaker 1: other child called nine one one, but the time emergency
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  Speaker 1: medical services arrived it was too late. The child had
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  Speaker 1: passed away and was pronounced dead at the scene. He
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  Speaker 1: was brought to the medical examiner's office for an autopsy,
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  Speaker 1: and at his autopsy he was a normal five month
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  Speaker 1: old male, no evidence of injury, no congenital anas, un normalities,
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  Speaker 1: or birth defects. Internally, it was the same, no injuries,
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  Speaker 1: no congenital abnormalities. But when I took out his throat structures,
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  Speaker 1: he had a Maraschino cherry blocking his airway. He had
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  Speaker 1: no teeth, so he had swallowed this cherry hole and
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  Speaker 1: it had gotten stuck in the back of his throat
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  Speaker 1: because his airway was so small, and the cherry completely
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  Speaker 1: blocked it, and he was unable to breathe and probably
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  Speaker 1: died within a few minutes. His cause of death choking,
• 15:29
  Speaker 1: manner of death accident. Food is the most common reason
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  Speaker 1: for pediatric choking and is one of the things we
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  Speaker 1: see the most at autopsy. I've seen other cases of
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  Speaker 1: non food related items. I have had one that was
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  Speaker 1: actually quite an unusual case of choking. The child didn't
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  Speaker 1: die initially from the choking incident, but from a later complication,
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  Speaker 1: and what he had swallowed was a cylindrical battery triple
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  Speaker 1: A to be exact. In this case, he was a
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  Speaker 1: four and a half year old male. He had developmental disabilities,
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  Speaker 1: and his brother had actually been feeding him Cheetos when
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  Speaker 1: he decided to switch and give him a battery, which
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  Speaker 1: the child swallowed. He was noticed after swallowing the battery
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  Speaker 1: to be choking on something. He was given a drink
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  Speaker 1: of water and appeared to be no longer in distress.
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  Speaker 1: The next day, the child had throat pain, trouble, swallowing, fever,
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  Speaker 1: and was throwing up. He was taken to the hospital
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  Speaker 1: and a CT was performed and it showed a battery
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  Speaker 1: was stuck in his esophagus. They were surgically able to
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  Speaker 1: remove the battery. But the thing about it is when
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  Speaker 1: batteries get in your throat, especially button batteries, they can
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  Speaker 1: generate an electrical current in the tissue fluids and that
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  Speaker 1: produces hydroxide at the negative pole of the battery, leading
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  Speaker 1: to corroso mucosal burns, and these burns can erode through
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  Speaker 1: the esophagus into the surrounding tissues, and that's what happened
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  Speaker 1: in this case. The child had mucosal injuries, but what
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  Speaker 1: had happened was the injuries were deeper than just the esophagus.
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  Speaker 1: They had burned through into the surrounding blood vessels near
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  Speaker 1: the esophagus, and eventually these erosions burst. The child initially
• 17:10
  Speaker 1: started with nosebleeds and as they were trying to control them,
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  Speaker 1: he began suddenly vomiting blood and a lot of it,
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  Speaker 1: and it happened so quickly they couldn't stop it, and
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  Speaker 1: he eventually bled out in a manner of minutes. At autopsy,
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  Speaker 1: what I found is one ulcer in his esophagus had
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  Speaker 1: gone completely through the esophagus and then completely through the aorda,
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  Speaker 1: creating what is known as an aortic esophageal fistula, which
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  Speaker 1: means there is a bridge between the aorta and the esophagus,
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  Speaker 1: leading to blood getting into the esophagus. But he also
• 17:48
  Speaker 1: had another erosion from his esophagus into the pulmonary artery,
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  Speaker 1: creating another fistula, which means the two biggest vessels of
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  Speaker 1: his body, the pulmonary artery in the aorda had a
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  Speaker 1: direct communication to his esophagus and there was no way
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  Speaker 1: to stop them. With these two blood vessels being compromised,
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  Speaker 1: the child bled out quickly and died. His cause of
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  Speaker 1: death was esophageal fistula of his aortic and palmary artery
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  Speaker 1: due to battery ingestion, and the manner of death was accident,
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  Speaker 1: so it was not a choking per se, but still
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  Speaker 1: something had been swallowed that resulted in his death. Inclosing,
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  Speaker 1: the death of a child is always difficult and upsetting
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  Speaker 1: to talk about and to hear about, but the most
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  Speaker 1: common manner of death in children is actually accidents, and
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  Speaker 1: accidents are almost always preventable, and we can do this
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  Speaker 1: by talking about child death and create awareness. And sometimes
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  Speaker 1: that awareness can save a life. So if you found
• 18:49
  Speaker 1: this episode helpful, share it, talk about it, and get
• 18:53
  Speaker 1: the information out there, because who knows, the life you
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  Speaker 1: might save might be your own or someone you love.
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  Speaker 1: And that brings us to the end of the episode.
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  Speaker 1: I hope you learned something. Until the next time.