CSI Medblogs rolls up its sleeves on the Tragic Case of Bosox Fan, Victoria Snelgrove's Death
I am now sure that there are at least several people who know exactly how Victoria Snelgrove died on the night of October 21, 2004. Surely the treating physicians, radiologists, and the house staff at Brigham and Women’s Hospital; Kathleen O’Toole ( the Boston Police Commissioner); and some Boston reporters; are, or have been made aware of just how the death occurred.
The rest of us remain sealed in the vacuum of our own ignorance.
Why?
I think I know.
If an exploding pepper ball killed Victoria Snelgrove – and let’s assume for a minute that it did – this represents death by an atrocious concatenation of coincidences, and fearfully bad luck.
Bad luck is the layman's term for the statistics of event occurrence. Statistics is a branch of mathematics that the average person shuns, despite its ultimate importance in understanding why many "unexplainable" bad and good things happen to bad and good people. Why don't we more frequently adduce statistical rationales to explain the many occurrences it might elucidate? As T.S. Eliot said "Humankind cannot bear very much reality."
THE MECHANISM
Let me say first that IF Victoria Snelgrove died as a direct result of a pepper ball striking her in the eye, then the likeliest of the unlikely explanations are:
1. As I have explained before, one proposed mechanism of death can be inferred by assuming the transmission of extraordinary pressure directed posteriorly through the globe, through the posterior orbit, then through the optic canal and superior orbital fissure. The implication is that there will therefore be disruption of cranial nerves and cerebral damage leading to demise.
2. As I also proposed before, the pepper ball could have killed Victoria Snelgrove by internal carotid artery/cavernous sinus injury from atypically propagated vectors of force or direct laceration from a sphenoid fracture.
3. A third mechanism I stated in a previous post was neurogenic shock, induced at the level of the brain stem and cranial nerves. There is a term for this type of extremely rare event: the oculocardiac or trigeminocardiac reflex, which has been reported from stabbings in the eye and is an event which leads to heart dysryhthms and asystole.
Here is a reference (Download reflex_reference.doc).
THE CONCATENATION
Bad luck can be defined as being present at the end of a string of unrelated – or limitedly related – coincidences. This is also the definition of good luck.
The astounding revelation when studying such strings of events is that any minor variation in any event would have prevented the outcome. We have all experienced this phenomenon in our lives. We preface these explanations by saying "if only...". A bad occurrence, when it makes its way into our lives, happens in a unique way. This is why it is often so hard to believe, to understand, and, ultimately, to put to rest in our minds and hearts.
What were the elements of this string of incidences the night the Boston Red Sox beat the Yankees in the ALCS game??
1. Petals on a Wet Black Bough: Eighty thousand pairs of eyes and a 20 million to one shot
It is estimated that there were 80,000 people present in Kenmore Square that night. With conservative estimations of geographic space and body orientation, I have calculated the a priori odds of Ms. Snelgrove being struck directly in the orbit, in that crowd, at about 20 million to one. I spared you the details of the calculation but I have uploaded my derivation that you can peruse here: (Download calculating_the_odds.doc0.
2. Framing Fearful Symmetry: No similar projectile has ever been documented to kill anyone even when people are trying to do this
As I previously wrote, in the definitive major study of paintball injuries to the eye, Dr. Daniel Listman, in the Journal Pediatrics, reported that of 149 paintball injuries identified in children, and 200 cases cited total, none had death as an outcome. This study is as close to the situation of Victoria Snelgrove and the pepper ball as can be approached scientifically.
I have also reviewed, extensively, the last 15 years of literature on orbital trauma in peace time and in war situations (here is a document Download orbital_literature.doc with some examples from my search). I have spoken with ophthalmic surgeons and trauma specialists. My literature search included thousands of various projectiles to the eye including high pressure pneumatic glue and paint gun injuries, fish gun injuries, projectile injuries by:
Harpoon
Pencil
BB
Pellet
Bullet
Chopstick
Screwdriver
Pacifier
Pen
Arrow
Knife
Ninja star
Fern
Fencing wire
...and NONE of these were fatal.
The ONLY fatal incidences I could retrieve were from the annals of military medicine and were mostly explosion or shrapnel mechanisms that involved more extensive cranio-facial trauma.
In other words, on TOP of the impossibly long odds that Victoria Snelgrove could get hit directly in the eye by this ball, the odds of this ball then killing her, are unique and incalculably high.
3. Caveat Emptor: Death by a Nonlethal Weapon
The mechanism used by the police was specifically designed and advertised as nonlethal. If we assume that the makers of this item did not purposely misadvertise its use then we have to understand a given: anything can be lethal in the right set of circumstances. Water is lethal if you breathe it in. Wood can be lethal if it falls on you. A sponge can be lethal stuck in your larynx.
I am not excusing mistakes that may have been made by the gun's manufacturers or the police. I am only saying that given that the gun was specifically designed not to be lethal, this adds another level of improbability to the eventual outcome, which is already absurdly remote in its chances.
4. The Ascent of Man : Teleological Reasoning in Orbit and Globe Injuries
I have already discussed the indirect evidence that militates against the mechanism of death proposed for Victoria Snelgrove. What I've said is:
The reason trauma to the globe does not cause death can be derived from standard evolutionary principles. Surely if this mechanism (direct blow to the globe) were fatal, our eyes would have developed behind calcium cages; however, the solution evolution worked out was to create a relatively closed-pressure chamber (the retro orbital space) with thin walls so that any backward-directed force on the globe would “blow out” one of the thin surrounding walls rather than direct the force posteriorly to the central cerebral structures. So by teleological reasoning, the woman shot in the eye with an exploding pepper ball should not have died.
THE CONCLUSIONS
1. The Blame: Sometimes The Fault Lies in the Stars...Victoria Snelgrove's Death was an Accident
Assigning blame is a mathematical computation. A smoking gun can be a 100% indicator of blame. A lightning bolt that strikes a jogger can be classified as 100% accidental. Unfortunately, not all the odds can be as readily grasped or calculated. However, it is important to try and assess relative probabilities when working out relative responsibilities. If we lay away any culpabilities of the crowd, then what is the culpability of the person who launched the pepper ball if we assume that the ball caused the death of Victoria Snelgrove?
When a mechanism designed to be nonlethal hits a spot that there is only one chance in 20 million it can find, resulting in a consequence that is unique in the history of forensic science -- and flys in the face of billions of years of evolutionary design -- that is, by any intelligent and reasonable assessment, an accident.
2. The Silence: Those who speak do not know, those who know do not speak
One of the most disturbing aspects of this entire incident has been the total silence of anyone who knows anything about Victoria Snelgrove's death. Although, as I have stated, the mechanism of her death is improbable and unlikely, there has not been one word about this from the press, or the police or the physicians.
Why the Silence? There are three main reaosns: government regulations; the omnipresence of the liability threat; and, the lassitude of the press.
A. The Government: In 1996 the Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which had, sequestered away in its body a "Wrongful Disclosure" provision which allows for fines up to $50,0000 and a year in jail for "disclosing individually identifiable information to another person." Doctors, hospitals and other health care providers have been put on alert that anything they say about any patient or any case is liable to violate this provision. Therefore, the public cannot know, from these providers, at this time, just how Victoria Snelgrove died.
B. The Liability Lawyers (The Torters): The inevitability, nowadays, of a massive assault by Torters on everyone involved in any case where there are deep pockets has everyone involved here running for cover. And the first thing your own attorney tells you is "keep your trap shut." So the police won't talk. The mayor won't talk. The Commissioner won't talk and the pepper ball manufacturer won't talk. Because they know that anything they say can and will be twisted in a court of perverse law to extort money from them in this continuing abomination that we have allowed these attorneys to foist on our country and our civilization.
C. The Lassitude of the Press
Reporters are people too. They have busy jobs and full schedules, deadlines and pressures. Especially in medical affairs, they are often in over their heads, as I have said before. So, it isn't hard to understand why a reporter might not zero in immediately on the true story of the case. I can understand that. But there are three issues that bother me. 1. The useless, repetitive, frank plagiarism of the news stories, especially on the Internet where a thousand stories are reiterated without further invention (as in all our blogs--many times!). This is especially pernicious when the original stories are cast in the wrong light. Like Victoria Snelgrove's story which has been set in the police brutality mode and continues down that slope wrong-headedly. 2. The temptation to package stories in familiar stereotypes is an infuriating characteristic of slothful reporting. But this foible alone, would not be serious. Unfortunately, this tendency in reporting leads to stereotyping that seriously adversely affects all of us in our every day life and jobs and NO profession has been vitiated as much by this kind of slapdash caricaturing as has the medical field. And I DO blame reporters for this. 3. Unlike the police and the hospital, the reporters are relatively immune from government regulations and torter's attacks. So it becomes their responsibility and duty to rescue us all from the unwary stupor we are immersed in by the "round up the usual suspects and villains" school of reporting. Important details that are omitted and yet make all the difference in the world to our society, our civilization and our freedom are left rotting under rocks unless reporters and journalists -- whose mission it should be to pursue these very aspects of the case -- seek the truth.
WHO KILLED VICTORIA SNELGROVE AND HOW DID SHE DIE?
The public still knows the answer to neither of these two questions. My conclusion is that something is wrong with our system of investigation, reporting, and disclosure.
Maybe that's why blogs evolved?
More to come from CodeBlueBlog.
