George Floyd's Paraganglioma

 Watching just fifteen seconds of the video of the tape of Derek Chauvin with his knee on the neck of George Floyd (which I must say right now is all I have seen of the 9 minutes and 30 seconds of this video) I concluded, "This ought to be a quick trial. All the prosecution has to do is to play this tape at its opening and closing arguments and this cop is guilty for any jury.

"You can believe your eyes."

But then I read the autopsy report and said, "Uh-oh."

As the prosecutor said during his opening, "You will hear about George Floyd's substance abuse, about his hypertension and about all the other things which might have contributed to his death, but he had all those things the day before he was killed and he would have had them for forty years after that day, had Mr. Chauvin not killed him."

And I found that convincing:  Until I read the autopsy report.

Yes, it's true there are a lot of folks wandering around with potentially lethal illnesses who would not die from them any time soon;  if you shoot a person with one of those illnesses, you have still murdered him, caused a premature death.

If a person has asthma, and you handcuff him and throw him into the back of a paddy wagon while he gasps for breath and he's dead by the time you arrive at the police station, dead from asthma, then you are guilty of what I would call "negligent homicide," i.e. you had such reckless disregard for his life that you essentially killed him.

 And what Chauvin did appeared even worse, because he did not simply throw the man into the police car and walk away, he actively pinned the man to the ground until he was...what? Dead? Or unconscious or stopped breathing?

How exactly did Chauvin's knee kill Mr. Floyd? Was the spine fractured and the spinal cord severed? The autopsy says no. There was no sign of trauma to the neck or the spine. No damage to the brain was seen. No bleed into the brain. No blood vessel ruptured, at least not that I saw on the first read, and I will have to go back and read that again.

If he died of a dysrhythmia, there would be no anatomical finding, no structural change to the heart. Dysrhythmia is an electrical event and leaves no visual trace. It's like trying to see a computer monitor screen going zig zaggy once the computer is turned off.

So how did Chauvin's knee kill George Floyd? Did he cut off the air in the trachea? The trachea was undamaged according to the report, although it could have been compressed, presumably, and not been damaged; as the prosecutor said, if you smother a person with a pillow it leaves no physical trace. The prosecutor mentioned this because he knows the defense will point to the absence of trauma to the neck, the trachea, the brain to say it wasn't being held down that killed Mr. Floyd. It was something else.

And what was that something else?

A 4 centimeter paraganglioma, which was discovered at autopsy,  could easily do that. A paragangliomia is a tumor which can secrete "adrenalin" otherwise known as catecholamines, epinephrine, nor epinephrine. This is the "fight or flight" experience, the "adrenalin rush" and it raises the blood pressure, the heart rate and can easily cause a dysrhythmia or a stroke and often causes death, if it happens under circumstances where its presence is unknown.

When I was training I saw two patients admitted to the hospital who died from such a tumor. 

One was admitted overnight to be held in the Cardiac Care Unit until she could have surgery the next morning, a coronary bypass procedure. She had been sent down from Connecticut and admitted to the CCU as a "boarder." Her doctor was a friend of the man who ran the CCU and there were no beds for her elsewhere, so she was "parked" on the CCU for the night until the surgeons could send for her the next morning. 

I was the  intern and I couldn't understand why a person who was not having a heart attack had been sent to the CCU which was explicitly for patients who had  or were having  heart attacks. "She's got connections" my resident told me. "Just tuck her in and the blades will be in before rounds tomorrow and take her off our hands."

But during the night one of the nurses dragged me in to check this patient's blood pressure, which the nurse had got at 240/140. The monitor had shown tachycardia at 120, but when I got in to see the patient her BP was 160/90 and her pulse 95, both high, but not much worse than you might expect in a patient facing a cardiac bypass surgery the next morning. 

The nurses called me a couple of times that night but I could never confirm the high readings they got. I duly entered into my note, "Rule out pheochromocytoma" knowing nobody would ever do it. That evaluation required collection of 24 hour urines and would delay surgery and nobody read my note. 

She was gone when I awoke the next morning for morning rounds. The surgeons had whisked her off to surgery, where several hours later she died in the recovery room with uncontrol able hypertension. The surgery had triggered an explosion in her pheochromocytoma (as a paraganglioma is called when it's in the adrenal gland) and nobody in the recovery room, not the anesthesiologists, not the surgeons had any idea she was harboring that explosive tumor.

Factory of "Adrenalin"

At the Morbidity and Mortality conference a week later, I was called to the stand, so to speak, and the pathology resident read my note: "Several episodes of hypertension/tachycardia reported by nursing staff, which I could not confirm. Rule out pheochromocytoma." And I had written orders for the 24 hour urine collections which were never done because the patient was on the operating room table 4 hours later.

"So why was this work up never done?"  the pathology attending asked me.

"Well," I had to say. "I don't know. She was gone before I got up the next morning."

Of course, that was a major catastrophe and a woman died because nobody knew what they were dealing with. Nobody knew she had this explosive tumor within her. They are rare. 

But nobody got charged with murder.  

Internal Time Bomb

They had put her under a severe physiological stress, surgery. Had someone wrestled her to the ground and put a knee, carefully, on her neck and shouted at her, that tumor might have exploded similarly--it is set off by "stress."  These patients are called "walking time bombs." 

A more accurate description would be an internal bomb with a trip wires--stumble across that trip wire and explosion.

Does any of this exculpate former Officer Chauvin?

Well, yes and no.

It might mean that knee did not choke George Floyd to death. It surely would have been stressful enough to set off that paraganglioma.

So, very possibly, Chauvin held him down while the explosion happened and by the time the police realized Floyd was in trouble, he was like that lady from the CCU now in the operating room and the recovery room. 

George Floyd was walking around with that unexploded ordinance and the stress of his struggles with the police could easily have set that paraganglioma off.  

Can you say that means the cop did not kill George Floyd?  

What I had reacted to when I first saw that clip is the willfulness of the policeman who was determined to show Floyd who was boss, something he and other police had likely done countless times before. Wrestling a big guy to the ground, pinning him down, exerting dominance.

As Carter from "The Wire" shouts from the top of a police car, after a young drug dealer has successfully evaded capture and is hiding in one of the building around the car, "You do not get to win! We are the police! We win!"

I have not seen enough of that video. I have to re read that autopsy report--to see if they stained the ganglioma for catecholamines to prove it was an pheochromocytoma/paraganglioma.

But, at least at this point, I  have reasonable doubt.

Chauvin no doubt was a bully, a man who did not care about the welfare of George Floyd.

The police are often called to deal with unruly men who may harbor all sorts of things in their bodies, in their bloodstream: drugs which exacerbate their unruliness or heart conditions or very rarely, a paraganglioma/pheochromocytoma.

But did Chauvin intend to kill Floyd?

Or was he simply doing what police are taught to do and enjoy doing: subduing some poor guy who carries a  bomb inside him. It may well be Chauvin blundered through a trip wire and set off a bomb, a rare bomb, but deadly, just waiting for something stressful to trigger it.

A female social worker  might have been able to bring George Floyd into the station house, safely, a few days later.  The cop sets off the bomb.

To the police, men like George Floyd may be treated like animals, a steer to be wrestled to the ground and "hog tied."  That's really what Chauvin may be on trial for: acting like "a police."

He may be convicted of murder, but what he may really be guilty of is the arrogance, the disregard, the contempt people see in police. 

PS:  Having said all this, I just watched the Dave Chapelle analysis of this event and am thoroughly convinced: Whether or not George Floyd was killed by his exploding paraganglioma, that explosion would not have happened until someone pinned his neck to the ground for 9 minutes and 30 seconds and if Derek Chauvin has to go to jail for 20 years to send that message to American police, that's worthwhile.