The science behind forensic toxicology

(AP Photo/Julie Jacobson) Featured Image -- 122
WRITTEN BY: Katherine Ellen Foley

When we get our blood tested for cholesterol, it doesn’t take long to get the results. And if someone turns up at the hospital with what looks like a drug overdose, doctors can perform a quick test to verify their suspicions before treatment.
But unlike popular crime series like CSI, in which investigators whip up test results in the span of a quick montage, most forensic toxicology reports take anywhere from a few weeks to a few months. This can be an excruciating wait after mysterious deaths and unsolved crimes. Why does it take so long?
Quartz spoke with Robert Middleberg, a toxicologist from NMS Labs in Willow Grove, Pennsylvania, to find out.
Unlike other medical tests, where technicians isolate a specific compound like cholesterol, Middleberg says that you don’t always know what you’re looking for with forensic toxicology. “If you have a young person who is found dead in bed and there’s no history of drug abuse, you’re looking for the proverbial needle in a haystack,” he tells Quartz.
Testing times

After a body is found and an autopsy is performed by a pathologist, a separate lab will look for any environmental or pharmaceutical toxins that could be the killers. Without any clear clues, Middleberg says they will start testing for about 400 different substances. “We never know what we’re going to get,” he notes. It takes creative intuition to guide a cycle of testing and interpreting the results of tests to inform further testing.
Once an initial analysis returns a match for a particular substance, toxicologists must gather more specifics for the official report. Bodies that have already started decaying produce some toxins naturally, like ethanol (another name for the alcohol we drink) and cyanide, so toxicologists may have to perform additional tests to determine whether these played an active role in the cause of death.
All of this is further complicated by the fact that samples often arrive in less than ideal conditions. “If somebody is pulled out of the water after being missing for two or three weeks, these samples are very, very bad,” Middleberg says.
Unlike testing in an emergency room to confirm an overdose, pathology focuses on specifics. “For [medical toxicologists], sometimes it doesn’t really matter exactly what’s there,” Middleberg says. “In our world, the pathologists want to know exactly what it is and how much.”
Not every test is a complicated affair—despite all of the unknowns, Middleberg says that most labs try to have a turnaround time of 3-5 days for ruling things out and 7-10 days for identifying the specific factors leading to death.
Looking for clues

Like detectives, toxicologists look for clues to narrow down which tests are necessary. Knowing a subject’s history with drug or alcohol use obviously helps. There are also several somewhat macabre rules of thumb that tip toxicologists off to seek substances they wouldn’t normally test for:
Bright red blood as a sign of carbon monoxide poisoning
A green brain as a sign of exposure to hydrogen sulfide
Chocolate brown blood as a sign of excess methemoglobin poisoning
Hair falling out can be a sign of chronic arsenic or thallium poisoning
Blue skin can be a sign of gadolinium poisoning
Cocaine and methamphetamines can change the shape of the heart
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Inmate who killed Jeffrey Dahmer reveals why he murdered the serial killer

CANON CITY, Colo. — The inmate who fatally beat serial killer and sex offender Jeffrey Dahmer in prison in the early-1990s has revealed his reasons for doing so in a new interview.

Christopher Scarver, who was incarcerated at the same Portage, Wisc., prison as Dahmer back in 1994, recently divulged the details of his killing to the New York Post.

“Some people who are in prison are repentant — but he was not one of them,” he told the Post, recounting details of Dahmer’s brutal and unapologetic taunts to other inmates.

Scarver said in the interview Dahmer used to fashion limbs out of the prison food, applying ketchup on places to represent blood.

Though they were taunts, the actions represented a more chilling reality. Dahmer was arrested in 1991 after police found human remains and decomposing bodies in his apartment. Dahmer later confessed to 17 murders, many of which included the rape and dismemberment of the victims.

In 1992 Dahmer was sentenced to 15 life terms in prison after a court rejected his insanity defense.

Despite Dahmer’s abominable past, Scarver told the Post the killer initially left “no impression” on him.

“I never interacted with him,” he told the Post. He would watch from afar, avoiding contact due to Dahmer’s friction with other inmates.

That was until Nov. 28, 1994.

Dahmer, 34 at the time, and another inmate were tasked to clean the bathrooms — unshackled and unattended.

Scarver, then 25 and himself a convicted murderer, was with them. He told the Post he’d kept a newspaper clipping that detailed Dahmer’s killings.

He found his fellow inmate to have a lust for flesh, and was “disgusted” with the details of his actions.

Scarver told the Post he’d gone to retrieve a mop when he felt someone poke his back. When he turned around, he saw Dahmer and the other inmate “laughing under their breath.”

“I looked right into their eyes, and I couldn’t tell which had done it,” he told the Post.

But after the three men split up, Scarver decided to follow Dahmer to the locker room.

He told the Post he confronted Dahmer with the news article, asking the killer if he’d really done the things described in the story.

When Dahmer tried to escape, Scarver then took a metal bar and swung it at his head, crushing Dahmer’s skull.

Scarver then found the other inmate, Jesse Anderson, and did “[p]retty much the same thing.”

Scarver told the New York Post he believes the prison officials left them all alone on purpose, knowing he hated Dahmer and wanted him dead.

“They had something to do with what took place. Yes,” he told the Post.

After the murders, he pleaded insanity, but later changed it to “no contest” in exchange for a transfer to a federal penitentiary.

According to the New York Post, Scarver was then sentenced to two life terms on top of the one he was already serving at the time.

Scarver had been sentenced in 1990 for the murder of his former boss during a robbery, the Post notes.

He is currently incarcerated at Centennial Correctional Facility in Canon City, Colo.

Scarver now spends some of his time writing poetry for his website.  Related:

Medical Students Don’t Learn About Death

The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.


Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.

I have never been sure whether to consider myself lucky or unlucky. Is that a morbid way to think about it? That maybe I was lucky (and my patients were lucky) that they didn’t die on my watch? That maybe I was lucky that I hadn’t had to experience those awful and heartbreaking conversations with a patient’s family. In the Russian roulette game of hospital care and medical education, I felt spared.

At the same time – and I feel almost selfish for saying this – I considered myself unlucky. I had never been around a dying patient. I had never known what it meant to take care of someone in their final days. I had never had the opportunity to learn and grow as a person and a physician from those difficult moments.

My first clinical experience with death was during my sub-internship, with a woman with end-stage ovarian cancer. I had scrubbed in on her most recent debulking surgery, and I had followed her post-operatively. Though her overall prognosis was poor, she was progressing well after this most recent operation. Her pain and abdominal bloating were slightly improved. She was even about ready to go to a rehab facility; all the arrangements had been made for transfer.

But then she started failing – started not being able to get out of bed. Started being more confused about herself and her surroundings. Started sleeping more of the day. She was physically and mentally breaking down. The cancer burden was overwhelming her body, and she was not able to hold up.

This experience was undoubtedly sad, but the experience for me was compounded by the suddenness and relative unexpectedness of it all. “She was not dying when I met her!” I naively believed.

She did have terminal cancer, after all.

The emotional impact was heightened for me because of the fact that only one of her family members was with her until the end. I felt bad that nobody she knew from outside the hospital was there for; yet I hope our medical team was able to be a somewhat second family to her in her final days. I visited in on her, spoke with her relative, did everything non-medical I thought to try to make her comfortable (I didn’t know much).

When she passed, I imagined the briefest moment of stillness amongst the chaos, but the hospital quickly moved on. There was no closure, no reflection, almost no conversation. When the other team members who had helped take care of her found out the news, there was a general statement of sadness, but then it was back to work as usual. There was more work to be done, other patients to take care of.

I heard that the nursing and floor teams held a small commemoration for our patient later that week (as they do for any patient on the cancer floor who dies). I wasn’t aware it was happening, and I’m positive none of the medical team was present.

Do doctors not mourn, too? Don’t we all need a moment to breathe, to reflect on our relationship with that patient, and to acknowledge our emotions about their passing?

Why don’t they prepare us for this?


The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.


Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.

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Remembering the Oklahoma City Bombing April 19th, 1995

Oklahoma City Bombing 20th Anniversary

In this May 5, 1995 file photo, a large group of search and rescue crew attends a memorial service in front of the Alfred P. Murrah Federal Building in Oklahoma City. The blast killed 168 people — including 19 children — injured hundreds more and caused hundreds of millions of dollars in damage to structures and vehicles.

Credit: Bill Waugh/AP file:

Decades After Selena’s Death, Case Continues to Make News

10613bf4-a526-4826-9f82-d814e18ec836-medium Death of a Rising Star: March 31, 1995: Selena is shot to death by the President of her Fan Club.

Her death, 20 years ago today, on March 31, 1995, rocked the Latin music community and devastated millions of fans. The Grammy-winning performer was a fashion icon and a role model for many young women. As TIME described her shortly after her death, “[s]he was the embodiment of young, smart, hip, Mexican-American youth, wearing midriff-baring bustiers and boasting of a tight-knit family and a down-to-earth personality — a Madonna without the controversy.”

When she died, she had just recorded her first album in English and, per CBS News, “was poised to become a crossover success when her death turned her into a legend.”

Her death was even more shocking because it came at the hands of a woman once considered one of Selena’s biggest fans: Yolanda Saldivar, who had founded Selena’s fan club in San Antonio.

Saldivar had also been hired to manage Selena’s clothing boutique, Selena Etc., but was fired a few weeks before the shooting when Selena’s family discovered that she had been embezzling money, Selena’s father told the New York Times in 1995. Selena demanded that Saldivar return some of the boutique’s financial documents, and they agreed to meet at a Days Inn motel in Selena’s hometown of Corpus Christi. But Saldivar refused to turn over the documents, shot the singer and then fended off police during a nine-hour standoff while she sat in a pickup truck in the motel parking lot, holding a gun to her own head.

While Selena has retained her fan base and even attracted a new generation of fans following her death, Saldivar remains in prison, where she is serving a life sentence for the murder. (She will be eligible for parole in 2025.) She has filed a string of unsuccessful appeals, arguing, among other things, that prosecutors coerced her confession and that she received ineffective legal counsel.

She may be better off in prison, however, given the fury of Selena devotees. In 2012, Saldivar’s brother told TMZ that she was still being held in solitary confinement for her own safety. Selena’s father recently told a Corpus Christi TV news reporter that he thought an early release would be a harsher punishment than life in prison.

“Not very many people like her,” he said.

Read TIME’s original coverage of Selena’s death, here in the TIME Vault: Death of a Rising Star