Chernobyl

I recently watched the highly rated HBO miniseries “Chernobyl, “a dramatization of the 1986 nuclear power plant disaster. I found the show engaging. Each episode brought the audience in, and although most of us knew something about the events surrounding the catastrophe, the viewer felt absorbed and tense throughout most of it. Job well done.

I was impressed with the realistic settings. Most of the series was filmed in the Baltic state of Lithuania, a decision that made perfect sense. Filming permits are much easier to get there than Russia. Additionally, having been occupied by the USSR, Lithuania has many of the same unattractive block-like building structures the Soviets are known for. It so happens that I recently took a trip to Russia and the Baltic region (see my previous blog), including Lithuania, and saw some of those on my trip.

Lithuania is also home to the Ignalina nuclear power station, a now decommissioned RBMK reactor, Chernobyl’s “sister” power plant and a near doppelganger of the Chernobyl reactor. The Ignalina power station is so similar to Chernobyl, in fact, that the European Union required it to be closed as a condition for Lithuania to join the EU. Interestingly, today, Lithuania is one of the most avid supporters of renewable energy in the EU.

I imagine that in addition to using the Ignalina reactor as the site of much of the action in the miniseries (with the help of special effects), the gripping scenes of the Chernobyl control room were filmed in the control room of the Ignalina reactor. The result was a very realistic re-enactment of events. So realistic, I felt like I was part of the action.

That said, there were some inaccuracies (surprise, surprise). I understand why instead of showing all the scientists that helped the lead scientist, Valery Legasov, the writers invented a female physicist (Ulana Khomyuk) to act in their stead. Showing the whole team would have been a distraction. However, some of the other information was inaccurate for unclear reasons (at least, unclear to me).

A major misrepresentation involved the danger posed to the public by the unprotected firefighters and nuclear power plant workers. Although they were exposed to dangerous levels of ionizing radiation and some radioactive materials had been deposited on them, these workers didn’t actually ingest any of the nasty stuff. Once these victims were hosed off, they were not radioactive themselves, and therefore were not a danger to others (not even to the unborn fetus of the firefighter’s wife). This is in contrast to the 1987 incident in Goiania, Brazil, involving radioactive cesium taken from a radiotherapy capsule left behind by a medical facility. The cesium glowed, and people found it fascinating. Some individuals ingested it and needed to be shielded to prevent exposure of others. Their urine was treated with resins to decrease the volume of radioactive waste. Twenty people required medical treatment, and four died.

At Chernobyl, in addition to radioactive iodine (half-life 8 days), radioactive strontium (half-life 29 years), radioactive cesium (half-life 30 years), and many other radionuclides were released into the air. Iodine tablets are effective in protecting against radioactive iodine only. Iodine is normally taken up by the thyroid to make thyroid hormone. When radioactive iodine is present, it, too is concentrated in the thyroid, significantly increasing the risk of thyroid malignancies in the future, unless it is flushed out by an abundance of non-radioactive iodine. To be effective in countering exposure to radioactive iodine, iodine tablets must be given within 12 -18 hours of exposure. In the case of the Chernobyl incident, the government dispensed iodine several days after the accident to some of those who were exposed. Members of the public, not knowing about proper dosing, bought iodine pills and overdosed their children, many of whom needed medical attention for bleeding ulcers from the excess iodine.

One more thing about the veracity of the miniseries: the makeup of some of the victims was a bit over the top. One guy looked nothing short of slimy. I’m not sure what that was about.

I found it interesting that Boris Shcherbina, the vice chair of the Council of Ministers who oversaw the Chernobyl investigation and cleanup, was described as being a former shoe salesman. While I couldn’t verify that, I found it plausible from what I know of Soviet bureaucracy, in which positions were granted in accordance to people’s loyalty to the party, rather than competence. That general lack of expertise goes a long way in explaining the failure of the Soviet Union’s economy, and periods of mass starvation.

Acute radiation exposure has fairly predictable effects, depending on the dose. At the time of the Chernobyl incident, it was known that below a certain exposure, victims were likely to suffer skin and gastrointestinal damage, but recover. At a higher range of doses, they would often die of bone marrow failure. At still higher levels, exposure was one hundred percent lethal, from damage to skin, gastrointestinal system, lungs, bone marrow, and central nervous system.

Bone marrow failure stops the formation of blood elements, including red cells which carry oxygen, white cells which defend against disease, and platelets which are needed for blood to clot. Without a functioning bone marrow, death ensues as the blood cells die off without being replenished.

I remember an American doctor, Peter Gale, going to the USSR after learning about Chernobyl to help with bone marrow transplants, the only hope of survival for patients with exposure to radiation at levels sufficient to destroy bone marrow. At the time, bone marrow transplantation was a much newer technique, not nearly as successful as it is today (although it is still far from one hundred per cent successful). In all, Dr. Gale and his team performed thirteen bone marrow transplants.

In retrospect, it appears that transplantation mainly served as a bridge from the time of bone marrow failure in victims with moderate radiation exposure, to bone marrow recovery from the few progenitor cells that remained. Once the marrow recovered, the transplanted marrow was rejected. Two people who received transplants and survived never had recovery of their own bone marrow, their bone marrow likely having been completely destroyed by their exposure. Others who received bone marrow transplants had higher levels of exposure, and died of other complications.

Gale and his team learned much about the effects of radiation poisoning on bone marrow and how to treat it. What wasn’t made public until years later was the team’s use of a new medication from the Swiss pharmaceutical company Sandoz (later merged with Ciba-Geigy to form Novartis). The medication, intended to help damaged marrow recover quickly, had been tested on animals but not yet tried on people. In a Bondian move, Gale arranged for a Swiss businessman to carry the medication to Sheremetyevo airport near Moscow in his checked luggage. Someone in baggage handling removed it before the businessman claimed his luggage, and the pharmaceutical was delivered to Gale. This scheme gave the businessman complete deniability if apprehended.

Gale and a soviet physician injected themselves with the drug, using ten times the dose recommended for humans. While Gale was essentially unfazed by the medication, his soviet counterpart soon developed severe chest pain and was hospitalized for a presumed heart attack that night. It was later determined that his heart was fine, but the marrow in his breastbone had expanded so much in response to the medication, he suffered excruciating pain in the chest area. The medication was subsequently given to Chernobyl victims, and likely contributed to the recovery of some with moderate radiation exposure by “kick-starting” the small amount of marrow progenitors that remained. Versions of this medication are routinely used today when bone marrow needs to be stimulated, such as after chemotherapy and after some bone marrow transplantations. In this country, the most commonly used is probably Neupogen made by Amgen. One known side effect is bone pain.

The long-term consequences of Chernobyl will never be known. Probably due to a combination of poor record-keeping and secrecy, the number of deaths from the effects of exposure is not available.

Despite changes in leadership, the Russians don’t seem to have changed much. The August 2019 Nyonoksa accident involving a nuclear-powered cruise missile released radioactive substances into the air. This was admitted only because Norway detected increased radioactive iodine. Although that was not conclusive on its own, as increased radioactive iodine is generally detected several times a year, the Russians stopped their own nuclear monitoring, reporting communication and network issues. Later it was ascertained that radioactive strontium, barium and lanthanum were also released.

Following this mishap, doctors treating the patients at one hospital were not informed of the radiation risks, medical staff treating the victims were told to sign nondisclosure agreements, and it was reported that the hospital records of the patients involved were deleted. One of the treating physicians was said to be contaminated by radioactive cesium. Seven people are reported to have died from the explosion.

As the explosion took place shortly before my Baltic trip, which included a stop in St. Petersburg, I considered bringing iodine pills with me “just in case.” However, as it appeared there was no increase in radiation detected that far from the explosion, and whatever would have travelled there would have cleared by the time of my visit, I ultimately decided against it.

About ten years ago, in the course of my work as a pathologist, I received a bone marrow sample from a young woman. I diagnosed her with an uncommon type of leukemia, one with a poor prognosis. I later learned that as a child, she had been in Chernobyl (or Pripyat) during the nuclear accident. She was treated, and her leukemic cells decreased, but she was far from cured. Despite that, she wanted to go back to Russia to visit family. She did that, but upon return, her leukemic cells were out of control, filling her marrow. Despite treatment, she died shortly thereafter. Was she a Chernobyl fatality? We’ll never know for sure, but I’d say there’s a good chance.

Hitler's Teeth

I recently took an extended (extended for me, anyway) vacation to the Baltic Sea area where I visited a number of countries. I saw many interesting places and was told about countless interesting facts. I re-learned a lot of history, much of which I’d actually lived through. On a tour of Berlin, one fact that struck me as particularly curious – one I had never heard about before – concerned forensic odontology. I had discussed the importance of this discipline in my very last blog, yet really had no idea how long it had been employed.

In reviewing the subject, I read that possibly the first instance of an identification based on teeth took place almost two thousand years ago in the Roman Empire. Did you know that Paul Revere (yes, that Paul Revere) was a dentist, who in 1776 identified a man killed in battle by a bridge he had fashioned for him? The man’s face had been disfigured by his injuries, making it impossible to identify him any other way and afford him a proper burial.

The first documented use of forensic odontology in a court case was in 1814, where again a bridge was used for identification, in this case to identify a dead woman. The crime took place in Scotland, where grave thieves removed the deceased woman from her grave, and sold her body to a medical school for dissection in an anatomy lab.

John Wilkes Booth (you all remember he shot Abraham Lincoln, right?) was killed by the US cavalry in 1865, after which he was buried. As seems to happen regularly, even back then, conspiracy theories started circulating, claiming Booth had escaped and was still alive. To put these theories to rest (as if it were possible to completely eradicate such rumors), Booth’s body was exhumed in 1893 and his family dentist made a positive identification of his remains based on the peculiar jaw formation the dentist had noted in his records when Booth had a filling restored. In what I read, no mention was made of the filling in the identification, leaving me to wonder if that tooth was missing for some reason, or if, perhaps, the corpse had no such filling, raising the possibility that it wasn’t Booth’s body in that grave. (Might he still be alive today?)

This brings me to what I learned in Berlin. Our guide brought us to a non-descript parking lot which happened to be built over the sight of Hitler’s bunker, the place where he died of suicide on April 30, 1945. The bunker underneath is now gone, blown up and excavated. The cement of the parking lot we stood on was probably poured in the late 1980’s. Located in East Berlin, the Soviet government made sure the bunker was destroyed, and kept the site unmarked to ensure no shrine would be built there by neo-Nazis. Finally, in 2006, the German government recognized the site as the place where Hitler had spent his last days. Today it is marked only by a single information board.

After his death, rumored to have been by cyanide and/or a gunshot to the head, Hitler’s aids doused his body with gasoline and burned it (along with the body of his blushing bride and partner in suicide, Eva Braun) nearby, as directed (he didn’t want their bodies desecrated, as happened to his buddy Mussolini and his mistress). According to our guide, he killed himself because he was disgusted that his military was so incompetent, it was unable to defeat the Allied power. He felt that neither Germany nor the world deserved him and therefore didn’t merit the honor of his leadership. It’s an interesting theory, but one I have not found commonly referenced.

When the Red Army arrived in Berlin several days later, they searched the area of the Chancellery. A private noticed a patch of loose dirt and, thinking he might find a Nazi treasure, began to dig. Instead of a treasure, he found the contents of a shallow grave holding the charred remains of two people.

Presumed to be the bodies of Hitler and Braun, autopsies were performed. Regarding the male’s body, the autopsy was performed by an army pathologist. She described the corpse as badly burned, smelling like burned meat. Only the jaw was fairly well preserved. The doctor apparently removed the jaw with attached teeth and placed it in a red jewelry box.

The head of the KGB at the time, Yuri Andropov (who later became a Soviet Premier, serving only fifteen months before he died of natural causes) ordered the remains (other than those in the jewelry box) to be secretly buried elsewhere, wanting to prevent the site of Hitler’s burial from becoming a shrine for fascists in the future. Over the years, Hitler’s remains were moved several times, reburned, and finally either thrown in an East Berlin river, or scattered in the wind around 1970 (I have read both scenarios; our guide said the remains were thrown in the river).

You may be wondering what happened to the jewelry box and its contents. The story now turns to Elena Rzhevskaya. A Russian Jew, she had been a literature student in Moscow when the Nazi’s attacked the Soviet Union. Wanting to help in the war effort, she became a Red Army interpreter because she spoke German. She mainly interrogated German POWs captured by the Red Army.

In April 1945, when Rzhevskaya was twenty-five years of age, she was transferred to the front for the final assault on Berlin. On May 2 she arrived at the Chancellery garden, where she was one of a handful to see the charred corpses, and served as an interpreter for the team trying to establish their identities. Before the world knew of Hitler’s demise, she was translating documents found in the bunker, and interviewing people who had been with him his final days.

After the autopsy, she was given the jewelry box to carry with her, tasked with finding someone who could confirm the teeth therein were those of Hitler. She was trusted with the teeth probably because she was an officer, and being female, wouldn’t get drunk on Victory Day.

While Hitler’s dentist had already fled to Bavaria, Rzhevskaya was able to find the dental assistant who had seen the Fuhrer days before his death. The assistant drew a sketch of Hitler’s teeth, which matched those of the charred remains.

The jaw and teeth remained secreted behind the iron curtain for many years because Stalin wanted to promote “Operation Myth,” a ruse to sow doubt about Hitler’s death, and spread the belief that Hitler was being hidden by the Americans or British. This was part of a perverse plan to associate the West with Nazi’s, but while that never gained traction, numerous theories arose that Hitler wasn’t dead (whether or not such theories would have sprung up if the Soviets hadn’t hidden the remains is debatable, but I would guess they would have, conspiracy theories generally not depending on facts).

Finally, in 2017, the Russian State Archive was given permission by Russia’s FSB (the successor to the KGB) to grant a team of French pathologists access to the jawbone and teeth. The team studied X-rays of Hitler’s teeth taken in 1944, as well as descriptions previously provided by his dentist and dental assistant, and found them to match the specimen that had been sequestered all those years. Hitler had gum disease and such bad teeth that only a few were left by the time he died. His crowns, bridges and dentures led to an easy and irrefutable match with the jawbone and teeth of the specimen. According to the lead author of the published study of Hitler’s teeth, “The teeth are authentic, there is no possible doubt. Our study proves that Hitler died in 1945.”

The exact cause of Hitler’s death remains in question, with varying sources saying he died by gunshot wound to the head (either self-inflicted or fired by an aid), cyanide, or both (a shot to the head at same time he bit down on a cyanide pill or ampule). No gunpowder was found in the jaw, indicating that if he’d been shot, it was through the forehead or neck, not the mouth. Bluish stains on some of his false teeth are said by some to be consistent with suicide by cyanide, although as cyanide is white, not blue, I question that conclusion.

The dental assistant who saw Hitler in his bunker every day until the end, was at the time hiding a Jewish dentist she had worked for in her home. She and Rzhevskaya became close, the dental assistant promising to take Rzhevskaya to her hairdresser when the Soviet interrogations were over. Unfortunately, Stalin sent Rzhevskaya’s friend to the gulag (along with others who knew Hitler had died) where she remained for ten years. She was told that instead of helping with Hitler’s teeth, she should have stopped the war by hitting him on the head with a bottle. In actuality, her crime was knowing Hitler was dead, a fact Stalin wanted to keep secret.

Rzhevskaya (who changed her name from Kagan after the war to hide her identity as a Jew so she could work) didn’t write openly about Hitler’s teeth until Stalin was dead. She died in 2017 at the age of 97 in Moscow after a career as a writer.

My Day with Cops

Approximately two months ago, I had the opportunity to spend a day with police officers from throughout the state. This wasn’t a social event. It was a conference on missing and unidentified persons. Not so much finding the whereabouts of people that had run away or been kidnapped. It was mostly about identifying dead bodies.

Here’s the background. I listen to a lot of podcasts. I incorporated the information I learned in one of them into my first novel, BlueSlim, which I have yet to publish (that’s another story – seems that writing a novel is more fun than publishing it, so I have yet to publish any of my three novels). The podcast I am referring to was about NamUs, which stands for National Missing and Unidentified Persons System (pronounced “name us” as in “please find out our names”). I’d never heard of this and, it turns out, neither had many others, including people in law enforcement. This national database, run by the Department of Justice, collects information on missing persons and unidentified bodies, in the hopes of matching up remains with missing persons.

Unfortunately, there’s a whole lot of them. There are around 85,000 active missing person cases at any time. About 4400 unidentified remains are found yearly, and roughly 1000 of those remain unidentified after a year.

Once NamUs is contacted about an unidentified body, information about that body, including location, clothing, other articles found with it, and other information gleaned (using forensic anthropology if needed) such as approximate age, height, ancestry, and gender is entered into the database. In addition, when possible, other information is stored, including fingerprints, dental information (which can be difficult to get if dental work was done in Mexico), and DNA analysis. Images of any fingerprints obtained are digitized and submitted to the FBI for possible identification.

After information about a missing person or unidentified body is entered into NamUs, a search is conducted to find a possible matching body or person. Anyone can enter information about a missing loved one and search the database, as long as a missing persons report has been filed. Before this was set up, a body found in Oregon would have a slim chance of being identified as belonging to a missing person in Georgia.

I am a member of a writers’ critique group. We meet twice a month to review each other’s submissions of approximately ten pages, offering suggestions, correcting typos, and generally giving each other a bad time (all in good fun – actually, I have a wonderful group). I am the oddball in the group. The others all have experience in the military and law enforcement, while I have a background in science and medicine.

When NamUs came up in the writing I had submitted one week, none of the others had heard of it. One of the group members, a retired police officer who locally volunteers his time to work on missing persons cases, was very interested. Checking around his department, he discovered that none of his colleagues knew about it, and he has since become the local NamUs liaison. He also instigated the above-mentioned day-long conference on Missing and Unidentified Persons, and arranged for me to be able to go. Of course, I jumped at the chance.

At the conference, I learned a lot about the different databases available for identifying bodies and solving crimes. Slightly less formal than a typical medical lecture, some speakers used occasional four-letter words. Nevertheless, the lecturers were well-prepared and seemed to really know their stuff. These agencies are happy to send speakers to groups of law enforcement officers, hoping to educate them about their existence and to teach them how to use these resources effectively. It appears to an outsider (me) that much more should be done to educate officers about the resources available, and train them to use these optimally.

NCIC (National Crime Information Center) seems to be the go-to database. It is run by the FBI and is available to law enforcement agencies nationwide. It provides information on stolen goods ( in seven property files: stolen articles, boats, guns, vehicles, license plates, parts, and securities), and people (fourteen persons files: supervised release, national sex offender registry, foreign fugitive, immigration violator, missing person, protection order, unidentified person, protective interest, gang, known or suspected terrorist, wanted person, identity theft, violent person, and persons denied guns as a result of a background check). NCIC searches can use height, weight, tattoos, incomplete licenses.

California is the only state that mandates all unidentified deceased are entered into NCIC. Many coroners and medical examiners outside of California don’t have access to NCIC.

Law enforcement will use NCIC during a routine traffic stop to immediately determine if the vehicle is stolen, or the driver is wanted. If the report is positive, the officer must first contact the agency that entered the information to verify that it is accurate and up to date. Then the officer can act accordingly.

Entry into NamUs, which is more user-friendly than NCIC, is optional in many states, including California. Over 16,000 missing persons cases currently active in NamUs. Over 18,000 have been resolved, with over 2,000 directly helped by NamUs. NamUs currently has almost 13,000 unidentified persons in its database. Almost 4000 such cases have been resolved in the past, 1700 of which were directly aided by NamUs.

Another important database is CODIS (Combined DNA Index System), the FBI’s database of DNA profiles. DNA samples from pathology specimens, including frozen tissue, histology slides, or smears can be used for this.

ViCAP (Violent Criminal Apprehension Program) is an FBI program for analyzing cases involving sexual assaults and attempts.

NCMEC (National Center for Missing and Exploited Children is a nongovernmental, federally funded program. It operates a hotline for the public to use to report information about missing children. They use programs for age progression, using photos of siblings and parents.

Below are a few other interesting facts I learned:

* In California, law enforcement must help if someone calls to make a missing persons report, even if from another state. There is no waiting period.

* The unidentified includes living people unable to identify themselves due to incapacitation (e.g. being comatose in a hospital) or mental impairment.

* During droughts, when lakes and creeks dry up, bodies once under water begin to appear.

* Facial recognition programs and fingerprint optimization programs are starting to be utilized by law enforcement.

* The HSK, or Highway Serial Killings initiative, was started in 2004. It operates under the FBI’s Behavioral Analysis Unit and is tasked with investigating highway body dumps. Apparently, there are many bodies dumped along highways. Nationwide, there have been around 780 victims (mostly women with “high risk” lifestyles), and over 460 suspects. Probably multiple serial killers are involved. Qualcomm has been keeping track of truck routes for analysis (although not all these serial killers are suspected of being truck drivers). Over 90 timelines have been compiled involving areas where bodies have been dumped. The FBI is not forthcoming about the progress of their investigations.

* Missing Person Day events are becoming more common. Multiple stations are set up where family members can deliver information about missing loved ones, and can enter their name into NamUs. They can also submit DNA samples. If the case is active, the information will be sent to officer in charge. If not, the case will go to a local agency or the Department of Justice. Every event has had some resolutions. A suspect even showed up to one.

* Dental records are very important for identifying the unidentified. Be sure to visit your dentist! But note that if you see a dentist in Mexico, your files will probably not be retrieved.

* Most Golden Gate Bridge jumpers wash up in Sausalito.

* Machete murders are usually drug related. Only the torso remains, making identification difficult. One such torso was X-rayed, revealing twisted wire in the chest typical of open-heart surgery. The X-ray was compared to that of a missing person, and a match was made.

I learned many interesting facts and heard many fascinating stories (I haven’t included everything here). The latter reminded me of case reports one might hear at a medical conference. First, the facts about an unidentified body (or, in a medical case, the patient’s symptoms and clinical findings) are presented, steps taken to solve the problem are described, and, finally, the person’s identity (or illness) is determined.

A word to the wise: Just in case—see your dentist regularly.