Life as a Microscopist
- Q & A with Igor Siwanowicz
“Life as a microscopist” is a series about men and women behind the microscopes. I was very honored to exchange a few messages with Igor Siwanowicz - scientist, photographer and microscopist - who gives us some insight into the biology of the tiny organisms he likes to study, and how he became interested in them and in microscopy. It was all so interesting, I kept everything. Enjoy.
1) About your winning entry at the Nikon Small World: can you tell us more about that organism?
Aquatic bladderworts prefer clean, nutrient-poor ponds and lakes; they satisfy their nitrogen needs by trapping minute prey – water fleas, copepods, rotifers etc. – in specialized organs called bladders, which are considered the most sophisticated trapping organs in the plant kingdom, a true testimony to evolution’s ingenuity.
Finding the specimen was one of those serendipitous events – I stumbled upon bladderwort while collecting dragonfly nymphs for my research in a pond located few miles away from my institute (Janelia Research Campus of HHMI in Ashburn, Virginia). Perhaps it is the perversion of the role reversal when a plant is devouring an animal that makes flesh-eating plants so interesting; I have been fascinated with carnivorous plants since early childhood – watching “Little Shop of Horrors” might have something to do with igniting my fascination. Admittedly, bladderwort is – at the first glance - far less spectacular than, say, a Venus flytrap or a pitcher plant; when magnified though its trap reveals amazing complexity. I had a very fruitful run with this plant – with the samples I collected I was able to produce a series of images, and several of them won prizes.
This pictures depicts the awesomeness of the bladderwort trapping organ and scored the 1st place in 2013 Olympus Bioscapes contest. The image shows the inside of a trap of the aquatic carnivorous plant, humped bladderwort (Utricularia gibba). Several elements of the bladder’s construction are visible in the image, giving some insight into working of this tiny – only 1.5 mm long – but elaborate suction trap. The driving force behind the trapping mechanism is hydrostatic pressure: the plant “cocks” the trap by pumping water out of the bladder, accumulating potential energy in its thick and flexible walls like in the limbs of a bow. Specialized cells called bifid and quadrifid glands are responsible for the task of active transport of water. They line the inner walls and are visible in the image as bright-blue elongated shapes. An unsuspecting prey – usually a tiny aquatic arthropod – is guided toward the trapdoor by antenna-like branches surrounding the entrance. Quite literally, the trap has a “hair trigger” – touching one of the trigger hair cells extending from the bottom of the trapdoor (their bases are visible right in the center of the upper half as 4 small bright circles; they are much better visible in the Nikon contest image where you can see the entrance to the trap (or the bladderwort’s “mouth”)) causes the entrance – or “valve” – to bulge inward. Once the equilibrium is disturbed, the walls rapidly spring back to their initial position and the prey is sucked in within a millisecond (1/1000th of a second), experiencing acceleration of 500 G! In the image, the valve resembles a mosaic-covered Byzantine arch; it is made of a single layer of tiny, densely packed cells regularly arranged in concentric fashion. Once inside, the prey dies of anoxia and is digested by enzymes secreted by the bifid and quadrifid glands.
The intricately shaped objects visible in the lower part of the image are those aforementioned green algae called desmids; two species belonging to the genus Micrasterias and three species of Staurastrum can be identified. Various authors have described algae in Utricularia traps as commensals (algae that thrive and propagate in the nutrient-rich interior of the trap), symbionts (bladderwort benefits from the carbohydrates produced by algae) or as prey. Recent studies show that algae are able to survive only inside older, inactive traps; more than 90% are killed inside vivid, young traps. It may be that late in the season when I collected the specimens, most of the traps were already inactive, which could explain why the trapped desmids seemed to be doing fine.
2) How did you start in the field of microscopy? Do you think that microscopy can be considered a form of art?
My interest in natural sciences and nature photography were developing simultaneously - my parents are biologists and I grew up surrounded by biology textbooks. I enjoyed browsing through the illustrations and photographs long before I learned how to read. It wasn’t until 14 years ago – 2 years into my PhD studies - that I bought my first camera and found myself on the supply side of nature photography, with the special focus on macro technique. I quickly realized that microscopy would perfectly complement that activity and give me an even more intimate perspective of my “models.”
Six years ago - after abandoning protein biochemistry and moving to the field of neurobiology - I finally gained an access to a confocal microscope. For the past four years I’m spending most of my working hours imaging various bits of invertebrate anatomy – mostly dragonflies, since that is our group’s model organism. In this way I managed to merge my extracurricular expertise of macro photography and insect anatomy with scientific approach.
Although it is not the primary objective of scientific visual data, surprisingly many research-related images have aesthetic merit; to fully appreciate the beauty of those often abstract and surreal forms one needs to approach them with an open mind. A French polymath and philosopher of science Jules Henri Poincare said that “the scientist does not study nature because it is useful; he studies it because he delights in it, and he delights in it because it is beautiful”. Not many scientists these days have the privilege and comfort to apply this somewhat utopist approach to their research, but lots do share the appreciation of beauty and are fully aware of the aesthetic aspects of their work. The marriage of scientific approach and artistic talent can be best exemplified by awe-inspiring work of Ernst Haeckel, who’s “Artforms from Nature” is a continuous source of inspiration for me.
Olympus And Nikon contests are organized with such people in mind. Images are rewarded for the artistic merit and visual aspects on par with and often above their scientific importance; that definitely grants those contests a broad appeal among non-experts and contributes to redeeming the image of science as a somber, wonder-less, unexciting affair utterly unintelligible for a layperson.
A bit about sample preparation and data collecting:
Back in the laboratory I embedded isolated traps in agar-agar gel and cut them into 0.5 mm-thick slices with a vibrating razor blade. Due to the chance component inherent to the process, in only 6 out of two dozen or so specimens, the razor passed either through the midline to produce two nearly equal halves, or through the plane parallel to the bladder’s trapdoor – a satisfactory success rate.
To produce the image, I used a laser scanning confocal microscope, a device that collects images in a very different way than a brightfield microscope (your standard biology class microscope). The confocal microscope is a fluorescent microscope; it means that the imaged specimen is illuminated (excited) with light of certain wavelength and emits light of a different, longer wavelength. The source of the excitatory light is a laser; a confocal microscope can be equipped with several lasers producing light of different frequencies (i.e., wavelength, or simply color), since each fluorescent molecule (a pigment that emits light) used in research only absorbs certain specific wavelengths of light. The specimen is illuminated, point by point, by a focused laser beam that moves somewhat like an electron beam producing the familiar scanned image on the phosphorescent surface of a cathode-tube TV or computer monitor. The light emitted from the specimen is collected by the objective and passes through a pinhole aperture that cuts off stray rays of light arriving from fragments of the sample that are not in focus – only light that is emitted from the very thin area (optical slice) within the focal plane can pass. Emitted light is then detected by the microscope’s photodetector (photomultiplier), and the image is reconstructed – point by point – on the computer screen. Because most specimens are much thicker than the focal plane, a series of images - called a “stack” - is collected by moving the specimen up or down. From those images, a three-dimensional image of the sample can be reconstructed.
In most cases samples have to be made fluorescent by the use of dyes or conjugated antibodies specifically binding certain intra- or extracellular structures. To be able to image cellulose (building material of plant’s cell walls) I used Calcofluor White, adye first used in the textile industry for its propensity for binding cellulose fibers but then abandoned because of its toxicity; Calcofluor still finds use in medicine for identification of fungal pathogens in animal tissues.
A confocal microscope “sees” the sample very differently than we do - to our eyes the specimens appear very different than the final image. The amount of ultraviolet light in sunlight is – fortunately! – too low to appreciably excite Calcofluor, and all we see is green from the natural pigment chlorophyll. When illuminated with UV light (405 nm), the dye present in cell walls glows bluish-green. The same short wavelength light is absorbed by chlorophyll, which emits red light.
To produce the image, I recorded emission in three channels (colors) simultaneously. Assignment of the color in the captured image to any given channel is purely arbitrary; however, I do assign blue to the channel recording light of the shortest wavelength, green and red in similar fashion, in the “natural” order. Combining the three channels - three prime color images – into one produces the whole palette of colors – in effect, it is like the microscope had trichromatic “vision,” just as we do.
MCKINNON FIRST BEGAN to realize that her memory was not the same as everyone else’s back in 1977, when a friend from high school, who was studying to be a physician’s assistant, asked if she would participate in a memory test as part of a school assignment. When her friend asked basic questions about her childhood as part of the test, McKinnon would reply, “Why are you asking stuff like this? No one remembers that!” She knew that other people claimed to have detailed memories, but she always thought they embellished and made stuff up—just like she did.
McKinnon’s friend was so disturbed by her responses that she suggested McKinnon get her memory checked by a professional. McKinnon put the exchange aside for almost three decades. Then one day in 2004, she came across an article about Endel Tulving, the researcher who had originally characterized the difference between episodic and semantic memory. McKinnon read about how, at the University of Toronto, Tulving studied an amnesic patient, K. C., who was in a motorcycle accident at 30 that resulted in brain damage affecting his episodic memory. He could not remember anything in his life except experiences from the last minute or two. Yet despite this deficiency, the patient could remember basic knowledge learned before his accident, like math and history, and when taught new information in experiments, he could retain lessons, even though he could not recall visits to the laboratory where he was taught. His case became crucial to Tulving’s theories about memory.
Like McKinnon, people with amnesia usually lose their episodic memories and keep their semantic ones. But amnesiacs tend to come by their memory loss through brain trauma, developmental disorders, or degenerative conditions. And they are often impaired in their day-to-day functioning; they cannot live normal lives. Reading about Tulving’s case studies, McKinnon recognized a resemblance to her own experiences—minus the brain lesions, injuries, or debilitating side effects. Her brain and life, as far as she knew, seemed to be healthy and intact.
One of Tulving’s arguments struck a particular chord. A profile of the psychologist reported his belief “that some perfectly intelligent and healthy people also lack the ability to remember personal experiences. These people have no episodic memory; they know but do not remember. Such people have not yet been identified, but Tulving predicts they soon will be.” McKinnon felt too intimidated to contact Tulving himself; he seemed too famous. So instead she set her sights on Brian Levine, a senior scientist at the Rotman Research Institute in Toronto who had worked closely with Tulving and whose expertise in episodic and autobiographical memory caught her eye.
On August 25, 2006, McKinnon sent Levine an email that referenced Tulving’s prediction about healthy people with no episodic memories:“I think there’s at least a possibility that I might be one of the people he was describing.
“I’m 52 y/o, extremely stable, with a very satisfying life & well-developed sense of humor. Contacting you is a big (and, frankly, scary) step for me … I’ll appreciate any guidance you may be able to give me.”
“I GET A lot of emails from people with various issues,” Levine says. “With Susie, I felt like this was worth pursuing.” So Levine invitedMcKinnon to his lab in Toronto. His first move, in collaboration with researcher Daniela Palombo, was to begin looking for some underlying physiological or psychological explanation for McKinnon’s apparent lack of episodic memories: a neurological condition, trauma, or brain damage caused by anoxia at birth. They found no such thing.
Next, Levine ran McKinnon through something called an autobiographical interview, to vet her own report that she lacks episodic memories. Before the interview, his lab team spoke with Green, a close friend of McKinnon’s, and McKinnon’s brother and mother, asking each for stories about McKinnon that they would try to verify with her.
When Levine and colleagues quizzed McKinnon about events that her friends and relatives described—like the time she was in The Sound of Music during high school—she had no such recollections, even when she was probed with follow-up questions like “Do you remember any objects in the environment?” The interview seemed to confirm that, sure enough, McKinnon had no recognizable episodic memories.
Soon, Levine discovered two more healthy individuals who also seemed to lack episodic memories. Both were middle-aged men with successful jobs, one of them a PhD. One was in a long-term relationship. Levine put both men through the same battery of tests in his lab. He also ran all three of his patients through an MRI machine. Each showed reduced activity in regions of the brain crucial to the mind’s understanding of the self, the ability to mentally time travel, and the capacity to form episodic memories.
Levine published a study about McKinnon and his two other subjects in Neuropsychologia in April 2015. Since then, hundreds of people claiming to have severely deficient autobiographical memory have reached out to Levine’s team. Each must go through a set of tests as well, he says, and results might lead to only a dozen or so provable cases. But the response suggests that the discovery of McKinnon and the other two subjects wasn’t a fluke. “It raises fairly large questions,” Levine says. “What exactly does recollection do for us?” If members of our species can get by so well without episodic memories, why did we evolve to have them in the first place? And how long are they liable to stick around?
SPEND ENOUGH TIME with McKinnon and it’s hard to escape the creeping sense that she’s not just different—she’s lucky. Memories that would be searing to anyone else leave little impression on her. Like the time in 1986 when the couple was living in Arizona and Green was jumped by a group of white men while out fishing. When he came home, his head was covered with welts. “She went to get ice and she started crying,” Green says. He began to cry too. They felt terrorized.
Once again, McKinnon knows the salient facts of the story, but the details and the painful associations all reside with Green. ForMcKinnon, the memory doesn’t trigger the trauma and fear associated with it. “I can imagine being upset and scared, but I don’t remember that at all,” she says. “I can’t put myself back there. I can only imagine what it would have been like.”
McKinnon also quickly forgets arguments, which might be the reason she and Green have stayed together so long, she jokes. She cannot hold a grudge. She is unfamiliar with the feeling of regret and oblivious to the diminishments of aging. A 1972 yearbook photo shows that she was once a petite brunette with a delicate face framed by a pixie cut. (“Dorky little innocent thing,” she says, looking at the picture.) On an intellectual level, McKinnon knows that this is her; but put the picture away and, in her mind, she has always been the 60-year-old woman she is now, broad-shouldered and fair, her face pinkish and time-lined, her closely cropped hair white and gray. She doesn’t know what it’s like to linger in a memory, to long for the past, to dwell in it.
More than a decade ago a woman named Jill Price came to the attention of scientists at UC Irvine. She exhibited a condition that is pretty much the direct opposite of McKinnon’s: the researchers called it hyperthymestic syndrome, or highly superior autobiographical memory. Price has an extraordinary ability to recall just about any fact that has intersected with her life: July 18, 1984, was a quiet Wednesday, as she writes in her memoir, and Price picked up the book Helter Skelter and read it for the second time. Monday, February 28, 1983, the final episode of M*A*S*H aired, and it was raining. The next day Price’s windshield wipers stopped working as she drove.
In contrast to McKinnon, who has received relatively little press attention, Price became an instant media sensation. Diane Sawyer had her on air twice in one day. Her powers of memory, after all, seemed supremely enviable, superhuman.
But as the UC Irvine researchers—and a story in WIRED—noted, Price’s extraordinary feats of recollection were accompanied by a kind of obsessive-compulsive fixation on recording the details of her life, one that appeared to have taken root after a “traumatizing” move to LA when she was a girl. As an adult in her 40s, she still lived with her parents. And she buttressed her memory with cramped pages full of notes on everything that happened to her in any given day.
Which is all just to say: When it comes to people with highly unusual memories, it’s not clear that we as a culture are so good at choosing who to envy.
YOU MIGHT THINK that McKinnon would lean on technology to help compensate for her disorder. After all, she lives at a moment when software companies are churning out products that are, essentially, surrogates for the very faculties she lacks. Isn’t a Facebook feed a kind of prosthetic autobiographical memory? Google Photos will even form gauzy retrospective mental associations for you: The artificially intelligent software plunges straight into your photo library, plucks out faces and related events, and automatically generates poignant little videos—synthetic episodic memories. Other software tools aim to capture your entire life in documents—emails, calendar reminders, schoolwork, voicemails, texts, snapshots, videos, and other bits of recordable data—to provide a searchable database of your memories.
And yet the life-logging impulse is lost on McKinnon. Once, she decided to keep a journal to see if she could preserve her memories. “I stopped doing that after two or three days,” she says. “If I get so obsessed with capturing every moment because I’m afraid of losing the memory, I’m never going to experience those moments.” And what else, really, does she have? She does use email, which sometimes serves as a useful reference. But she doesn’t make a special effort to log her experiences there. And she doesn’t use social media. No Pinterest. No Instagram. She had a Facebook account, but she quit using it. It didn’t interest her.
Even if she had a Facebook feed, she would have very little to put there in the way of photos or videos. McKinnon once borrowed a video camera to film one of their departures on a Caribbean cruise, but she didn’t enjoy it. She lost the feeling of the moment, she says. She likewise doesn’t take photos. She says she doesn’t find them that compelling to look at. Sure enough, I notice there are no pictures on the couple’s refrigerator, shelves, or walls. No framed wedding portraits. No posed beach shots. There are just a few photo albums in an upstairs office.
McKinnon pulls down the album of her 1981 courthouse wedding to Green in Maywood, Illinois. There’s a shot of the friends who surprised the newlyweds on the steps outside. There’s one of Green opening a gag gift—a set of four mugs with images of cats having sex. McKinnon is practiced at laughing through all the anecdotes about the day that she has memorized over the years, with help from the album. But looking at the pictures, she says, feels like observing somebody else’s wedding.
Today, though, she learns something new about the day she married Green. As we look over the album, Green mentions a close friend who attended the wedding. “I didn’t even know she was there,” McKinnon says. That’s because there are no photos of this friend. Because she was the one behind the camera.
This actually feels like the kind of error anyone could make: Doesn’t the person behind the camera often get edited out of recall? Even when the person behind the camera is you?
While it’s abundantly clear that McKinnon isn’t using technology to become more like us, it’s conceivable that technology could, over the long run, make us all a bit more like McKinnon. My iPhone now holds 1,217 photos and 159 videos just from the past eight months. By focusing on clicking picture after picture, I may actually be blurring away my memories of these experiences through something researchers call “the photo-taking impairment effect.” And by automatically storing all those photos in the cloud—which relieves my mind of the burden of cataloging a bunch of memories—I may be short-circuiting some part of my own process of episodic memory formation.
“What would humanity lose if they lost some of that ability?”McKinnon asks during one of our conversations, as if wondering aloud for me. “If they had technology to replace it, what would be lost? The human experience would change, but would it be a plus? Or a minus? Or—just a change?” I CAN HEAR McKinnon sniffling. We’re sitting in a dark movie theater at Olympia’s Capital Mall, watching Inside Out. Out of the corner of my eye, I see that she’s crying. Most of the movie takes place in the mind of an 11-year-old girl named Riley. The girl’s emotions, represented as cartoon workers in a control room, are on an emergency mission to save her from psychological catastrophe: the loss of her core memories, which look like little glowing orbs with video loops playing across their surface. The core memories power her personality islands, which—well, it’s hard to describe, but suffice it to say the structures of Riley’s personality begin to crumble when her core memories go missing.
McKinnon loves the movie, despite the fact that it seems to present her daily reality as an utter catastrophe. (When we talk about the islands of personality, core memories, and the control room of Riley’s consciousness, McKinnon laughs. “If I have the islands,” she says, “I’m not sure there’s any connections to headquarters.”)
I’m surprised to find out that, even though she doesn’t experience her own life as a narrative, McKinnon loves stories. Especially fantasy and sci-fi: Game of Thrones, The Hunger Games. She’s read all the books, seen all the movies and episodes. She can’t remember what they were about, but that just makes it better. Each time she rereads or rewatches something, it’s like experiencing it for the first time. (Here’s another thing to envy about her: She is impervious to spoilers.)
But she cannot for the life of her make up a story. She does not daydream. Her mind does not wander. This lack of imagination is common among amnesiacs. Most of us can visualize a beach scene on command, for example: We can picture lounging on a chair with a piña colada in hand, roaring waves, grains of sand between our toes. When McKinnon tries this mental exercise, she can visualize a hammock, maybe. “And then there’s probably a palm tree. As soon as, in my mind, I’d try to grab that palm tree, I lose the hammock.” She cannot fit the images together into a finished puzzle. She also cannot play chess, even though her husband plays often. “I can’t hold in my mind more than one move ahead.” In other words, not only does McKinnon lack a window into the past, she also lacks a window into the future.
McKinnon and I did a lot that day. We ate, we spoke, we walked around the mall. But of course, she doesn’t remember the details, nor does she seem to mind. While most of us experience life as a story of gain and loss, McKinnon exists always and only in her own denouement. There is no inciting incident. No conflict. And no anxious sense of momentum toward the finale. She achieves effortlessly what some people spend years striving for: She lives entirely in the present.
Climate: Cold to extremely warm; ocean acidification and anoxia, ozone destruction
Aftermath: Permanent ecosystem reorganization; low O2 for >106 years
There’s good reason why the End-Permian extinction is referred to as “The Great Dying”; 95% of all marine families, 53%of all marine families, 84% of marine genera, and 70% of known land species went extinct,
The extinction likely occurred in three stages: 1. Land extinctions over ~40,000 yrs 2. Very abrupt marine extinctions 3. Second phase of land extinctions
Calcifying marine organisms such as brachiopods and bryozoa were the hardest hit, representative of ocean acidification. The last of the Cambrian fauna also died off, and this was the only known mass extinction of insects
So what exactly made the End-Permian extinction so severe? There truly was a perfect storm to make this the deadliest million years in Earth’s history.
Earth had been emerging from a moderate ice age when the largest flood basalt event in history (the Siberian Traps) occurred, which released vast amounts of CO2. The oceans then became increasingly warm, acidic, stratified, and euxinic from decaying organic matter. The atmosphere also became flooded with light (biogenically fixed) C, possibly from seafloor methane hydrates or from coal gas released as a result of heating from the Siberian Traps. Greenhouse gases soon caused global temperatures to spike, leading to massive extinction. Global euxinia in the oceans then became a severe problem, with sulfate reducing bacteria releasing large amounts of H2S, poisoning the oceans and atmosphere and thinning the ozone layer. These systems then created a cycle of positive feedbacks: more die-offs → more euxinia → more H2S → more die-offs.
Marine ecosystems were forever changed after the extinction. Land ecosystems didn’t recover for ~5 My, and O2 levels remained low throughout much of Triassic time.
Click HERE to see all Mass Extinction Monday posts
I’ve got my eyes on you human 🐙💀 The #blueringedoctopus - if they bite and release their venom within five to ten minutes, you would begin to experience parasthesias and numbness, progressive muscular weakness and difficulty breathing and swallowing. Nausea and vomiting, visual disturbances and difficulty speaking may also occur. In severe cases, this is followed by flaccid paralysis and respiratory failure, leading to unconsciousness and death due to cerebral anoxia. Interestingly, your heart continues to beat until extreme asphyxia sets in. Some victims report being conscious, but unable to speak or move. They may even appear clinically dead with pupils fixed and dilated. So be afraid human- be very afraid. 🐙💀
I’ll arrange them into categories (multi-chap, oneshots/drabbles, NSFW, and such! I’m prone to missing ones I’ve enjoyed in the past, and probably got buried in my archives asjdlkj so I’m sorry in advance OTL
(This is all based on my opinions/experiences and my approval does NOT determine the quality of anyone’s work!)
why making leo fitz forget everything would be a poor decision
so, in the time since the season finale most of the speculation (and fiction) around Fitz has been to do with him being in a coma and waking up with no memory of the team and of Jemma. Personally I believe this is the worst route they could possibly take with Fitz’s character (as well as being almost Scientifically inaccurate). Full explanation (including science! under the read more)
Firstly, let’s look at what we know.
- His brain was without oxygen for several minutes. We do not know the extent to that, but we can gather he is suffering from Hypoxia/Anoxia. Hypoxia refers to a lack of oxygen in a general or specific area (in Fitz’s case, the brain) and Anoxia is complete and total lack of Oxygen (most severe). Prognosis depends on whether he experienced Hypoxia/Anoxia. I myself am taking the worst case scenario of Anoxia.
- Severe anoxia will result in coma. Longer the coma, more severe the consequences will be on waking. Some patients in a coma can move in to Persistent Vegetative State. They are highly unlikely to ever to achieve higher functions above a vegitative state. But considering comments by Iain and other cast members I don’t think this is likely.
- Anoxia can have several consequences that all depend on the severity of the condition. Several specific brain areas are more vulnerable to Anoxia leading to some distinct characteristics.
Hi! So, if you're strangled (by hands) by someone who's really angry and vicious right to the point where you're about to blackout and then get saved, what is there to expect? Can you talk afterwards? How bad is the swelling, the pain? I know you're supposed to get checked by a doctor, but what exactly would they be able to do? And lets imagine you go to the hospital like that and won't tell what/who happened, then I guess the hospital is calling the police, right? Thank you!
WARNING: TRIGGER FOR CHOKING, STRANGULATION, AND DOMESTIC VIOLENCE.
Hey there! So your character’s been strangled… eep! That’s a really scary experience!
I’ll actually answer your last question first: at least here in the US, there are only a very few things that hospitals are mandated reporters of:
Suspected child or elder abuse/neglect.
Everything else, to my knowledge, is between your characters and their healthcare providers. Rammed packets of cocaine down your gullet until you had a massive heart attack? Nope, not reported. Contracted a bird disease from an illegal cock fight? Totally on the DL as far as the hospital is concerned. So no, a little choking is not, in fact, automatically reported.
That being said, most medical providers will encourage someone to press charges, whether they want to or not. Most strangulations are related to intimate partner violence, which is a situation that can rapidly turn lethal for the victim.
Now, on to the medicine. Mostly post-strangulations need to be evaluated by doctors for airway swelling. A lot will depend on the exact placement of the hands, amount of force, etc. But most chokes bad enough to make someone almost pass out will likely also produce bruising where the fingers were gripping.
The structures of the airway are both relatively well-defended, and also delicate. They’re pretty solid against direct injury, so a tracheal fracture (literally a broken windpipe) is unlikely (though possible; it’s something they’ll be evaluated for). However, swelling in the airway itself can rapidly become life-threatening if it occurs, and it’s a possible side effect of strangulation. It can occur up to 36 hours after the injury, too, so even after your character goes home, they may yet have serious issues that could even be life-threatening.
I’ll cut to the goodies, which are a list of possible injuries following strangulation:
Voice Changes—May occur in up to 50% of victims,may be as minimal as simple hoarseness (dysphonia) or as severe as complete loss of voice (aphonia).
Swallowing Changes—Due to injury of the larynx and/or hyoid bone. Swallowing may be difficult but not painful (dysphagia) or painful (odynophagia).
Breathing Changes—May be due to hyperventilation or may be secondary to underlying neck and airway injury. The victim may complain of dyspnea (shortness of breath) .Breathing changes may initially appear mild, but underlying injuries may kill the victim up to 36 hours later.
Mental Status Changes—Early symptoms may in-clude restlessness and combativeness due to tempo-rary brain anoxia and/or severe stress reaction.Changes can also be long-term, resulting in amnesiaand psychosis
Involuntary Urination and Defecation
Swelling of the Neck—Edema may be caused by any of the following: internal hemorrhage, injury of any of the underlying neck structures, or fracture of the larynx causing subcutaneous emphysema.• Lung Injury—Aspiration pneumonitis may develop due to the vomit that the patient inhaled during strangulation. Milder cases of pneumonia may also occur hours or days later. Pulmonary edema symptoms may also develop.
Visible Injuries to the Neck—These may include scratches, abrasions, and scrapes. These may be from the victim’s own fingernails as a defensive maneuver but commonly are a combination of lesions caused by both the victim and the assailant’s fingernails. Erythema on the neck may be fleeting, but may demonstrate a detectable pattern. Ecchymoses may not appear for hours or even days. Fingertip bruises are circular and oval, and often faint. A single bruise on the victim’s neck is most frequently caused by the assailant’s thumb
Chin abrasions—May occur as the victim brings their chin down to their chest, to protect the neck.
Ligature Marks—May be very subtle, resembling the natural folds of the neck. They may also be more apparent, reflecting the type of ligature used.Ligature marks are a clue that the hyoid bone maybe fractured.
Petechiae—May be found under the eyelids, periorbital region, face, scalp, and on the neck. Petechiae may occur at and above the area of constriction.
Subconjunctival Hemorrhage—This may occur when there is a particularly vigorous struggle between the victim and assailant.
Neurological Findings—These may include ptosis (droopy eyelid), facial droop, unilateral weakness, paralysis or loss of sensation. (This is an absolute worst case scenario wherein the choke has damaged the carotid artery or the person was choked long enough to cause brain damage – A.S.)