Episode 27: When the Textbook Doesn’t Fit

Medicine loves rules, but the human body doesn’t always play along. In this episode of Kohroner Chronicles, Dr. Roland Kohr explores two unusual cases that remind us why anatomy, and forensic science, often defy the textbook.

The Curious Case of Harry’s Liver

A listener wrote in with a question about Harry, a long-time drinker whose liver seemed almost immune to alcohol damage.

“Harry could get fall-down drunk,” Dr. Kohr explains, “but for some reason his liver resisted showing the scarring and cirrhosis we’d expect.”

The case opens a wider discussion about how differently human bodies react to stress, alcohol, or disease. Not every alcoholic has a cirrhotic liver, and not every cirrhotic liver belongs to an alcoholic. Viruses such as hepatitis B and D, and even other infections, can mimic or create liver damage without a single drop of liquor involved.

“The point,” Dr. Kohr notes, “is that people don’t read the textbook before they become patients.”

When Bodies Break the Mold

Dr. Kohr recalls seeing two rare cases of situs inversus, a condition where every organ is mirrored to the opposite side of the body.

“The heart’s on the right, the liver on the left, spleen flipped too,” he says. “Most live normal lives, but some have Kartagener syndrome, which also affects the tiny micro-cilia in the airways and reproductive system. Those individuals can be infertile and have chronic respiratory issues.”

It’s a vivid reminder that “normal” anatomy is more flexible than we imagine.

Q & A with Dr. Kohr

Q: When Harry was hit, vehicle vs. bicycle, how do you even begin analyzing that?

A: I’m not an automotive expert, but we can gather evidence: paint chips, bumper height, impact patterns. Those samples go to specialists who can chemically identify paint unique to certain car brands. Every manufacturer, and even custom paint jobs, leave chemical fingerprints.

Q: Have vehicle sizes changed how you interpret trauma?

A: Absolutely. Modern trucks have high bumpers that strike at waist level. Decades ago, impacts happened at the knees. A low sports car might flip a pedestrian up and over the hood; a tall pickup tends to knock them down and run them over. Even blood spatter or tire-tread patterns can hint at vehicle type and speed.  The movie “My Cousin Vinni” was actually a pretty good example of that sort of applied science.

Q: Do you ever consult on gunshot cases?

A: Frequently. I’ve seen hundreds of gunshot wounds. While I’m not a certified ballistics expert, as a forensic pathologist I must understand basic physics, velocity, mass, energy transfer, etc. I can distinguish between contact, intermediate, and distant gunshot wounds, trajectories, and interpret what likely occurred. Courts generally accept that expertise when it’s tied to human anatomy, not weapon design.  When additional expertise is needed, I definitely reach out to those whose qualifications can help

Lessons from the Unpredictable

Whether studying an oddly resilient liver, a mirrored set of organs, or evidence from a collision, Dr. Kohr’s takeaway is the same:

“Textbooks describe the average, not the absolute. Every person is an experiment of one.”