I woke up unusually early on this chilly, pre-winter morning. So instead of just lying there thinking about things that do me no good thinking about, I got up, made my daily cup of boutique Folgers’s instant decaf and sat down to write. I love the darkness as the sky turns pink and the total quiet and solitude that I’ll have for a few hours.
It was my intention to write about Excited Delirium - this weird, controversial thing that kills people. Black people mostly. And I will. But first I’m going to veer out of my lane a bit and talk about the hate and dysfunction that we’ve been seeing so prevalently around us.
For some three weeks the United States House Of Representatives argued and fought among themselves about who was going to lead them. In the end they picked a calm, bespectacled, far right extremist, conspiracy theorist, and key architect of the January 6th plan to overturn the will of the American people, Michael Johnson.
Johnson made the cut because he worships at the altar of Donald Trump. Donald Trump worships at the altar of hate which, unbelievably, seems to appeal to millions of Americans. Certainly this is not all about race, but just below the surface where it’s out of site, race is in the mix. America has had many racist presidents. But only two, Woodrow Wilson and Donald Trump either implicitly or explicitly, supported or advocated American-on-American violence. And we now have a Trump sycophant leading the U.S. House. This can’t be good for America.
And then there’s Maine. I grew up on a dairy farm in NH, right next door to Maine. Maine might be one of the last states I’d expected to hear of mass murder. Eighteen people dead. Thirteen wounded. One of the things that most jumped out at me was the lede, “Deadliest mass killing this year.” This year! That lede unintentionally emphasized both how common place America’s mass murders have become and how deadly. Without dwelling on the history of our mass murders and trying to recall them, I kinda thought that with eighteen dead, the lede was going to read, “Deadliest mass murder…ever.” But nope…not so. Merely the deadliest this year.
And with hundreds of law enforcement being dispatched from as far away as New York, I wondered if a handgun with a 10-round clip would have created such a large response. I’m a Marine. I was a qualified sharpshooter each of the four years and four days I was in. I don’t think that I have not owned some kind of a gun or three since I was maybe 16 years old. I like guns. I wielded an AR-16 assault rife in Vietnam - along with a .50 caliber machine gun. But I wonder – is an assault rifle in the hands of a civilian ever used for anything other than to intimidate or murder masses of people?
Maine Democrat Representative Jared Golden, who had enjoyed an A+ rating from gun rights advocates, said he regretted his past opposition to assault weapons bans and would now support such a ban. “To the victims and their families, I ask for your forgiveness and support as I seek to put an end to these terrible shootings.”
Mike Johnson, our latest Speaker of the House says the problem is with our hearts, not assault. weapons: “At the end of the day, it’s, the problem is the human heart. It’s not guns. It’s not the weapons. At the end of the day, we have to protect the right of the citizens to protect themselves, and that’s the Second Amendment.” So there you have it. Guns don’t kill people. Hearts kill people. Who knew?
And then there’s the mess in the Middle East where in less than three weeks over 8,000 people – men, women, and 3,197 children on both sides - have been killed and which is sucking all the oxygen from the issue of Ukraine fighting Russia for that all-American ideal of freedom. I’m not going to pretend for a moment that I have any insight or advice. All I know is that a functional American government needs to be involved.
Here's a clip from a friend of mine – a pediatrician who travels often from here in Grand Junction CO to Gaza to treat children – who remains trapped in Gaza.
What I know for sure is that the United States plays a role in everything. We need a functioning government, not one that is fighting amongst itself and grandstanding and pandering to its base. We tend to refer to our elected officials as our leaders. But pandering isn’t leading. Chasing after your base - trying to get ahead of them - isn’t leading. We are living in an era where we need strong, thoughtful, humane leadership. Your assignment during the next presidential election cycle is to knock on doors. I’ve done it. It’s rewarding. Regardless of who Trump is running against, the country cannot endure four years of an unleashed Donald Trump …his hate…his divisiveness…his minions…his sycophants.
Better yet, get involved in the Republican primaries. There are moderate Republicans out there who would make good, maybe even great presidents. It is going to take smart, courageous, moderate Republicans to right what is wrong with this country and defy the crazed, extreme, MAGA right.
Ok…Excited Delirium. I feel like I just worked myself up enough that maybe I have it. Yeah, I’d never heard of it either until Jordan Neely was choked to death by Daniel Perry on a NYC subway last June. Later in the month I was sitting on my deck with a good friend and enjoying good convo and an adult beverage. The Neely/Perry incident came up. My friend, a long-time federal law enforcement officer, expressed his belief that Neely had not died from being choked, but rather from a thing called Excited Delirium. I had never heard of Excited Delirium. My friend – I’ll call him Rick – filled me in. He’d never seen it either, but in training he’d seen many videos. Evidently, in Rick’s explanation of Excited Delirium, a person can get themselves so agitated that they suffer cardiac arrest and die. I was told it’s not uncommon in law enforcement use-of-force fatal encounters. That’s likely what caused Neely’s death. In a sense, Neely had killed himself. All he had to do was give in and calm down instead of getting all worked up about being choked.
To Rick, that scenario was more likely than a good Samaritan choking someone so aggressively and for such a protracted period of time as to cause his death. Rick did not think that a person could have the stamina to keep a strong hold onto a person’s neck for 15 minutes. Being a good and fair person, Rick also did not want to believe that a good Samaritan would be more amped up…more aggressive…more afraid…more angry during a violent encounter with a Black American than he would be with a White American. And right there is the problem. The belief that racism in America barely exists. That we actually are the fair, equality-driven, color-blind citizenry our constant narrative proclaims us to be.
Multiple videos show Perry choking Neely from behind with his forearm against his trachea for 15 minutes. I didn’t argue or say much to Rick. These are the types of difference of opinions that these days can stress friendships. But it seemed obvious to me that if a person is being choked and subsequently dies with the person’s arm around his neck, he was strangled to death and not Excited Deliriumed to death. Weeks later the NYC Medical Examiner agreed with me and ruled Neely’s death a homicide by strangulation.
Much ado was made of Perry being a Marine thus having been taught the choke hold. There’s truth to that. I was taught the choke hold while in Marine boot camp. We practiced on each other. We were also taught to let up unless it was our intention to kill the person.
Over the next few days I thought of Eric Garner who in 2014 was placed in a chokehold by a NYPD officer, taken to the ground, and held there until he died, all while begging for air. Garner had been illegally selling single cigarettes…a crime that harms the city by denying it a few dollars of tax revenue. Garner was obese and had asthma. Law enforcement supporters quickly weighed in. Garner had caused his own death by being an overweight asthmatic. Again, it seemed to me that Eric Garner had been killed by a hold that had been banned by the NYPD itself. And again, the Medical Examiner agreed with me…Eric Garner died by homicide. Strangulation.
I thought about another Federal Law Enforcement friend. “If Eric Garner had not resisted arrest, he would not have been placed in a (banned) choke hold and he’d still be alive.” When Garner was approached by the NYPD officers and told he was being placed under arrest, he waved his arms about and cried, “No! Not again! Just leave me alone. Please…just leave alone!” Another Black man who’d “caused his own death” at the hands of Law Enforcement. This time for waving his arms around.
I thought about Adolf Lyons, a man I’d read about back when Eric Garner was killed: Early on the morning of October 6, 1976, 24-year-old Adolph Lyons was pulled over by two Los Angeles police officers for driving with a burned-out taillight. The facts of the incident were later recounted by Supreme Court Justice Thurgood Marshall, “The officers greeted him with drawn revolvers as he exited from his car. Lyons was told to face his car and spread his legs. He did so. After an officer slammed his hands against his head, Lyons complained that the keys in his hand were hurting him.
Within 5 to 10 seconds, the officer began to choke Lyons by applying a forearm against his throat. As Lyons struggled for air, the officer handcuffed him, but continued to apply the chokehold until he blacked out. When Lyons regained consciousness, he was lying face down on the ground, choking, gasping for air, and spitting up blood and dirt. He had urinated and defecated. He was issued a traffic citation and released.” Lyons, of course, was Black.
Lyons sued the Los Angeles Police Department for damages and asked a federal judge to enjoin the further use of chokeholds except in circumstances where they might prevent a suspect from seriously injuring or killing someone. Lyons also argued that his constitutional rights had been violated by being subjected to potentially deadly force without due process.
His case, Los Angeles v. Lyons, eventually made it to the Supreme Court. In April 1983, the justices ruled against Lyons 5 to 4. The majority punted on the question of whether chokeholds are constitutional, instead finding that Lyons lacked standing to sue the LAPD since he could not prove that he might be subjected to a chokehold again.
I thought about what I recalled the enraged Justice Marshall had written in his dissenting opinion, “Although the city instructs its officers that use of a chokehold does not constitute deadly force, since 1975 no less than 16 persons have died following the use of a chokehold by an LAPD police officer. Twelve have been Negro males…It is undisputed that chokeholds pose a high and unpredictable risk of serious injury or death. Chokeholds are intended to bring a subject under control by causing pain and rendering him unconscious. Depending on the position of the officer's arm and the force applied, the victim's voluntary or involuntary reaction, and his state of health, an officer may inadvertently crush the victim's larynx, trachea, or hyoid. The result may be death caused by either cardiac arrest or asphyxiation. An LAPD officer described the reaction of a person to being choked as "do[ing] the chicken," in reference apparently to the reactions of a chicken when its neck is wrung. The victim experiences extreme pain. His face turns blue as he is deprived of oxygen, he goes into spasmodic convulsions, his eyes roll back, his body wriggles, his feet kick up and down, and his arms move about wildly.”
And then I thought about what Daryl Gates, the LAPD’s Chief of Police had said about the use of the chokehold: “We may be finding that in some blacks when it is applied the veins and arteries do not open as fast as they do in normal people.” Yeah…normal people, chief. Bear in mind that this was when the Los Angeles police department was the national poster child for racist policing. Gates was still chief when Rodney King was beaten by 5 LAPD officers eight years later.
Eventually the Neely/Penny thing dropped out of the news and I stopped thinking about it until a few days ago when I read that my home state of Colorado is likely joining California in prohibiting coroners from listing Excited Delirium as a cause of death. Because it doesn’t. Choking causes death.
This decision to prohibit mention of Excited Delirium came four years after the death of 23-year-old Black American Elijah McClain in Aurora Colorado after an encounter with police after McClain had been stopped for acting suspicious while walking home carrying a bag of groceries. After he was placed in a chokehold and became unresponsive, paramedics who had been called to the scene diagnosed him with Excited Delirium and injected him with Ketamine from which he died. A jury subsequently found one former officer guilty of criminally negligent homicide and third-degree assault. A second former officer was found not guilty of any charges. The paramedics were charged and are still awaiting trial. Testimony focused on the controversial term "Excited Delirium" as well as police use of a carotid restraint on the 23-year-old. Also at issue was the use of Ketamine.
Elijah McClain, 143 pounds
On the same day that a jury issued a mixed verdict in the trial of the two Aurora police officers, the American College of Emergency Physicians voted to rescind a paper it had issued 14 years prior on "excited delirium." Emergency room doctors were the last major medical group to conclude excited delirium is not a valid medical or psychiatric diagnosis.
Colorado State Representative Judy Amabile, in introducing her bill that would bar the term from being used in police training and coroners’ reports, said, “We know this is junk science and we have to stop using it.”
So what is Excited Delirium? Junk science? Real science? Just another explanation of a Black death at the hands of Law Enforcement? I turned to Steve Meyers, a friend, and a physician for some 40 years, for help understanding Excited Delirium. He turned to his medical journals.
The term Excited Delirium was first used in the 80’s to describe cocaine toxicity. Then the journals quickly addressed the issue of the day - Excited Delirium death - or RRCA, Restraint Related Cardiac Arrest, as it is called in the world of medicine, which more accurately describes death while experiencing Excited Delirium. “Individuals experiencing hypoxia (lack of oxygen, e.g. chokehold) will become agitated and violent as they struggle for breath. Some people in that situation will become violent as a natural and uncontrollable reaction in an attempt to get sufficient oxygen. RRCA occurs almost exclusively by law enforcement restraint. Persons experiencing Excited Delirium rarely experience cardiac arrest in the absence of aggressive restraint. Law enforcement officers (or strangers on a NYC subway) will likely interpret the natural reaction to insufficient oxygen as resistance and apply increased pressure, increased duration, or both.
Elijah didn’t die from Excited Delirium. He died from being strangled. Ditto for Jordan Neely, Eric Garner, James Thompson, Rodney Lynch, Dustin Boone, Roger Owensby Jr, Carl Glenn Wheat, Gerald Arthur, Torres Harris…
Was this about race? The paramedics who treated Elijah with Ketamine estimated his weight at 200 pounds. That’s a hard-to-make, 57-pound error, especially for paramedics, who often dose based on weight. 200 pounds looks nothing like 143 pounds. If Elijah had been injected with the appropriate dosage, he might still be alive. Law Enforcement – and White Americans in general – in study after study, routinely estimate Black men to be larger than they are and Black children to be older than they are. Timothy Russell, the Cleveland police officer who shot and killed Tamir Rice in Cleveland in 2014 for holding a toy gun thought the 12-year-old was 18. Tamir would likely be alive if Russell had recognized him as the child that he was.
Tamir Rice, age 12
If Black Jordan Neely had choked and killed a White Daniel Perry on a NYC subway, who can honestly envision Americans donating over $2,000,000 for his legal defense fund? Many donors thanked and congratulated Perry, America’s latest hero.
 Text from Up To Date, the preeminent online medical text book for medical providers.