Learn 'How Not to Die'

After you die, your blood sugar begins to drop continuously toward zero. I can't even test for glucose levels in the blood because the blood breaks down right after death and interferes with testing. But I can test for glucose by using eye fluid drawn into a syringe–a procedure that can make you shudder if you've never seen it before. Each adult human eye contains about one-fifth of a teaspoon of jellylike fluid called vitreous humor. This fluid is very reliable for testing because it is isolated and protected, and therefore less subject to contamination or cell breakdown. I collected eye fluid from Kim's eyes and sent it to our toxicology lab. Glucose levels in the eye decrease after death, too, so a finding of elevated glucose would strongly indicate diabetes. Sure enough, when the toxicology report came back, it revealed that Kim's eye-fluid glucose was 378–massively elevated for a postmortem level.

Once I put all the facts of the case together and reviewed her tissues under a microscope, it was clear to me that over time, elevated glucose had caused widespread organ disease. It not only left Kim blind but it also caused a loss of sensation in her extremities and impaired her blood flow. Gangrene set in and allowed a deadly infection to take hold. The infection invaded her bloodstream, causing sepsis–an often fatal condition. Sepsis takes its name from the Greek word meaning "to putrefy." Known for generations as "blood poisoning," it generally means bacteria have breached the natural barriers of the skin and organs to enter the bloodstream.

Once there, they produce an overwhelming infection, the biological equivalent of tossing a grenade into your body. Blood pressure drops, vessels leak, and the lungs and kidneys fail. The result can be septic shock so severe that no amount of intravenous fluid or medication can reverse the condition. This is what happened to Kim Atani. Normally, a case like this would be closed, but I had to get to the bottom of why she had not sought medical care. Was it a case of negligence on the part of her husband, Simon? Could his inaction have contributed to her untimely death? If it was found that he had acted negligently, charges could be brought against him. I called Simon and told him that his wife had had diabetes. He was in denial about it, but more from ignorance about the disease than anything else. I pointedly asked why she didn't seek medical care and why he didn't seek medical care for her. He told me that his wife had had some bad experiences with doctors, that she refused to see one, and that she hated the medical establishment.

There was nothing he could do to get Kim to see a doctor, and so he vowed that he would do what he could to take care of her. In the end, and after confirming her fear of the medical system, I believed him. He was sincere and really cared about his wife. Many people make choices that ultimately lead to their demise, and at autopsy, my findings reflect this. As a medical examiner, I'm one of the few people given permission to look behind the curtain of someone's life, and what I observe is often senseless and tragic. I don't judge how people live, but I will say this: Not going to the doctor when you have a major health issue is your decision, but missing needed care might mean I'll be the doctor you'll eventually visit. Kim Atani and Victor Baca suffered not only from deadly but treatable illnesses; they also may have suffered from latrophobia or odontophobia.