Learn 'How Not to Die'

Eventually, Victor's organs ceased functioning, and he died. The tragedy was compounded by the fact that Victor's death could easily have been prevented. A routine course of antibiotics provided in a timely manner would have stopped the infection in its tracks.

Checked Out

As with the case of Victor Baca, I've seen firsthand the terrible complications that can arise when people don't go to the doctor, ignore a physician's advice, or decide to take medical matters into their own hands.

Another example from my case files is that of Kim Atani, age forty-eight. She was a woman who could have lived a long, normal life had she received proper medical care. Kim, who was blind, and her husband, Simon, were living in their Orlando home when Simon found her collapsed on the bedroom floor.

He called 911, and Kim was rushed to the hospital, where she later died. Her body was sent to my morgue to be autopsied.

Some of the most important information any physician–forensic pathologists included–can have is a medical history. But Kim arrived at the morgue without any medical records. I had to rely solely on observation to figure out why she died.

Clearly, something terrible had been happening. Her teeth were fractured at the gum line. She was also covered with bedsores, oozing craterlike wounds that can become seriously infected.

Medically known as "decubitus ulcers," bedsores develop quickly as tissue dies when blood flow is impaired by the continuous pressure of body weight on the soft tissues sandwiched between bone and a firm surface.

There was also gangrene, or dead tissue, which appeared as large, black, shriveled areas across her left foot. Gangrene is caused by progressive loss of blood to an area, and there are two types: wet and dry. Both are caused by poor blood flow, but in wet gangrene, the tissue is also infected with bacteria. Kim had wet gangrene.

Gangrene is often associated with advanced cases of diabetes. I dissected Kim's wet gangrene and discovered that the infection had burrowed down to her bone. If discovered in time, a limb so acutely diseased would have been amputated to prevent the spread of a life-threatening infection. With my scalpel, I made the standard Y incision, a deep cut from shoulder to shoulder across the chest, followed by a straight line down to the pubic bone. I then opened the torso like you'd open a jacket or sport coat.

Ribs were cut so I could gain access to the organs, which are removed, weighed, and dissected during the autopsy. After opening her up, I could see that her body harbored several other possible killers.

Her kidneys and liver were damaged, and her coronary arteries were more than 95 percent blocked. These findings were pieces of the puzzle that, along with her blindness, periodontal disease, and gangrene, began to fit a pattern.

It appeared to me that Kim Atani had been suffering from long-standing untreated diabetes. Diabetes is a metabolic disorder. Its hallmark is a failure to metabolize glucose, or blood sugar, carried by the bloodstream to fuel every part of the body. The failure is caused by problems with the hormone insulin.

Either the body doesn't make any (or enough) insulin, or cells don't respond to insulin properly. In either situation, glucose is unable to enter cells. It starts amassing in the bloodstream, where it can reach concentrations over ten times the normal level.

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