Some explanations for a sudden death

In My Humble Opinion
1

This may not be the best forum for this, but SDMB has an amazing wealth of people who are incredibly knowledgeable on a variety of topics so I thought I’d start here before trying more specialized forums on the 'net.

This is not in any way asking for medical advice/opinions/et cetera. The person involved is dead and buried as of yesterday, no medical decisions involving myself or any other living person I am associated with are going to be (or can be) made based on anything said here.

I’ve put this in IMHO because I don’t feel it’s appropriate for GQ as I don’t think any truly factual answers can be had given the limited information I’ll be able to give. I’m mainly just looking for some direction/general ideas.

Anyways, a relative of mine died in the early morning hours of January 1st. She was 71 and aside from a few minor health matters that had arisen over the past couple of months she was in exceptional health regular physicals/blood work et al turn up exemplary, longest hospitalization was to have tonsils removed as a very young child. Only persistent medical conditions over any appreciable period of time were environmental allergies and heart burn brought on by eating the usual foods (she stayed away from pizza and such because of the indigestion/heart burn caused, she used several OTC heart burn medications on a semi-regular basis.)

I’ll detail all the recent medical events in her life leading up to her death.

  1. Urinary tract infection - From what I gather this was sometime near Thanksgiving (possibly diagnosed several weeks earlier) she was on an antibiotic for it. The antibiotic caused a mild allergic reaction (caused skin irritation) she stopped using it and went back to her doctor and got a prescription for a different antibiotic. It has been said by close family members she may not have used this second antibiotic like she should have, and she never went back to her doctor for a follow-up.

  2. Flu like symptoms beginning around Dec. 20th and persisting until death. She had been sicky with congestion and fatigue that was bad enough she complained about it, and she was fairly hesitant to complain about things. It seemed to reach its peak on Christmas day when she made the family dinner, it had apparently abated after that, but became more severe around Dec. 31st.

  3. While preparing Christmas dinner, on the morning of Dec. 25 she fell on her slate floor, the fall was bad enough that she felt sore and complained of stiffness/pain on Christmas day, didn’t complain any day after that.

On Dec. 31st she was visited by several family members. Her flu-like symptoms were bad enough that one of her doctors said she should consider going to the doctor as soon as possible. She agreed, and said she would go after the New Year.

She was, aside from the flu-symptoms, alert, communicative, et cetera the last anyone saw her on the 31st.

On the early morning of January 1st (5:30-6:00 AM) she called one of her daughters (she has three) saying she was feeling very bad and needed to go to the emergency room. Her three daughters arrived at her home all within a short period of time, they called 911 and reported that she was in a very bad state. She was reportedly “delirious” and “out of her mind.” Her symptoms grew worse as they got into the ambulance and she lost ability to speak and was suffering what her daughters could only describe as “what looked like a stroke.” She had the mental presence of mind to answer questions from the EMTs via non-verbal communication (holding up of different numbers of fingers to answer their questions.)

Her physical appearance had some changes her daughters noticed as they looked at her. Long dark lines were running from through her arms and up towards her chest, and there were dark patches of skin that, when touched, fell off in “flakes.”

They get her to the emergency room and she is ill but still cognizant and alert, the daughters are left in the waiting room. Around half an hour later a doctor takes them into a side room and begins asking a laundry list of questions. The questions had an odd tone and one of the daughters asked, “Is she dead?” and the doctor replied that she had died and they were not sure why.

The main reason I’m coming to the forum comes next. Shortly after receiving that news they were asked if they wanted an autopsy performed, they were all emotionally distraught and just said no, as they didn’t want her being cut on. In retrospect they all wish they had said yes, but once she was given over to the funeral home and all those arrangements were under way they didn’t feel their desire for knowledge was important enough to suspend a funeral which they all wanted to get through as soon as possible as they were all grief-stricken.

They were also informed that the medical examiner didn’t find any need to perform an autopsy and that if they wanted one they would need to front the bill themselves.

The doctor told them that they attempted to take her blood when she was taken into the ER. Repeated attempts to draw blood failed. They found that a large percentage of her blood had pooled into her stomach, and I’m guessing this is what made it impossible to draw blood from her arms as would be the normal proceess.

Ultimately she died because of internal bleeding, the blood pooled in her stomach and her health deteriorated extremely rapidly and she had died within minutes of being brought in.

Various theories have been abounding about what happened:

-Some sort of infectious disease
-Ulcer (a nurse said the deceased “probably” had blood in her stool that she hadn’t told anyone about)
-Internal bleeding brought on by her fall on Dec. 25th

I’m just wondering what someone who has some medical experience would, from this fairly limited amount of information, say was the “most likely” cause of her death. I’ve got some guesses myself but, they are just guesses (which is really all anyone can offer sans an autopsy) but the guesses of more knowledgeable people would be helpful and informative.

The last bit of info I have is the mortician (not a medical professional by any measure) mentioned that her body “had a lot of infection in it” and that he says that having done many bodies over many years. How he could come to that conclusion via the embalming process as I know it, I do not know.

2

First and foremost, my condolences on your loss.

While I have no theories as to the cause of death, what the medical examiner said puzzled me. I was under the impression that if the family wished, an autopsy would be performed if the death cannot be explained or if there were signs of foul play. For example, if the decedant put a gun to his own head and pulled the trigger, or had cancer for years, that is likely the cause of death. But the actual cause of death in this case seemed a mystery, with no apparent reason to suspect foul play. I would think that the ME would have wanted to perform an autopsy.

In my dad’s case, he died suddenly at 50. The doctor said it was either a massive heart attack, or his aorta burst. While no one suspected anything fishy about his death, other than an otherwise healthy 50 year old man suddenly dying, the doctor offered to arrange for an autopsy. We declined, reasoning that an autopsy may confirm the cause, the end result would be the same. At no point did they say “You’ll have to pay for it up front, though.”

3

I think the reason they ask you to pay for the autopsy is because someone her age can die at any time, even if it’s bizarre. Autopsy is generally only considered necessary if foul play or something horribly infectious is suspected.

Regardless, that’s a very sad story. I’m sorry for your loss. I’m curious as to what it could be. Maybe someone with medical background will recognize this and share.

4

I’m very sorry to hear of your loss.

This sounds like the classic signs of an infection that’s gotten into the bloodstream (streptococcus maybe?). Other than that I have no other suggestions. My condolences.

5

Yeah, after browsing the net I came to the conclusion it was most likely a strep infection that got out of control.

A friend of the family who is an MD reviewed all the information at hand and he came to the conclusion that it was necrotizing fasciitis, possibly caused by a strep infection that had gotten out of control or possibly caused by exposure to an open wound/cut she possibly could have had. He said she could have gotten it by taking out the garbage or even by taking her brother to the hospital. He said the bacteria could have caused vomiting, stress, and even an ulcer which could have been a secondary cause of death, and that it would have affected blood flow causing low blood pressure and shock.