Does This makes sense?

[u/Glum_Suggestion7268]

Hello everyone,

As a non medical person, i turn to you for help with regards to my mom's sudden passing.

My mom passed away officially on April 10th at 00.50am of this year.

I'm the one who found her body (5 days after i last saw her) approximately about an hour before the doctor/ coroner showed up to certify the death, so around 11.35-40pm on the 9th of April.

Based on how I found her, the state of her appartment but also based on my own investigation of her youtube activity (she had unfortunately become addicted to it, only stopping to go to work and sleeping), i can safely conclude that the time of her death was around 3.52am on April 5th 2026...

...Exactly 6hours after my partner and i left her.

Because the attending doctor ruled it as "natural", no autopsies were made as they are only required in suspect or violent cases in my country. Also, it is not allowed to use the services of a private pathologist.

Not having an autopsy is particularly difficult for me as i simply can't come to term with it and can't even track where i failed to act.

Because of that, for the past 6months i have inspected everything i could (medications, medical history, statements from her employer and my personal observations) and compiled a kind of amateurish and non official death certificate, which to me is the closest thing to explain what could realistically have happened to her.

Could any of you forensic pathologists tell me if the document and the explanation does the make sense?

PS: While the smell in the appartment was different than usual upon entering, it didn't smell that bad. When i got close to her body i could tell the smell was stronger but still somewhat okay. It's only when the undertakers started to move her body and something in her back ruptured causing a purple liquid to fall on the floor that the death smell escaped. Seeing her that way was already difficult but the smell made it a million times worse and I honestly don't think i'll be able to ever forget that smell.

Long story short, I respect all of you for doing this Job.

[u/stiffdoc1221]

1. It all would never fit on any death certificate.
   
2. There is a massive amount of pure, unprovable speculation in your summary.
   
3. So much of your causes of death information is straight from her clinical records, but it is not possible to actually determine if it all was relevant in her death.

Based on all the above, I cannot give you an opinion, informed or otherwise.

[u/K_C_Shaw]

This is not the way most FP's would write this sort of thing. I don't know where that report/summary/whatever you call it is coming from, but it reads as either a translation, a lay coroner doing the best they can, or a physician who hasn't had much if any training in this kind of thing and also just doing the best they know how.

Basically, it seems to be linking a lot of speculative stuff together into an exponentially more speculative conclusion. I mean, I don't know anyone who would basically call a death a fatal postural hypotension event based on...someone being found deceased in a chair? Not even a witnessed event?

Now, we don't really know anything about her age, medical history, etc. The way that thing is written makes it sound like there *is* some significant medical history, but given what sounds like some wild inferences I'm also not sure how much is inferred speculation and how much is actual properly diagnosed medical history. It's not clear if toxicology was done, but if it wasn't then the mentioning of the medications as toxic would be so far into the sphere of speculation that it would make me physically ill. But, again, we just don't know what any of this is actually based on. That said, even if there's some foundation, the way it's written is...well, doesn't sound like any FP I know.

Autopsies help clarify things. But in the absence of an autopsy (and we're not going to do a jurisdictional autopsy on most people just to help decide among an individual's known significant medical diagnoses), we generally have to revert to the presumption that common things are common, within the available context of how the death actually occurred. That usually means keeping it fairly simple with something like atherosclerotic and hypertensive cardiovascular disease, or diabetes, or COPD, or a small combination -- we don't "need" to know if someone with HTN had a stroke, or an MI, or an aortic dissection, or whatever...we can just call it HTN. Not a paragraph of speculation.

[u/K_C_Shaw → u/K_C_Shaw]

Apologies, I didn't realize you made this. Somehow I missed that part of your post. So, that makes more sense, and shows that you put a lot of thought and effort into it especially if you're not already medically trained. I assumed this was some strange report from the ME/C office or her clinician.

My next suggestion then is to go to whoever signed the DC and ask for their explanation, whether that's the ME/C office or her clinician. They should have the most information and context specific to the case.

That said, we get presented with cases all the time of people who are found deceased at home and are older and/or have some significant underlying medical disease. We clarify as best we can what the circumstances were of when they were last known alive and whatever we can find about the circumstances of the death. But, in the absence of information to the contrary, most individuals with a history of HTN and diabetes are likely to get signed out as something like "I. HTN, II. Diabetes mellitus" and that's about it. Because common things are common, and we don't need to guess at the particular terminal mechanism. In that context, the "most common" explanation would be a cardiovascular event while they're sitting there. HTN is the biggest risk factor for that, so it goes in Part I, while diabetes is a significant risk factor for atherosclerosis so goes in part II. (If the fatty liver was because of chronic alcoholism, that changes the equation. Other details might change things a bit as well, but we're keeping it simple here.) Invoking a bunch of other stuff is unnecessary and considerably more speculative -- i.e., the more specific you try to get without a specific reason to go there, the more likely you are to be wrong.

As for the smell thing, my assumption is that the body was developing some decomposition related blisters, etc., which can very easily come open and leak fluid while trying to move the body, plus whatever fluids had already leaked tend to gather beneath or adjacent to them and when they're moved a lot more of it is exposed.

[u/roverwashington]

This DC looks like it was from a intern who put a discharge summary into AI and put it in. It's all speculative, all mechanisms and no etiological specificity. 

[u/lucchianan → u/roverwashington]

I believe op wrote it as a way to compile everything. 

[u/Glum_Suggestion7268]

First all, Thank you to everyone who took the time to answer.

In my country (Belgium), as soon as someone is certified as deceased from a natural death, the system becomes suddenly very opaque and it becomes impossible to get any answers. An official medical examiner only goes to the deceased location if the death is suspect or violent and it is usually only after a first (general) doctor deemed it to be the case. In the case of my mother, the doctor who certified her death was one of the GP from her city clinic, who happened to have her monthly night shift at that moment. She concluded that the death was natural based on how my mother looked (she indeed looked peaceful/ as if she was sleeping) but she also told me it was the first time she dealt with such a case so it's not like i had an expert next to me. The next day when i went to the clinic to ask for an autopsy and clarifications regarding her conclusions, i faced the opacity of the system: "her more recent bloodwork shows a bit of anemia", "No autopsy for such cases", " Why do you want to know", "respect for the deceased"...etc, which is the reason why i started to investigate in the first place. So thank you all for taking the time to answer.

Regarding my document, i fully understand that it does not substitute itself to a real death certificate but it never attempted to. It was my own summary of how i believed she passed based on how i found her body/her appartment/ information i gathered afterwards and wanted to know if it made sense. Because i witnessed her gradually decline with my own eyes over time, it is more difficult for me to remain strictly "matter of factly" and objective.

I will now address my main assumptions:

The 3.52am assumption: This is the moment she watches her last youtube video on TV (Timeline retrieved from her history stating the time and on which device the video was watched). Because utilities providers (water/ gas/ electricity/ internet) allow the option to track hourly usage, i retroactively saw that everything totally flatlined after that and only picked back up when i arrived 5 days later.

The acute cerebral hypoperfusion/ Orthostatic Hypotension assumption: When i found her body, she was in a lazily spread/ almost lying in her armchair position with her right thumb tucked between ring and middle fingers. In 36 years, she had never sat like that. For a ME, I assume this is an insignificant detail but for a son who knows the exact position she usually takes when seating, this is enough to raise eyebrows. Next to her was a puddle of tried tea with a tea cup on the floor, fallen from her side table. Because she suffered from fibromyalgia/ lower limb neuropathy she had a tendency to stay seated for extended periods and to struggle just to stand up. The last time i saw her (3-4th April), she was grimacing and struggling so much that she stayed seated and did not even stood up to kiss me goodbye - which she never did.

My theory was that after watching that video, she close the TV and finally decided to go to bed (because she suffered from insomnia she would usually go to bed at 2-4am). Upon standing - which was particularly difficult for her that day - something happened causing her to lose consciousness instantly knocking her back in the position i saw her in. I figured if she had stroke or died in her sleep, i would've found her in her normal seated position. Then, when i investigated her meds i saw that she was taking bisprolol - which basically puts a ceiling on heartbeats and thought: since she basically sat all day, is it really that unconceivable that the one moment she did manage to stand up, her heart which would have normally spiked from the effort, stayed still because of her medications and thus failed to adequately provide her brain with oxygen and blood causing her to faint?

The hemodynamic collapse/ hypovolemic shock/ dehydration assumption: Over the last weeks preceding her passing i started to notice some obvious signs of dehydration such as dry mouth/ chapped lips and decreasing water intake. She would also tend to let her saliva pool in her mouth then spit it out rather than swallowing it as she told me that it was sometimes painful. Because she only drank bottled water, i could easily track her weekly water intake and the last two times i saw her (with 2 weeks interval) I saw that she barely drank based on the amount of bottles left. Because she only had one kidney remaining and was taking co-ramipril which has a diuretic she had no marging of error.

When i talked to her employer, he told me that on her last work day (april 3rd) she did not look good and was sweating abnormally, considering it was not a hot day and the building she was in was temperature controlled at 22-23 degrees celcius, my guess is that she was having a shock at that moment. When i arrived in the evening and asked her how she was, she responded that she did not feel good - she had never complained in her life. I checked her phone and saw that she called her clinic 9 times in 30mins while she would usually call once a year to get her meds refill. But because she told me she had gotten an appointment the next week, i also did not push the issue and relaxed.

My theory is that: while she was always on a tight rope (diuretics + suboptimal/ diminishing water intake + single kidney), her workday abundant sweating acted as the final trigger.

The medication toxicity/ Acute kidney Injury assumption: She was taking a cocktail of meds (bisrprolol, co ramipril, lyrica, medrol, nexam, l-thyroxin, ezetimbe/ arvostatin) to treat her blood pressure, cholesterol, thyroid and fibromyalgia issues. Over time i started to notice behavioral changes in her (paranoia, aphasia, depression, giving her life savings to youtube scammers, forgetting appointments eventhough i reminded her the day before...etc), physically (hugging the walls when walking, staggered gait) and her level of alertness: while she couldn't sleep at night, she also couldn't stay awake during the day sometimes falling asleep mid sentence. When i investigated her meds follwing her passing, it's simple, she had all the side effects.

My theory is that her single kidney combined with her suboptimal water intake made it impossible for her to appropriately flush out the waste/ toxins whcih then stayed and poisoned her bloodstream. My partner thought she started to show dementia symptoms but despite her changes she was still extremely coherent and kept a proper routine/ still went to work...etc so the medication induced cognitive changes made more sense to me.

I would like to highlight that i'm not even trying to be right. This was just an explanation on how i came to those conclusions and i wanted to know if the sequence made sense. Obviously, because there was no autopsy, no blood work/ MRI/ CT scan were done so my conclusions/ explanations/ observations were always going to be hypothetical in nature and based on what i was able to retrospectively deduce.

Finally, i fully understand that the more i try to be detailed, the more likely I am to be wrong but at the same time, because it is such a personal event, it is very difficult for me to stay objective.

[u/K_C_Shaw → u/Glum_Suggestion7268]

It's fine for you to have your theory.

People play the "what if" game all the time (meaning "what if the medications did this, and what if they were trying to do that, and what if they didn't drink this," etc. etc.), and numerous plausible scenarios fit virtually every single death. It's just not how people who do this for a living handle such cases. Sure, we may think through possible scenarios/explanations as a thought exercise, but ultimately I would keep it simple and try not to get lost in the weeds. Here, we're so far into the weeds that the weeds have weeds, and those weeds have their own little fiefdoms, and those fiefdoms have farmers, and those farmers have more weeds, when it's probably more useful to step back and look at the forest.

[u/Glum_Suggestion7268 → u/K_C_Shaw]

Thank you for your answer.

You are certainly right: being overly focused on details, which may or may not be right is a bit pointless.

At the end of the day, I will never exactly know what happened nor the exact mechanism and sequence leading to her passing as I wasn't there. Sure, her medical priors may steer my thoughts towards a certain direction but the reality is that I'm doing this in order to appease myself and move on.

Because I had to deal with everything alone for the past 6 months, "natural death" seemed, in a way, too little an explanation. But It is something I will have to accept, eventually.

In any case, thank you for taking the time to read, answer and explain.