Season 1 Episode 13: The Toxicology Report
You died today and when I hear this,
I step out into the dewy sunlight
to listen to the robins sing.
You died today and I move the clothes
from the washer to the dryer. I call
the dog in from the rain.
You died today and I must continue on
with this business of living.
- from the poem “mother” written by me, k.b. marie
And this is the true story of “Who Killed My Mother?”
It’s still dark outside, when I untangle my legs from the thirty-pound dog sleeping on them, and slip out of my warm bed. Bleary-eyed, I find the toilet. Sit. Yawning, I open my phone and compulsively check my email like every other technologically addicted person in the world.
One subject line stops me: Medical Examiner Records.
I open it, squint at the text.
Do not reply to this e-mail message or send messages to this e-mail address as it is only an outgoing e-mail box. Your message will not be seen or answered.
I begin frantically rummaging through my toiletries basket, trying to find my contacts so I can actually see the smudged letters on my phone. I wash my hands, get my lens into my eyes, and open the attachment.
I’m gripping the sink, heart-pounding when Kim comes into the bathroom, sees me and frowns. “What’s wrong?”
I look up, catch sight of my wide, panicked eyes in the mirror. “He lied to me about how he found her. And he lied to the police.”
I set up at the kitchen table. I’ve got my notepad, pen, a steaming cup of tea. Chai with milk. I needed something stronger than green today.
On one side of the computer screen, the autopsy report is open. On the other, a blank word document.
As you can imagine I’m prepared to really get into this. I’m going to read this autopsy at least four or five times through, this morning alone, scraping it for every question I can possibly think of. I want to be prepared when I speak to the examiner.
I want to leave no stone unturned.
The report begins with my mother’s name, Leitha. Age 56. And where she was found—at my grandmother’s house on July 4th, 2020. Type of death: suspected homicide.
Time of death: 2:55pm.
Here is my first question. How can the time of death be 2:55 pm when I’d already talked to the detective by then, and Joe had already found her dead that morning, at least as early as nine.
I scribble this down, and move on to the narrative summary:
“Reportedly the decedent was a 56-year-old white female who was discovered unresponsive in the residence by family at approximately 09:00 hours on July 4, 2020. 911 was contacted. Emergency Medical Services responded to the residence to confirm asystole .”
I look this word up. Apparently it’s just a fancy word for the type of cardiac arrest that means, yes, you are really dead.
“Reportedly the decedent had a history of drug use (heroin), hypertension, and mood disorder.”
I write my next question: who told the police she had a history of heroin use? Because my mother had never used heroin. I didn’t know about the hypertension, but I’m not surprised. It wasn’t like my mother had a great diet or anything. And the mood disorder too, I was well aware of.
“Detective Barnes contacted the Medical Examiner’s Office via pager to request a response. Due to the suspicion of a homicide, Medical Examiner jurisdiction was accepted. I, the medical investigator, responded to the residence to perform a brief body examination and document the scene with photography.”
Here I hesitate. Slowly, I scroll through the PDF to see if there were in fact photographs of my mother’s corpse attached with the report. Blessedly, there were not. Probably for the best, considering my vivid imagination does a fine job of recreating the image of my mother’s dead body all on its own.
“Middle Tennessee Removal Service transported the decedent’s body to the Center for Forensic Medicine for further examination. Final disposition arrangements were unknown at the time of this report.”
It is signed by the medical investigator and dated at 4:59 p.m. on the day my mother died.
At the bottom of this first page, were two more boxes one with the cause of death - acute fentanyl intoxication and another with the manner of death - accident.
I write down: does the medical examiner this it’s really an accident? Or does this mean they don’t have enough to convict him?
Next page: it has my mother’s name, sex, race, and age again as well as the date and time of death. But it also has the date and time of when the autopsy was performed. July 6th, 2020 at 9:45 a.m.
Below this repetition of the identifying information is a section titled Pathologic Diagnoses. It reads:
“1. Acute fentanyl intoxication:
A. Mild pulmonary congestion (right lung 310 grams, left lung 680 grams)
2. Hemorrhage in the left parietal and left temporal scalp without injury to skull or brain.
3. Layered anterior neck dissection negative for hemorrhage in strap muscles.
Summary of Case & Opinion
This 56-year-old white female was found unresponsive, lying on her right side, in the bedroom floor of the residence she shared with her brother. Clothing was piled on her body. Her past medical history is significant for drug abuse, hypertension, hepatitis C, and mood disorder.
Autopsy reveals petechial hemorrhages on the right side of her face and in the right eye, consistent with her lividity pattern and how her body was found. A layered anterior neck dissection does not reveal hemorrhage in the strap muscles of the neck, and a fracture through the other layer of bone only is noted on the hyoid bone and does not exhibit associated hemorrhage.”
Joe lied to me. He’d painted a picture that he’d simply woke on Saturday morning, and out of concern, had gone into the bedroom and had found my mother unresponsive in her bed. He’d made no mention of her being in the floor. Nor had he explained why he might have—bizarrely—piled clothes on top of her.
The official story, at least what’s written under “summary of case and opinion” was that my mother was found lying on her right side, unresponsive.
And while I write down questions about the clothes, I also want the examiner to explain why she would have bleeding on the left side of her head if she was found on her right side.
It can only mean that her head was injured before she died, since the scalp had bled. You don’t bleed after you die. There isn’t a working heart to move the blood around.
And it couldn’t be the collapse that caused her head injury, because she would’ve been found on her left side then, if that is the side of her head that made contact with the floor, right?
But it wasn’t. The blood pooled on the right. So the idea that she collapsed in her bedroom and simply died isn’t likely.
It isn’t possible that my mother, fell in her bedroom, hit her left head when she collapsed and then rolled entirely onto her other side and died. Especially since most of the fluid accumulation was also on her left side.
The left lung had 680 grams of fluid and the right lung only 310. Shouldn’t the right lung have more fluid, if that’s how it settled?
To me it seems like she was lying on her left side as she was dying. Then when she died, she was turned onto her right side, where the blood then settled and pooled.
Because if someone is unresponsive enough to fall down, they probably don’t have it in them to roll over. I check this against the internet of course, and it agrees. Unconscious people don’t move.
The simple conclusion to this is that Joe moved her, before she died.
So is it possible she did collapse in the living room, injuring her the left side of her head and this is where Joe found her, per one version of his story? If so the overdose was well on its way by then, fluid creeping into her lungs, beginning to drown her, by the time Joe found her. And if he’d found her and moved her, as reported in one of the versions of his story—she would’ve been in bad shape, with symptoms impossible to overlook.
She would’ve likely already been blue in the face, lips. Likely she would’ve been short of breath, possibly gasping.
How curious—that Joe supposedly saw her turn blue like this during a supposed seizure that happened months before. That he’d understood the danger then, had acted immediately and appropriately, resuscitating her and had promised to get medical help should it ever happen again.
And yet in this instance where the symptoms would’ve been no doubt as serious if not more alarming, he didn’t call an ambulance or drive her to the hospital. Instead he carried her to her bedroom and put her…in the floor.
Then he didn’t get a pillow or blanket for her the sister he was putting on the floor instead of the bed — he piled…clothes…on top of her body.
The toxicology report doesn’t show up until pages 6 and 7 of the nine-page autopsy report.
There were six substances found in the blood taken from my mother’s femoral artery: 4-ANPP (positive). Caffeine (positive), Cotinine (positive), Nicotine (positive), fentanyl (33 ng/ml), norfentanyl (2.9 ng/ml).
None of this would mean anything for me if it weren’t for the helpful reference comments explaining each of the findings below these results. But even so, I have questions and jot them down along the margins of my notepad as I go.
“1. 4-ANPP (despropionylfentanyl) is a precursor chemical used in the production of fentanyl/fentanyl related compounds and is also a fentanyl metabolite and may be a metabolite of other fentanyl-related compounds.
2. Caffeine is a xanthine-derived central nervous system stimulant. It also produces diuresis and cardiac and respiratory stimulation. It can be readily found in such items as coffee, tea, soft drinks, and chocolate. As a reference, a typical cup of coffee or tea contains between 40 to 100 mg of caffeine.
No doubt my mother’s “item” of delivery for this caffeine was her beloved diet soda.
3. Cotinine is a metabolite of nicotine and may be encountered in the fluids and tissues of an individual as a result of tobacco exposure.”
Again, not surprising since my mother smoked close to a pack a day.
“4. Nicotine is a potent alkaloid found in tobacco leaves at about 2-8% by weight. It is reportedly found in various fruits, vegetables, and tubers, e.g. tomatoes and potatoes, but at a smaller weight per fraction. As a natural constituent of tobacco, nicotine is found in all commonly used smoking or chewing tobacco products, but also in smoking cessation products. Nicotine is extensively metabolized, the primary reported metabolite is the oxidative product cotinine.”
The report will also note the anthracosis in my mother’s lungs, which the medical examiner will explain as normal for someone who smokes. But it can also be caused by air pollution or breathing dirty air.
5. Norfentanyl. This is the primary inactive metabolite of the synthetic narcotic analgesic fentanyl. The substance is known to interfere with the identity and/or quantity of the reported result: Benzyl Fentanyl.”
Then we arrive at the fentanyl itself. “Fentanyl is a DEA schedule II synthetic morphine substitute anesthetic/analgesic. It is reported to be 80 to 200 times as potent as morphine and has a rapid onset of action as well as addictive properties.
It is reported that patients lost consciousness at mean plasma levels of fentanyl of 34 ng/ml when infused with 75 mcg/kg over a fifteen min period. Peak plasma levels averaged 50 ng/ml.”
My mother’s fentanyl level was 33 ng/ml at the time of her death. That means how much was left in her body when she died. That’s not how much she ingested. That’s when her body gave up. Whatever she ingested, must’ve been much higher than that—which means her fentanyl intake most definitely rendered her unconscious, making the bleeding head from a collapse possible.
And the dose must’ve been truly massive. “The mean peak plasma level of fentanyl concentration in adults given an 800 mcg oral transmucosal fentanyl preparation” (which the internet describes as a lozenge or lollipop) “over 15 minutes is reported at 2.1 ng/ml ( with a range of 1.4-3.0 ng ml) at approximately 24 minutes.
My mother’s level wasn’t 1.4, 2.1, or even 3.0 ng/ml. It was 33 ng/ml. Nearly ten times the amount found from a 800 mcg lollipop or lozenge.
In 2018, the DEA stated that as little as 2-3 milligrams of fentanyl is a lethal dose for most people. And they shared a photograph of what 2 milligrams looks like. It looks like a few pop rocks beside a penny.
It’s so small.
That’s why “law officers and first responders are warned to wear protective clothing during known raids to prevent inhalation or skin absorption of the drug” (“Fatal Fentanyl”).
In another photograph I see three vials showing how much heroin it takes to kill you compared to fentanyl. It’s 30 milligrams for heroin, and just the 2-3 for fentanyl. Side by side, it looks like a pinch of dust (heroin) compared to mere dusty residue stuck to the glass (fentanyl).
It isn’t until I see this photos of the drugs side by side do I realize just how little 30 milligrams is. If it really takes so little to kill a person, then it would’ve been so easy for Joe to roll the lethal dose into a cigarette. And it only takes a few minutes to smoke a cigarette so my mother likely would’ve gotten more than enough even if she’d only taken a few hits before suspecting that something was wrong with the taste of it.
And if Joe really did mistake the fentanyl for heroin when he bought it, and gave her enough “heroin” to kill her, the aforementioned 30 milligrams, it would’ve been ten times more than necessary to end her life.
I’m not convinced that Joe wasn’t already home, watching all of this unfold as it happened. I think he would’ve wanted to make sure his plan had worked and it would’ve hit her system quick.
But let’s say for argument’s sake he really did leave? Maybe to give himself an alibi. When he’d come back and found her collapsed, my mother would’ve definitely been showing signs of an overdose at this point.
Is that why Joe chose to dump her on the floor, rather than put her in her bed. Because she showing these signs of fentanyl toxicity? And if so, which ones?
Seizures? Coma-like unresponsiveness? A blue face or lips? A limp body? A shallow heartbeat? Slow breathing or gurgling sounds?
And are we to believe that when Joe “found her” he didn’t recognize the danger she was in? That he didn’t understand that she was dying?
Of course he did.
Joe knew what an overdose looked like. He would’ve recognized it immediately when he found her.
And that’s why I don’t need any more information to glean Joe’s intentions that night. This picture is clear enough:
Joe didn’t help my mother when she was dying, because he wanted her to die.
I make the first two or three passes of the autopsy report with a purely analytical mind. I’m pretty adept at this actually being an INTJ. I usually lead with thoughts instead of feelings as a first-line of defense against pain.
But this never lasts of course because I do have feelings — so when I read my mother’s autopsy report for the fourth or fifth time, it finally hits me.
The woman in this report isn’t a mystery to be dissected. This death isn’t a puzzle to solve. This is my mother.
The corpse that the examiner is describing is my mother’s.
“…that of a well-developed, well-nourished (body mass index of 23.3 kg per meter squared) white female clad in a camouflage print shirt and green shorts. The body weighs 136 lbs and is 5 ft 4 inches in length, and appears consistent with the reported age of 56 years. Rigor is present to an equal degree in all extremities. Fixed lividity is on the anterior surface of the body, except in areas exposed to pressure. Petechial hemorrhages are on the right side of the face.
The clear descriptions of her body cut open, her organs examined, my mother dismantled—none of this is the part that cuts me. What cuts me is this simple decidedly unpoetic line:
The scalp hair is gray mixed with brown.
My mother died wearing a camouflage t-shirt and green shorts. And her hair was gray mixed with brown. When I was a little girl, I loved to brush my mother’s hair. Identical to my own: thick, unruly. I liked to gather it in my hands and brush it, in long, slow stokes. Sometimes she’d let me braid her hair. Or pull it up into a ponytail.
There hadn’t been any gray in her hair, the last time I’d seen seen her alive. Our last face-to-face encounter in December 2012.
That was the year the boyfriend she’d been living with for years had suddenly died. She’d been understandably sad about it, so I’d invited her to come and visit us in Michigan—us because Kim and I were already living together by then.
I thought this would be fine because my mother had already been to Michigan to visit me in 2009, just three years before. Then I’d asked her to come because I was at my most depressed and was in bad shape and like most ailing children, I wanted to see my mom.
I was suicidal and slowly weening myself off my bulimia, but I wanted her to come because I’d thought that even a shitshow of a visit would still likely have a better outcome than what happened if I’d spent the New Year alone.
But to my surprise it had been a good visit. A really good visit. She’d been sober, lucid. We hadn’t fought. We’d watched TV and ate take out. She’d liked how quiet my apartment was. Enjoyed walking around my campus to see where I went to school, worked.
Mostly we just talked. And I was comforted just by her being there.
Sitting by the window with her glasses on, reading the journals where my poetry had been published and telling me of how proud she was.
That was it. Her on my rinky dink sofa, in my rinky dink apartment that always smelled like garlic because I guess some vampire hunter lived down the hall, but it had been so nice, so, dare I say, nourishing, that I’d erroneously, expected an equally good visit in 2012.
I expected her to be depressed, of course. Unhappy.
Instead, she was in a full-blown manic episode.
For the next five nights, my mother rarely slept for more than a hour at a time day or night. The only pills in her bag was her Celexa, but I didn’t see her take it once. She came with 8 pills and left with 8. She did however, take Benadryl, which she chased with diet coke, saying it was the only reason she could get the little sleep that she did.
She kept smoking in the apartment even though I kept trying to get her to go outside onto the balcony because Kim is asthmatic. She refused to do this because it was December. In Michigan. And because she also refused to wear pants or much clothing at all, I was hesitant to actually shove her out there.
She watched the movie Bridesmaids with Kristen Wiig and Maya Rudolph on repeat. For the entire visit. When it ended, she’d simply restart the movie and begin again, laughing at all the same jokes as if she hadn’t just watched it.
She broke a glass and tried to flush it down our toilet. She tore open a bag of coffee and poured it all over our new white sofa.
She had a meltdown when she found our box of recycling in the closet, telling us that we lived like filthy animals because we stored trash in our house. She insisted that she could, in fact, clean our house better than we did, even though kept using the bathroom with the door open and never washed her hands.
My wife started muttering oh-my-god-she-didn’t wash. Oh-god she didn’t wash again. Kory- she’s not washing!
My mother also tried to steal—for reason’s I don’t entirely understand—
my wife’s flip-flops. But only one of them, which I found in her coat pocket.
Once I’d tried to go down to the store to get the coffee and cigarettes she’d asked for, while Kim was at work. I got a call from a neighbor that my mother was running around the parking lot, confused, asking for me, unable to figure out which apartment she was supposed to be in.
“Where did you go? I don’t know where I am!” she asked me on the phone after my very kind neighbor let her talk to me.
“I’m at the store getting what you asked for!”
At night, when we went to bed and left her in the living room on the sofa with her blankets and pillows, she wouldn’t remember where she was or what time it was. She’d turn the movie on again. Turn it up 10x louder than it needed to be. And begin rushing around the apartment in a panic. Until I got up, went out there, turned the TV down. Reminded her where she was, what time it was and encouraged her to take another benadryl.
I probably don’t need to tell you that by the third night of all of this, my under-slept girlfriend one-day wife was losing her mind.
The more erratic my mother became, the more unhinged Kim became. My reaction, however, was quite different.
In the face of my mother’s psychosis, I fell right into the coping mechanisms I’d used all my childhood. I became very calm. Very focused. I spoke to her in slow, soft terms. When she broke something. Tried to steal something. Or started the movie for the four thousandth time, I manifested patience that I never managed to have in my day-to-day existence.
The only time I almost lost it myself was with the smoking because I was genuinely worried Kim was going to have an asthma attack. Which is why I’d put her back on the plane when our five days were over, grieving or not.
I say all of this, as a context for Joe’s situation. If this is what my mother had been like in the last few months of her life, maybe Joe needed no other motivation—not money from a yet-to-be found insurance policy, or the uncontested inheritance of my grandmother’s estate—than this.
His own peace of mind. Freedom from the caregiving responsibilities of taking care of someone so unwell. But even if Joe thought caring for her was too maddening, too much, driving him to the edge of his own sanity—he had no right to end her life.
And let’s be honest—I’m probably being too generous with this scenario. He was probably motivated to kill her for simpler, more selfish reasons than his peace of mind.
It’s weeks and weeks before the medical examiner finally calls me back. When she does, I’m lying on my sofa, flirting with a headache, my arm draped dramatically over my face to block out the light.
I recognize the Nashville area code, but not the number.
I shoot upright, accepting the call. “Hello? Hello?”
“Can I speak to Kory please?”
“This is she.”
“Hello Kory, this is the medical examiner. Dr. Champion. I’m so sorry it took me so long to get back to you. I understand you have questions for me?
“Yes,” I say. “Yes I do.”
Davidson County Office of the Medical Examiner. Center for Forensic Medicine. Report of Investigation by County Medical Examiner. (MEC20-2303). Nashville, July 2020.
“Fatal Fentanyl: Is this Now America’s Most Dangerous Drug?” https://www.drugs.com/illicit/fentanyl.html