My brother's autopsy report arrived in the mail on Christmas Eve. I'd ordered it the week before. My experience with the Bureaucracy of Death was that everything took six-to-eight weeks, so its miraculously rapid arrival came as a Yuletide surprise.

I was expecting a bunch of numbers, like when I got my own blood test results back from an average check-up. I expected the words "creatinine" and "hematocrit" and a tornado of enigmatic abbreviations like "AST (GOT)," "BUN," and "MCV," followed by numbers ranging from .6 to 253. I assumed my brother's autopsy report would be gibberish and I'd need to eventually—but not right away—go on the Internet to translate all the medical lingo. That's why I opened it, on Christmas Eve, as my husband and I were preparing to leave town and spend the holiday at the Oregon Coast, because I assumed the information in the document would be meaningless to me.

I ordered the report because I ached for meaning. For answers. For something to soothe and satisfy my own broken heart and head and lungs. Why, exactly, did my forty-five-year-old brother die in his sleep four months earlier?

PART I


Name of the deceased: Stephen D. Prato1


Date and time of death: August 29, 2011, 03:55 hours


PATHOLOGICAL DIAGNOSES:


I.   Pulmonary emboli

        A. Phlebothrombosis,2 left lower leg;

                1. Osteomyelitis, right foot3

        B) Phlebothrombosis, right calf


TOXICOLOGY:


Blood positive for caffeine, cotinine, nicotine, theobromine, alprazolam (57 ng), morphine (72 ng), oxycodone (10 ng), olanzapine (200 ng), zolpidem (140 ng), diphenhydramine (79 ng), fluoxetine (190 ng), norfluoxetine (960 ng). Other than the above findings, examination of the specimens did not reveal any positive findings of toxilogical significance.4

PART II


IDENTIFICATION: The body is identified by Petrona Maloney, home health aide, at the scene.5 Fingerprints are taken.


CLOTHING AND PERSONAL EFFECTS: The body is received unclad. A gray shirt has been cut away and is found underneath the body.6


CIRCUMSTANCES OF DEATH: The decedent is a 45-year-old man who has a prior medical history of probable narcotic overdose, respiratory failure, obstructive sleep apnea, morbid obesity, hyperventilation syndrome, bipolar psychiatric disorder, and infection of the left foot with osteomyelitis.7


The decedent was found lying supine in his bedroom at 0330 hours on August 29, 2011. On the evening of August 28, 2011, the decedent had reportedly consumed a large amount of food and then went to bed.8 The decedent was pronounced dead at the scene.

PART III


EXTERNAL EXAMINATION:


The body is that of a well-developed, obese, Caucasian male who weighs 402 pounds, is 72 inches in length, and appears compatible with the stated age of 45 years.9


The body is cool to the touch. Rigor is fully fixed in all extremities and jaw. Diffuse, fixed, purple livor extends over the posterior surfaces of the body, except in areas exposed to pressure. The scalp hair is brown and measures 1 inch in length over the crown.10


The irides are brown; the pupils are bilaterally equal at 0.5cm. The corneas are translucent.11 There is a large amount of vomit material over the narges and the mouth.12


EVIDENCE OF RESUSCITATION AND/OR MEDICAL THERAPY:


Evidence of emergency resuscitation and/or medical therapy includes a nasoesophageal tube within the esophagus with an open port for the trachea, adhesive defibrillation and electrocardiographic pads on the chest and abdomen,13 multiple puncture wounds with surrounding hemorrhage on the lower abdomen,14 and an Ulna Boot on the left ankle and foot with associated gauze pads over the ulcer and an intravenous catheter within the left antecubital fossa.15


OPINION:


This 45-year-old, Stephen Daniel Prato, died of complications of pulmonary emboli. The decedent has an ulcer on the foot and has phlebothrombosis of both legs, which are consistent with the emboli found in the lungs. The manner of death is natural.16

















Title graphic: "Official Business" Copyright © The Summerset Review, Inc. 2014.

































1 AKA: Steve, Big Steve, Bubba, and Big Brother.

2 One of those blood clots we're warned about on long air flights, across the country or across the ocean. We are told to do exercises in our seat (raise and lower your toes; raise and lower your heels) or to get up and stretch, to walk up and down the aisle, past the other passengers watching a movie or eating nuts or sleeping restlessly.

3 This means an infection in the bone. Steve struggled with these infections in his calves and feet for two years, a result of sitting, and more sitting, then lying down all the time, first because of pain, and then because he was oversedated by his abuse of the pills he was prescribed for the pain.

4 Meaning, Steve did not die of an O.D., like I thought he did—almost hoped he did, because it seemed like the simplest answer.

5 Petrona Maloney was apparently the last person to see my brother alive, and the first one to see him dead. I have never heard of her, talked to her, or met her. She didn't even know I existed. When my brother died, the first person she called was our family accountant, and then our family accountant called me.

6 I know this shirt—an athletic tee, one that he had in several colors, in red and yellow and green and blue, and when I tried to fold them for him once, when I tried to neaten them up next to his bed, he told me I was stacking them wrong, that he had a very specific order in which each color was to occur.

7 I know all this. Of course I know all this. But there is something about seeing it recorded on Some Official Report that makes it seem that much worse. That much more tragic.

8 What was my brother's last meal? If he'd had a choice, if he'd known it would be his last, he would have had filet mignon and lobster tail and a creme de menthe aperitif. But what he probably had, instead, was spaghetti and sausage from the Italian restaurant up the street that we'd been going to since we were teens, the same place my husband and I had our first date.

9 My brother had, for his entire adult life, been about six-foot-four. But the autopsy report said seventy-two inches. That's six feet tall, even. Had Steve shrunk? Are we all shorter when lying down? Or had something already left his body at the time of the autopsy report, something that once made him stand tall?

10 Steve's hair was an inch long. An inch. I hold my thumb and forefinger apart from each other, trying to estimate what that looks like. I get out a ruler. I hold it up to my scalp. He must have just gotten a haircut.

11 I wish I was a poet. I would write a poem about my brother's translucent corneas. The lines would be short, but evocative. And at the end, the language would lift up and fly away.

12 I wonder when he threw up—when the thromboses were rushing to his lungs? After? Can someone throw up after they are dead? I look up the word "narges" online. It says a narge is a nut from a plant/species with a shell and a kernel. This does not help me.

13 The EMTs tried to shock Steve's heart. How many times? Certainly, by the time they got there, it was clear he was dead. How many times did they have to shock him, and at what levels, before they could definitely call it?

14 What? Why in God's name were there multiple puncture wounds on his belly?

15 The antecubital fossa means "the inside of your elbow." I looked it up. Why was there an I.V. in Steve's elbow? What magic serum did they think would save him?

16 Natural—what does that mean? We tend to think "natural" is synonymous with "normal." But nothing about the circumstances of my brother's death is normal. Some mysteries will never be solved. There are no easy answers for my broken heart and head and lungs.