Final Autopsy and Toxicology Report

[Host]

What? They found dry ice in her throat?

Not dry ice, but a submission of dry, thick, sticky or stretchy discharge.

 

[sabpascu]

The discharge of scant secretions being sero-sanguineous and usually of a reddish-brown color is a result of solidified carbon dioxide.

I'm gonna quote you again just in case you didn't get my drift. Solidified carbon dioxide is dry ice. From what you said one can conclude that the secretions they found in her upper respiratory tract are a result of dry ice. Which doesn't make any sense...

 

[sabpascu]

Not dry ice, but a submission of dry, thick, sticky or stretchy discharge.

The autopsy report says "scant secretions". Correct me if I'm wrong but I thought the word "scant" meant "little amount" and not "dry, thick, sticky or stretchy".

I'm still confused about the solidified carbon dioxide tho.

 

[Host]

I'm gonna quote you again just in case you didn't get my drift. Solidified carbon dioxide is dry ice. From what you said one can conclude that the secretions they found in her upper respiratory tract are a result of dry ice. Which doesn't make any sense...

I'm sorry for the confusion, what I meant to deliberate was that in cases of dry drowning (if we're to assume she didn't aspire as much fluid into the lungs) she would have generated pressure or vacuum resulting in condensed discharge of the bronchus. It would then be a thick layered substance, correct?

Also (to anyone who may know about this), where both hands found wrinkly due to deprived oxygen? Or was it solely from prolonged water exposure?

 

[sabpascu]

I'm sorry for the confusion, what I meant to deliberate was that in cases of dry drowning (if we're to assume she didn't aspire as much fluid into the lungs) she would have generated pressure or vacuum resulting in condensed discharge of the bronchus. It would then be a thick layered substance, correct?

Also (to anyone who may know about this), where both hands found wrinkly due to deprived oxygen? Or was it solely from prolonged water exposure?

So you're just assuming the cause of death to be dry drowning, correct? Cause in such an eventuality there wouldn't be fluid in the lungs. There were 200 ml of fluid in the left lung and 300 in the right one. While it's correct that in cases of dry drowning you could see mucus or froth this is not the case here because there's quite a lot of fluid in her lungs. About 1 cup in each lung. The minimum amount of fluid in lungs that could cause a person to drown is about 10-20 ml. So if you were to put your face in a bowl of water and breathe in you would probably drown.

And the hands and soles of the feet were wrinkly because of prolonged water exposure, not oxygen deprivation. If you are interested in the mechanism behind this I can explain it to you.

 

[Salem]

Closing for just a bit until we can do some review here. Shouldn't be long.

Salem

 

[Salem]

Okay - open for business. Please be respectful of one another. Everyone is entitled to their own opinion and their own interpretation of the facts.

Thanks,

Salem

 

[AlphaWolf]

Such a strange case....When EL was first found it was hard to imagine how or why she would go inside a Rooftop Cistern.

Still wonder why the tanks were so easily accessible ( no locks?)

Sadly it looks like they were not secured and she climbed inside and drowned.


RIP

 

[mindhunter]

Still wonder why the tanks were so easily accessible ( no locks?)

Sadly it looks like they were not secured and she climbed inside and drowned.


RIP

Correct they weren't locked.

I agree with sabpascu, and I have a hard time understanding how anyone can think that the video of Elisa Lam is anything other than a paranoid psychotic episode brought on by her bipolar disorder. I do, however, disagree with her on one issue: I don't think Elisa was on psychiatric drugs at the time of her death. I think she stopped taking them in the days before she died, and I think the full blown psychotic episode she suffered was the result of her no longer taking any drugs to control her bipolar disorder. What trace amounts of drug left in her system may have been leftovers from the drugs she had been using in the days or weeks before the actual day of her death.

The only serious question I have is why the elevator door stayed open for so long.. yet closed right after she left the elevator.

 

[Sherwood Park]

Correct they weren't locked.

I agree with sabpascu, and I have a hard time understanding how anyone can think that the video of Elisa Lam is anything other than a paranoid psychotic episode brought on by her bipolar disorder. I do, however, disagree with her on one issue: I don't think Elisa was on psychiatric drugs at the time of her death. I think she stopped taking them in the days before she died, and I think the full blown psychotic episode she suffered was the result of her no longer taking any drugs to control her bipolar disorder. What trace amounts of drug left in her system may have been leftovers from the drugs she had been using in the days or weeks before the actual day of her death.

The only serious question I have is why the elevator door stayed open for so long.. yet closed right after she left the elevator.

People are so uncomfortable with severe mental illness and the topic of suicide. When you put both together people want to create a crime story.

The most logical at this point is a paranoid/psychotic episode (as you wrote) leading to her suicide. As strange as it all seems, paranoid behaviour and suicide a two things we are not going to understand; there's no way to enter their minds.

Elevator: it's possible that if someone on another floor pushed a button the elevator would close and head to that floor right away. Our elevator at work sits on whatever floor a person exits to until someone on another floor pushes the button. Also, if you get into the elevator and don't select a floor right away it just sits there.

 

[sabpascu]

Correct they weren't locked.

I agree with sabpascu, and I have a hard time understanding how anyone can think that the video of Elisa Lam is anything other than a paranoid psychotic episode brought on by her bipolar disorder. I do, however, disagree with her on one issue: I don't think Elisa was on psychiatric drugs at the time of her death. I think she stopped taking them in the days before she died, and I think the full blown psychotic episode she suffered was the result of her no longer taking any drugs to control her bipolar disorder. What trace amounts of drug left in her system may have been leftovers from the drugs she had been using in the days or weeks before the actual day of her death.

The only serious question I have is why the elevator door stayed open for so long.. yet closed right after she left the elevator.

The amount of medicine they found in her system indicate that she did take her medicine recently, let's say 1-2 days. I don't think she stopped taking her medicine entirely because they found adequate doses of some of it in her system (such as venlafaxine and lamotrigine) and only bupropion (wellbutrin) metabolites meaning she probably didn't take her wellbutrin that morning. My suspicion is she wasn't taking them adequately, probably skipping doses given the discrepancy between the number of pills she was supposed to take and the ones she had remaining.

 

[mindhunter]

The amount of medicine they found in her system indicate that she did take her medicine recently, let's say 1-2 days. I don't think she stopped taking her medicine entirely because they found adequate doses of some of it in her system (such as venlafaxine and lamotrigine) and only bupropion (wellbutrin) metabolites meaning she probably didn't take her wellbutrin that morning. My suspicion is she wasn't taking them adequately, probably skipping doses given the discrepancy between the number of pills she was supposed to take and the ones she had remaining.

We'd need the help of a professional toxicologist to determine how long exactly it had been since Elisa last took her prescription anti-psychotic medication. All we know for sure from the toxicology report is that there were trace amounts of prescription drugs in her system and that she was definitely not intoxicated at the time of her death.

However, I don't think missing a pill the morning of her death would have caused a powerful full blown psychotic episode such as the one we all saw in that elevator clip. The powerful attack Elisa suffered is more consistent with someone who had a serious mental imbalance, took powerful drugs to fight off her psychotic episodes, and then suddenly stopped taking these medications thereby causing the very effects of bipolar disorder that those medicines were designed to prevent.

 

[mindhunter]

Elevator: it's possible that if someone on another floor pushed a button the elevator would close and head to that floor right away. Our elevator at work sits on whatever floor a person exits to until someone on another floor pushes the button. Also, if you get into the elevator and don't select a floor right away it just sits there.

This is really the only part of the case that confuses me. If we look at the elevator clip, we can clearly see her pressing the elevator buttons early in the film.. in fact she does it at least one more time later during the clip - pressing several buttons. Yet the elevator door does not close.

Then suddenly, as soon as Elisa leaves the elevator (presumably to walk up the flights of stairs, out onto the emergency ladder, and up to the rooftop where she then flung herself into the watertank) the elevator doors close and resume operation. Is it just coincidence that Elisa didn't really press the elevator buttons, and that as soon as she just left the elevator door someone on an upper floor happened to press for an elevator, thereby causing it to resume service?

 

[Nickfalzone]

This is really the only part of the case that confuses me. If we look at the elevator clip, we can clearly see her pressing the elevator buttons early in the film.. in fact she does it at least one more time later during the clip - pressing several buttons. Yet the elevator door does not close.

Then suddenly, as soon as Elisa leaves the elevator (presumably to walk up the flights of stairs, out onto the emergency ladder, and up to the rooftop where she then flung herself into the watertank) the elevator doors close and resume operation. Is it just coincidence that Elisa didn't really press the elevator buttons, and that as soon as she just left the elevator door someone on an upper floor happened to press for an elevator, thereby causing it to resume service?

Don't take this the wrong way, but this subject has been covered ad infinitum in the elevator video thread. To summarize, she hit the "door open" button at the end of the row each time she went through the buttons. The door open button on those elevators supposedly keeps the doors open for quite awhile, I believe as much as 2 minutes unless door close or other floors are hit. What is strange to me is "why" she hit the door open button, but I believe she did this because she is severely myopic, was not wearing her glasses, and did not know that she hit that button. Clearly the first time she hit the buttons she stepped back and was waiting for the doors to close. When they did not, she reacted (imo) as if she was shocked/scared as to why they didn't close, then went to hide in the front as if she thought someone was holding the elevator open by hitting the button outside it.

 

[Nickfalzone]

Also, to address a post above, I did not realize she was on bupropion. This is in addition to an ADHD stimulant medication, correct? Wellbutrin itself can cause mania as it works like a stimulant on norepinephrine and dopamine receptors. The more I think about it, her doctor really loaded her up on these medications. Not being a psychiatrist myself, I can't say that this was done in error, but all these mind-altering meds seem like a bad combo to me. What I keep coming back to though is that she apparently did not act crazy at home, and assuming she was staying fairly consistent with the meds, I don't see why she would have a manic episode while in LA - but that being said, if you took the average person off the street and gave them all these meds in the same dosages, they would probably have a complete psychotic meltdown. Presumably she had been on them for awhile, and titrated up as she became used to them, but even for a psych patient she seems overly medicated.

 

[sabpascu]

Also, to address a post above, I did not realize she was on bupropion. This is in addition to an ADHD stimulant medication, correct? Wellbutrin itself can cause mania as it works like a stimulant on norepinephrine and dopamine receptors. The more I think about it, her doctor really loaded her up on these medications. Not being a psychiatrist myself, I can't say that this was done in error, but all these mind-altering meds seem like a bad combo to me. What I keep coming back to though is that she apparently did not act crazy at home, and assuming she was staying fairly consistent with the meds, I don't see why she would have a manic episode while in LA - but that being said, if you took the average person off the street and gave them all these meds in the same dosages, they would probably have a complete psychotic meltdown. Presumably she had been on them for awhile, and titrated up as she became used to them, but even for a psych patient she seems overly medicated.

I don't think most people realize the extent of her disease. The autopsy report clearly states she was on Lamotrigine, Quetiapine, Venlafaxine, Wellbutrin (these being the medications prescribed by her psychiatrist). These are all very strong medications and an indicator that she was severely depressed is that she was prescribed 225 mg of Venlafaxine per day which also happens to be the maximum dose allowed per day. Then there's the Wellbutrin which is also an antidepressant. And the Lamotrigine, probably used for treating hypomania as part of her bipolar disorder. Her physician prescribed her Quetiapine, too, as needed, so I believe she suffered from insomnia as it is used as a sleeping aid, too. They're not a bad combo and I don't think (and hope) someone would have prescribed this amount of psych meds if they weren't needed. I mean, they're clearly trying to address her bipolar disorder and her depression as part of it.
This is all very serious stuff and the effects of the medication vary from person to person so no one can really tell what she was experiencing as side effects or actual symptoms of her disease.
I know from personal experience, school and other people's experiences that antidepressants while they seem to solve one problem somehow manage to create a bunch of other problems.

 

[Conductor71]

I don't think most people realize the extent of her disease. The autopsy report clearly states she was on Lamotrigine, Quetiapine, Venlafaxine, Wellbutrin (these being the medications prescribed by her psychiatrist). These are all very strong medications and an indicator that she was severely depressed is that she was prescribed 225 mg of Venlafaxine per day which also happens to be the maximum dose allowed per day. Then there's the Wellbutrin which is also an antidepressant. And the Lamotrigine, probably used for treating hypomania as part of her bipolar disorder. I mean, they're clearly trying to address her bipolar disorder and her depression as part of it.
This is all very serious stuff and the effects of the medication vary from person to person so no one can really tell what she was experiencing as side effects or actual symptoms of her disease.

(Snipped for space)

With all due respect, not one of us is qualified, medical background or not, to continue arguing that EL suffered from Bi-polar Disorder. We do not have any real proof of this. While I concede that the most logical explanation for her death is that she did suffer some sort of break with reality, we cannot say with certainty what the cause was. The arguments presented are based on conjecture/assumption. We simply do not have enough factual information to go on...period.

I think it is just as disrespectful to EL, who is not here to explain, and her family to continue asserting that she was indeed bi-polar. If we are to go with the argument that people cannot handle mental health disorders or do not understand them; this does not at all help. If anything, it further perpetuates ignorance and stereotype. The LA coroner's office really should be held more accountable. Manner of death attribution is not a frivolous matter; it is considered a serious statistic that shapes public health funding and research.

The facts:

We have no official diagnosis from EL's doctor that she suffered from Bi-polar Disorder. There is something called a psychological autopsy that can be performed in cases of equivocal death; it costs money and likely the LA Coroner does not foot the bill. Still, it seems dubious to not have any sort of professional affidavit as part of the autopsy confirming diagnosis. Especially, if mental health becomes a scapegoat.

ALL of the drugs she was prescribed are used to treat major depression. The Quetiapine and Lamotrogine are used as adjuncts. I am not a medical professional but this can easily be verified on PubMed in journals and by patients themselves (see the online forum "CrazyMeds"). Again… with the assumptions.

Though this has been extensively discussed, EL's social media posts do not confirm any official diagnosis. In fact, if you look at her posts we can safely say she was being treated only for depression. That is all.

Finally, it is naive to assume that her doctor was a specialist; we do not know if she was a psychiatrist. It takes a big leap of logic to say that the totality of her prescriptions "proves" the extent of her disease. It may just reflect a doctor's incompetence or lack of experience. In fact, EL addressed trying so many different drugs and noted that Wellbutrin was the only one that even touched her depression.

Given that, it is not fair to make the claim that EL was non-compliant in taking her meds based on the labeled dosages. In actuality, when one has a drug recalcitrant type of depression or any sort of neuropyschiatric disorder it is not uncommon to be forced to self experiment with varying drug combos and dosages; doctors will even admit it is trial and error. This can change over time and patients can work out with their doctors new dosage combos once drugs have been prescribed at any time during treatment; this can be done via email. Thus, you cannot assume that the dosages given in the report were current or accurate.

I agree that some of the ideas and explanations that have been put forth are pretty outlandish, but it is bothersome to see people doggedly claim that they have all the medical facts; thus, all the answers when clearly that is not the case. In essence, it is not cool to pass off assumption as fact to imply that those of us who dare challenge a medical opinion are inane. A little humility would make a world of difference.

 

[sabpascu]

(Snipped for space)

With all due respect, not one of us is qualified, medical background or not, to continue arguing that EL suffered from Bi-polar Disorder. We do not have any real proof of this. While I concede that the most logical explanation for her death is that she did suffer some sort of break with reality, we cannot say with certainty what the cause was. The arguments presented are based on conjecture/assumption. We simply do not have enough factual information to go on...period.

I think it is just as disrespectful to EL, who is not here to explain, and her family to continue asserting that she was indeed bi-polar. If we are to go with the argument that people cannot handle mental health disorders or do not understand them; this does not at all help. If anything, it further perpetuates ignorance and stereotype. The LA coroner's office really should be held more accountable. Manner of death attribution is not a frivolous matter; it is considered a serious statistic that shapes public health funding and research.

The facts:

We have no official diagnosis from EL's doctor that she suffered from Bi-polar Disorder. There is something called a psychological autopsy that can be performed in cases of equivocal death; it costs money and likely the LA Coroner does not foot the bill. Still, it seems dubious to not have any sort of professional affidavit as part of the autopsy confirming diagnosis. Especially, if mental health becomes a scapegoat.

ALL of the drugs she was prescribed are used to treat major depression. The Quetiapine and Lamotrogine are used as adjuncts. I am not a medical professional but this can easily be verified on PubMed in journals and by patients themselves (see the online forum "CrazyMeds"). Again… with the assumptions.

Though this has been extensively discussed, EL's social media posts do not confirm any official diagnosis. In fact, if you look at her posts we can safely say she was being treated only for depression. That is all.

Finally, it is naive to assume that her doctor was a specialist; we do not know if she was a psychiatrist. It takes a big leap of logic to say that the totality of her prescriptions "proves" the extent of her disease. It may just reflect a doctor's incompetence or lack of experience. In fact, EL addressed trying so many different drugs and noted that Wellbutrin was the only one that even touched her depression.

Given that, it is not fair to make the claim that EL was non-compliant in taking her meds based on the labeled dosages. In actuality, when one has a drug recalcitrant type of depression or any sort of neuropyschiatric disorder it is not uncommon to be forced to self experiment with varying drug combos and dosages; doctors will even admit it is trial and error. This can change over time and patients can work out with their doctors new dosage combos once drugs have been prescribed at any time during treatment; this can be done via email. Thus, you cannot assume that the dosages given in the report were current or accurate.

I agree that some of the ideas and explanations that have been put forth are pretty outlandish, but it is bothersome to see people doggedly claim that they have all the medical facts; thus, all the answers when clearly that is not the case. In essence, it is not cool to pass off assumption as fact to imply that those of us who dare challenge a medical opinion are inane. A little humility would make a world of difference.

Well it's wrong to assume her physician was NOT a specialist. If you read the autopsy report you will see that in form 3A which lists the medicine that was found with her belongings, under physician it says: Dr. Sarah E. Scarfe. General practitioners or any other kinds of specialists cannot prescribe that kind of medication unless they're a psychiatrist. A psychologist also cannot prescribe this kind of medication even thought they are campaigning for it in the U.S and Canada. So I'm not just assuming her physician was a psychiatrist, I know so because no other kind of MD can prescribe psych meds.

First this discussion was revolving around how someone else drowned her or poisoned her...now you're arguing about whether she was bipolar or not? Her sister clearly stated in the witness statement that Elisa Lam had a history of depression and bipolar disorder. If that doesn't prove it then I don't know what will. The media can be very deceiving and manipulative by saying her father stated that he knows for sure she didn't suffer from bipolar disorder. I mean...really...is there a video or something of him actually saying that? (no, there isn't)

As you said, you are not a medical professional and just because you Googled those drugs and looked up stories on PubMed journals doesn't mean that you're right about ALL of her meds being used to treat depression. Depression is a part of bipolar disorder and such a combo of meds definitely targets both depressive and manic episodes. It's easy to Google stuff and take information for granted, but every psych patient is different and must be treated so.

Well all of those drugs were issued to her on 1/11/2013, how do you think the dosages weren't accurate? I mean, it was only 20 days before she died, seems a bit excessive to assume her doctor adjusted her dosage via e-mail on such a short notice....

 

[Conductor71]

Well it's wrong to assume her physician was NOT a specialist. If you read the autopsy report you will see that in form 3A which lists the medicine that was found with her belongings, under physician it says: Dr. Sarah E. Scarfe. General practitioners or any other kinds of specialists cannot prescribe that kind of medication unless they're a psychiatrist. A psychologist also cannot prescribe this kind of medication even thought they are campaigning for it in the U.S and Canada. So I'm not just assuming her physician was a psychiatrist, I know so because no other kind of MD can prescribe psych meds.

Actually, any MD in the States or Canada can prescribe anti-psychotics. Please provide a reference that says otherwise.

What does a psychologist have to do with anything? Last I knew, psychologists are conferred PsyD or PhD degrees, so they cannot prescribe any sort of medication.

Her doctor's name is in the report as the prescriber. Her specialty is not provided. Even if it is psychiatry, you have no way of knowing that she is competent or her level do experience.

Well all of those drugs were issued to her on 1/11/2013, how do you think the dosages weren't accurate? I mean, it was only 20 days before she died, seems a bit excessive to assume her doctor adjusted her dosage via e-mail on such a short notice....

I still don't understand how the date of 1/11/2013 tells us anything factual other than the date the pharmacy filled her prescription. The prescription could have been issued six months prior and obviously there were some changes. EL had at least 10 more pills than the 60 prescribed for two of her meds. What law says the dosage on the prescription always matches at any given time. There is such a thing as titration. A doctor will agree to altering doses of meds verbally or in writing in between visits when a patient is experiencing troublesome side effects, but the the original script is not revised in the interim.

I have yet to see a prescription label that includes that original prescription date, and I question that they even can list it given privacy laws. They usually simply give the date of the last refill supplied at the pharmacy. The origin of the prescription can be inferred if the number of refills is printed. I still do not see how one can state with absolute certainty how much of any one drug or in what combos EL should have been taking them. There is a personal medicine history on file, and without talking to EL or her doctor we have know way of knowing what she was taking and why.

 

[Montjoy]

Her doctor's name is in the report as the prescriber. Her specialty is not provided. Even if it is psychiatry, you have no way of knowing that she is competent or her level do experience.

Yes, she is a psychiatrist. Seeing as you are questioning her competence, I am curious about how you are in a position to do so.