Found Deceased CO - Adam Gilbertson, 29, Denver, 14 Dec 2017

[Philigumbo]

Yes, I only quoted the summary opinion. All other information was in the body of the autopsy report. He was fully clothed, pants buttoned/belted, but unzipped. Shoes and socks. No jacket was listed as clothing, but I remember the searcher who found Adam said his clothing matched the missing person flyer, so perhaps that was removed at the scene before he was put in the body bag? Personal effects were absent, per the report, so not sure if police recovered a wallet or his phone.

I was afraid they might include photos in the autopsy report, but thankfully not.

Only 35 grams of the heart remained after decomposition. A portion of the right lung was identified, 220 grams, no left lung, so that is why they could not specify drowning with certainty. I had wondered earlier whether after so long before being found they could determine he drowned. Most of the internal organs as well as most of the rib cage were absent or too decomposed to identify, consistent with postmortem changes, per the report.

Bloodwork was taken from his leg:

Blood Alcohol Concentration (BAC)------- 0.162
Amphetamine----------------------------------- 420 ng/mL
Dihydrocodeine / Hydrocodol Free-------- 6.1 ng/mL
Hydrocodone - Free--------------------------- 260 ng/mL
Hydromorphone Free------------------------- 1.7 ng/mL

Cocaine use was determined through the urine sample: Presumptive Positive.

Hope this helps answer any questions.

Hydromorphone is Dilaudid. Wow. Strongest there is. It’s prescribed to hospice patients. The amphetamine could be Adderall, I believe.

 

[dspdenver]

Hydromorphone is Dilaudid. Wow. Strongest there is. It’s prescribed to hospice patients. The amphetamine could be Adderall, I believe.

I believe the hydromorphone and the dihydrocodeine are just metabolite byproducts from the hydrocodone being processed in the body. That fits with the very low trace amounts. One line in the autopsy report supports this:

"A. Postmortem toxicologic analysis of peripheral blood with
detection of ethanol, hydrocodone (and metabolites), and
amphetamine."

I found a study of hydrocodone blood levels over time on the web and it showed a 10mg hydrocodone dose (which seems to be the normal high dosage pill amount) would spike to about 60 ng/mL in the first hour before dropping by half within 3-4 hours. That would be at least 4-5 Vicodin taken together to reach the autopsy level shown, and depending on how long before death, perhaps more. So I don't think now that Adam could have taken a handful of pills early in the evening and still have the 260 ng/mL level after 1 AM, or that he popped pain pills all night long.

Sadly, I now think he may have taken them when he got home from the bad night at Charlies before heading to Syntax, or even in the bathroom at Syntax after posting his candle video. He did not seem so messed up when posting the video - which he was able to text a caption to without typos - that he would have gotten lost a few minutes later when leaving the bar, so I think he knew where he was heading, but may not have wanted to end up in the river, but just be found the next morning on the riverbank so his family would not have to find him when checking his home.

All just my own speculation, since I always thought the candle video was a goodbye, and not something the coroner could use when reaching their opinion.

 

[Satchie]

I never followed this case. A sad end. My question is, what could have lead him to go alone to that dark and dreary place, far along the river, late at night, when he had to work the next morning? Seems like dark thoughts, to me.

I noticed AG's Instagram quote is one of my favorite movie lines ever. There was only a little discussion about it here.

La vida es como la espuma, por eso hay que darse como el mar.

Translation in the film: Life is like the surf, so give yourself away like the sea.

Comes at the end of this 46 sec clip of Y Tu Mama Tambien.
https://m.youtube.com/watch?v=s45uWzDkVBM#

SPOILER ALERT: the character who says this, Luisa, knows she's soon going to die of cancer. She didn't have this philosophy before her diagnosis. In the film she's learned to let go of her past and her attachments, to love everyone without possessiveness.

It's a fairly yoga-compatible quotation, but not common, I think because it comes from a piercing awareness of how brief and fragile life is.

 

[dspdenver]

Looking back at that hydrocone study, the dosage was based on *two* 10mg pills of hydrocodone bitartrate, which looking on my old tooth abcess pain prescription is the formulation used for hydrocodone pills. So that would double the number of pills Adam would have had to take in close proximity to reach the level at his death. This is assuming he used leftover pills from previous pain prescriptions, rather than pills illicitly obtained to feed a drug habit, which could have been higher dosages.

Thankfully, I have little to no experience in drug and alcohol interactions. In the end, the ME ruled this an accidental drug and alcohol toxicity event, and they have the training to support their conclusion.

 

[inmyhumbleopinion]

I believe the hydromorphone and the dihydrocodeine are just metabolite byproducts from the hydrocodone being processed in the body. That fits with the very low trace amounts. One line in the autopsy report supports this:

"A. Postmortem toxicologic analysis of peripheral blood with
detection of ethanol, hydrocodone (and metabolites), and
amphetamine."

I found a study of hydrocodone blood levels over time on the web and it showed a 10mg hydrocodone dose (which seems to be the normal high dosage pill amount) would spike to about 60 ng/mL in the first hour before dropping by half within 3-4 hours. That would be at least 4-5 Vicodin taken together to reach the autopsy level shown, and depending on how long before death, perhaps more. So I don't think now that Adam could have taken a handful of pills early in the evening and still have the 260 ng/mL level after 1 AM, or that he popped pain pills all night long.

Sadly, I now think he may have taken them when he got home from the bad night at Charlies before heading to Syntax, or even in the bathroom at Syntax after posting his candle video. He did not seem so messed up when posting the video - which he was able to text a caption to without typos - that he would have gotten lost a few minutes later when leaving the bar, so I think he knew where he was heading, but may not have wanted to end up in the river, but just be found the next morning on the riverbank so his family would not have to find him when checking his home.

All just my own speculation, since I always thought the candle video was a goodbye, and not something the coroner could use when reaching their opinion.

RBBM

Excellent post, dspdenver.

I’ve felt exactly the same way as what I bolded above, and having read what you found about hydrocodone blood levels over time (thank you for taking the time to look into this), I now feel even more strongly about it.

I’ve also found a couple of articles that may be relevant to what we are discussing:

“Accidental Deaths

Accident is defined for medical examiner death certification purposes as an unnatural death resulting from an inadvertent chance happening. Traffic related fatalities (involving vehicles used for transportation on any public roadway) are classified as accidents. On the job injury related deaths are referred to as industrial deaths and are classified as accidents. Deaths related to illicit drug or excessive medication use, in the absence of evidence specifically supporting the conclusion of the manner of death being homicide or suicide, are classified as accident.”

“Suicide
Suicide is defined for Medical Examiner death certification purposes as a death from self-inflicted injury with evidence of intent to die. Evidence of intent includes an explicit expression, such as a suicide note or verbal threat, previous attempts, or an act constituting implicit intent. An example would be of a self-inflicted contact/close range gunshot wound (particularly of the head, chest, or abdomen) that is recognized as having very high potential for lethality, and is considered to be implicit evidence of intent to die.” (all BBM)

https://snohomishcountywa.gov/806/Cause-Manner-of-Death

WARNING: A very informative and comprehensive article about how forensic scene investigations are conducted, the following piece contains some VERY GRAPHIC IMAGES:

“Why: When appropriate, known information/supposition should be included into the preliminary assessment whilst remaining objective (Investigators: ‘We think this person committed suicide because of this note/because they called a friend and said as much/because they were recently indicted/filed for bankruptcy/getting a divorce/under the treatment of a physician for a severe mental illness/etc’). It may be useful to include a statement at the end of the scene report to indicate that ‘the aforementioned conclusions are subject to revision due to ongoing investigation.’” (BBM)

https://emedicine.medscape.com/article/1680358-overview#a1

 

[dspdenver]

“Why: When appropriate, known information/supposition should be included into the preliminary assessment whilst remaining objective"

https://emedicine.medscape.com/article/1680358-overview#a1

I was surprised there were not accompanying documents about Adam's recovery site, pictures, information from police interviews with friends he may have been with that night, etc. But maybe all that was part of the preliminary assessment and once the ME makes a finding, they only include the evidence they thought relevant and can be proven and they leave out any ancillary data. In this case, without explicit self-harm statements, which the candle video is not, that would be deemed irrelevant. They did include a description of the steep bank down to the small flatter area of the riverbank where he was found, the contusions to his arms and legs, his medical history (which suggested he would have needed pain medications at some point) and the tox results.

 

[dspdenver]

Translation in the film: Life is like the surf, so give yourself away like the sea.

Comes at the end of this 46 sec clip of Y Tu Mama Tambien.
https://m.youtube.com/watch?v=s45uWzDkVBM#

SPOILER ALERT: the character who says this, Luisa, knows she's soon going to die of cancer.

One of Adam's best friends did reminisce that they loved to quote movie lines to each other. Earlier remarks about this quote basically said such quotes can have very different meanings to each person, so unless you knew him and when he put up that quote, it is tough to know how it related to Adam at the time he went missing.

Way back at post #427 it was said by a poster that Adam asked his friend's permission to post his angsty Tess cancer video (from late 2014 or early 2015 - my guess as to when he made it) not long before he disappeared, and the friend posted it after he was missing to give insight into Adam's character. I saw Tess and that video as his inspiration for becoming a hospice nurse, as she had to quit her job as a hospice social worker when she got cancer back in 2014. So if that video was on his mind last December, maybe it was an indication he was again in a self-questioning mindset and needed inspiration, or that the path he was inspired to pursue back then was not as fulfilling as he had hoped.

 

[Satchie]

One of Adam's best friends did reminisce that they loved to quote movie lines to each other. Earlier remarks about this quote basically said such quotes can have very different meanings to each person, so unless you knew him and when he put up that quote, it is tough to know how it related to Adam at the time he went missing.

Way back at post #427 it was said by a poster that Adam asked his friend's permission to post his angsty Tess cancer video (from late 2014 or early 2015 - my guess as to when he made it) not long before he disappeared, and the friend posted it after he was missing to give insight into Adam's character. I saw Tess and that video as his inspiration for becoming a hospice nurse, as she had to quit her job as a hospice social worker when she got cancer back in 2014. So if that video was on his mind last December, maybe it was an indication he was again in a self-questioning mindset and needed inspiration, or that the path he was inspired to pursue back then was not as fulfilling as he had hoped.

It does seem he was, for his age, unusually aware of death and dying. Most people in their 20s consider anything like a cemetery or a hospice to be super creepy and to be avoided at all costs. I'm not trying to draw a direct link, just making the observation that that line, from that film, is associated with poignant rather than happy-go-lucky feelings.

There were undoubtedly many things going on in his life that he didn't post about on social media, that would have been very important to his state of mind in his last days.

 

[Philigumbo]

I’m a biased on this, but I’m always surprised when “accidental” is included in COD in someone regarding pharmaceutical drugs who is highly educated in them. Nurses definitely are highly trained in pharmacology. It always makes me sad. That person has reached the bottom and needed help for a long while.

 

[dspdenver]

Intentional or unintentional, I just want to shake Adam and say "How could you be so stupid... broken... whatever... for this to have happened that night?"

(I accessed Adam's SM once more today, so I spent my whole 10-mile walk thinking too much of him again....)


[O/T: With Adam's thread winding down, I just want to take the opportunity to thank WebSleuths for providing this forum, as well as all of Adam's threadizens here for being kind enough to let me blubber on when I've needed to. It's been quite an experience.]

 

[anonypotomous]

Intentional or unintentional, I just want to shake Adam and say "How could you be so stupid... broken... whatever... for this to have happened that night?"

(I accessed Adam's SM once more today, so I spent my whole 10-mile walk thinking too much of him again....)


[O/T: With Adam's thread winding down, I just want to take the opportunity to thank WebSleuths for providing this forum, as well as all of Adam's threadizens here for being kind enough to let me blubber on when I've needed to. It's been quite an experience.]

I wish I could give you a big hug. Your posts have been so thoughtful and insightful. I know Adam really touched your heart. We're all here with you, sad and disheartened.

Sent from my SM-N950U using Tapatalk

 

[Philigumbo]

I believe the hydromorphone and the dihydrocodeine are just metabolite byproducts from the hydrocodone being processed in the body. That fits with the very low trace amounts. One line in the autopsy report supports this:

"A. Postmortem toxicologic analysis of peripheral blood with
detection of ethanol, hydrocodone (and metabolites), and
amphetamine."

I found a study of hydrocodone blood levels over time on the web and it showed a 10mg hydrocodone dose (which seems to be the normal high dosage pill amount) would spike to about 60 ng/mL in the first hour before dropping by half within 3-4 hours. That would be at least 4-5 Vicodin taken together to reach the autopsy level shown, and depending on how long before death, perhaps more. So I don't think now that Adam could have taken a handful of pills early in the evening and still have the 260 ng/mL level after 1 AM, or that he popped pain pills all night long.

Sadly, I now think he may have taken them when he got home from the bad night at Charlies before heading to Syntax, or even in the bathroom at Syntax after posting his candle video. He did not seem so messed up when posting the video - which he was able to text a caption to without typos - that he would have gotten lost a few minutes later when leaving the bar, so I think he knew where he was heading, but may not have wanted to end up in the river, but just be found the next morning on the riverbank so his family would not have to find him when checking his home.

All just my own speculation, since I always thought the candle video was a goodbye, and not something the coroner could use when reaching their opinion.

No on the hydromorphone being a metabolite of anything. It’s Dilaudid. Nothing breaks down to Dilaudid. Totally unrelated to hydrocodone, in any metabolite.

 

[dspdenver]

No on the hydromorphone being a metabolite of anything. It’s Dilaudid. Nothing breaks down to Dilaudid. Totally unrelated to hydrocodone, in any metabolite.

FWIW, from the study:

https://www.samhsa.gov/sites/defaul.../flegel-research-studies-dtab-june-2014_0.pdf

From the single 20mg hydrocodone bitartrate dosage studied, HM and DHC were non-detectable in blood fluid, but did show up between 2-4 hours after dosage in the urine samples. The body must do a good job of keeping these metabolites out of the bloodstream, less so the hydrocodone and norhydrocodone.

I assume if Adam took multiple hydrocodone pills, that could account for the HM and DHC showing up in the autopsy blood test.

 

[dspdenver]

I was surprised, as well, by the toxicology. He was putting his whole career on the line.

My question is, what could have lead him to go alone to that dark and dreary place, far along the river, late at night.

The case for accidental death, which I'd really like to be the case:

Adam drives home after the bad night out, but is still wound up, doesn't want to stay home alone feeling that way. Maybe has some pain, takes a few pain pills, walks to Syntax bar. (If he wanted to die by the river, why even go to that bar?) Maybe he took pain pills earlier, doesn't remember with all the alcohol and party drugs in him how many he took.

Nothing is going on at the bar, he starts feeling the effects of the latest pain pills mixed with the alcohol, cocaine and amphetamines. With all the drugs and alcohol overwhelming his liver function, maybe his body can't clear as much hydrocodone from his blood as the study I referenced showed, so that might account for the level in the tox screen even if Adam took far fewer pills than I speculated. (They obviously can't do studies to see how blood levels change in such circumstances.)

He wonders if he is in trouble, but if he calls for help, the nursing career he worked so hard for might be over. Maybe he can walk it off. Under the influence, he makes his candle video as a sort of goodbye, just in case, then leaves the bar hoping to walk around until he's feeling okay enough to go home and sleep it off. For some reason he heads toward the river, maybe hoping to go to Denny's for food, but changes his mind or is too out of it by then to remember where he was going. And eventually ends up at the riverbank and falls as his body is overwhelmed by the drug and alcohol toxicity.

As I said earlier, the coroner had to rule it an accident without good evidence of intent to self-harm, and the above is a plausible drug and alcohol-induced scenario, IMO. I'll never know the truth, but I know which I would prefer to believe.

 

[Dingodogloco]

The case for accidental death, which I'd really like to be the case:

Adam drives home after the bad night out, but is still wound up, doesn't want to stay home alone feeling that way. Maybe has some pain, takes a few pain pills, walks to Syntax bar. (If he wanted to die by the river, why even go to that bar?) Maybe he took pain pills earlier, doesn't remember with all the alcohol and party drugs in him how many he took.

Nothing is going on at the bar, he starts feeling the effects of the latest pain pills mixed with the alcohol, cocaine and amphetamines. With all the drugs and alcohol overwhelming his liver function, maybe his body can't clear as much hydrocodone from his blood as the study I referenced showed, so that might account for the level in the tox screen even if Adam took far fewer pills than I speculated. (They obviously can't do studies to see how blood levels change in such circumstances.)

He wonders if he is in trouble, but if he calls for help, the nursing career he worked so hard for might be over. Maybe he can walk it off. Under the influence, he makes his candle video as a sort of goodbye, just in case, then leaves the bar hoping to walk around until he's feeling okay enough to go home and sleep it off. For some reason he heads toward the river, maybe hoping to go to Denny's for food, but changes his mind or is too out of it by then to remember where he was going. And eventually ends up at the riverbank and falls as his body is overwhelmed by the drug and alcohol toxicity.

As I said earlier, the coroner had to rule it an accident without good evidence of intent to self-harm, and the above is a plausible drug and alcohol-induced scenario, IMO. I'll never know the truth, but I know which I would prefer to believe.

I know this area well and it still seems really odd that, even under the influence of alcohol and drugs, that someone would walk this way instead of going to wash park and a number of other places that are close by. It’s very industrial and sketchy. This part of the south platte is frankly, pretty gross, and he was on a no-trespassing section that’s a highway maintenance road. Basically not all that picturesque regardless of how high you might be. It still seems to me he may have been motivated to meet someone. Maybe they never showed up. Likely we’ll never know but wonder what the rules of privacy are around releasing phone/dating app records?


Sent from my iPhone using Tapatalk

 

[dspdenver]

This part of the south platte is frankly, pretty gross, and he was on a no-trespassing section that’s a highway maintenance road.

I've gone to his memorial spot a number of times now and don't really find it all that bad during the day, though it certainly is not scenic. There are tall highway streetlights along there that might keep that area somewhat lighted, though I have not been there at night to confirm. But I agree that Adam would have needed a reason to be on the south side of Alameda for an accidental death, which would be consistent with him wanting to go to Denny's, where he would have to cross to the south side of Alameda from the north walkway at the intersection just past the rail lines.

If he decided to then skip food and keep walking to the river, it would be natural to stay on the south sidewalk. At the service road along the river, since the sidewalks there have No Pedestrian signs, and there are concrete barriers mostly blocking the sidewalk on the bridge over the river, that could prompt him to turn south in a haze to walk along the east side of the river. Or who knows, maybe he wandered all around both sides of the river south of Alameda before stumbling to his death, as we have no idea how long he was out there as his body was being poisoned by the drugs and alcohol before he died.

It still seems to me he may have been motivated to meet someone. Maybe they never showed up. Likely we’ll never know but wonder what the rules of privacy are around releasing phone/dating app records?

Unfortunately, we don't even know if his phone and wallet were found, nor if he still had on his Arc'teryx jacket when he was found. The autopsy report noted there were no personal effects with his fully clothed body, but the jacket and knit cap he had on at the bar were not listed as being on him. The police never said anything about the investigation after he was identified and I suppose were never asked by the press whether his phone was found and checked for whatever Adam was doing on it for his short time at Syntax. If it was found and they were able to access it, there was certainly no suicide note found, as that would have been relayed to the ME for their manner of death determination.

I can't really see Adam heading to the river area, even druggedly, if someone on an app enticed him, but then, I never expected his drug use from his online persona. We also have no information on how normal it would be for Adam to try to meet up with a stranger by app that late (or any time), though leaving the friends he was reportedly with earlier in the night to continue to other bars alone could mean he was hoping to meet someone that night.

I'm sure Adam did not start out the night planning it would be his last, but it would seem a sudden decision to harm himself after a bad night out and influenced by the drug and alcohol interactions answers most questions of what he did before and after Syntax bar. But it is impossible for us to know just what went on in his head that night; the autopsy evidence of a fall certainly points to an accident where he could have rolled into the river, whatever reason brought him there. I just would prefer to believe it was accidental, rather than some toxic whim and accumulation of disappointments with his life in Denver (of which there were no real indications I've found) leading him to the river.

 

[dspdenver]

Also, AFAIK, after he was found there was zero public speculation from those who knew Adam about what had happened to him or what the police were finding out. I know early on in the search the family had said they were waiting for info from LE about Adam's online and phone app history, but I never heard any followup on what might have been revealed, if anything.

Maybe soon after the autopsy LE and the family were informed that there was no preliminary evidence of foul play and so no further investigation was warranted unless the tox results changed things. Perhaps those who knew Adam best reluctantly accepted the implication of his final candle video....

 

[dspdenver]

1 in 5

Hard to believe that Adam is part of this statistic: one in five deaths of 24-35 year-olds in America is now opioid related. Adam was 29.

"The most dramatic increase in illicit and prescribed opioid-related deaths was seen in those aged 24 to 35. By 2016, 20 per cent of all deaths in this age group were related to opioid use -- up from only 4 per cent in 2001."

One in every 5 deaths in young adults is opioid-related in the United States: Proportion of deaths that are opioid-related has increased by nearly 300 percent in 15 years

 

[Mica]

1 in 5

Hard to believe that Adam is part of this statistic: one in five deaths of 24-35 year-olds in America is now opioid related. Adam was 29.

"The most dramatic increase in illicit and prescribed opioid-related deaths was seen in those aged 24 to 35. By 2016, 20 per cent of all deaths in this age group were related to opioid use -- up from only 4 per cent in 2001."

One in every 5 deaths in young adults is opioid-related in the United States: Proportion of deaths that are opioid-related has increased by nearly 300 percent in 15 years

This is a major problem in our country. It’s killing far too many teens and young adults. Sorry Adam became a victim.

 

[tarabull]

Remind me, did Adam take an Uber the night he was last seen??? IIRC, he did...

TIA.