Death: Manner vs. Cause -- Language of Death

Another unfortunate death (when is death fortunate?) allows us a glimpse into conflicting issues of life and death.

Budd Schulberg died at the age of 95, “of natural causes at his home in Westhampton Beach, on Long Island,” said his wife, Betsy Schulberg, but a family spokesman said that he suffered breathing problems Wednesday afternoon and was rushed from his Westhampton, L.I., home to Peconic Bay Medical Center, where he was pronounced dead. His wife states that, “he was taken to a nearby medical center, where doctors unsuccessfully tried to revive him”.

As a novelist, Oscar-winning screenwriter (On the Waterfront with Marlon Brando) and Hall of Fame boxing correspondent, he would have appreciated the subtlety of language in the exact manner and cause of his death.


Manner of death is how a person died – natural, accidental, suicidal, homicidal, undetermined or unclassified; cause (mode) of death is what is directly related to the death, such as the type of disease state (e.g. severe asthma attack) or type of injury or under what circumstances (e.g. gunshot wound to the head).

It sounds like his manner of death was natural (meaning that it wasn’t caused by an inflicted injury) – but so is any disease that one dies of. Most people think of a “natural” death as one that is to be expected, such as an older person dying of a heart attack, but a young person dying from meningitis is also “natural,” in that it wasn’t caused by something external to one’s own body.

The cause of his death may have been respiratory arrest.

So, the phrase “died of natural causes” is actually a misnomer and should be “died in a natural manner,” however people dying in hospital beds with tubes sticking out of them hardly sounds like a natural manner.


Piecing this together, it sounds as if he had respiratory arrest (possibly from severe asthma or pulmonary embolism,) and he stopped sending oxygenated blood to his brain and to his heart. An ambulance arrived and administered advanced cardiac life support and once he arrived at the hospital this was either continued or he was pronounced “dead on arrival.”


So, where did he die?

We know that he either died at home or in the hospital:

- He stopped breathing at home and if his heart stopped working and he stopped receiving oxygenated blood to his brain, then his death occurred at home and the resuscitation efforts from then on were on a person already dead.

- On the other hand, if he had breathing problems and was rushed to the hospital and was pronounced dead after resuscitation efforts, then his time of death would be when they stopped trying to resuscitate him – and his place of death was the hospital.


So, when did he die?

There are three possibilities:

- Before being picked up by the ambulance.
- On the ambulance.
- In the Emergency Department (ER).


So, how did he die?

Which happened first?

- His heart stopped.
- His brain didn’t receive oxygen and so the nervous system connections to his heart stopped work and his heart stopped pumping.


Just as Budd Schulberg was controversial in life (naming names in the Communist Party, scathing attack on Hollywood by the son of the head of Paramount Pictures), so too, his death, while seeming uncontroversial, carries with it unanswered questions.



Remember:


Questions beget questions.


- Dr. Daniel Kantor, MD BSE
Medical Director
Neurologique

info@neurologique.org
http://www.neurologique.org/