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A 42-year-old man was found with his head, torso, and most of his upper and lower extremities completely submerged in a bathtub filled to the brim with water. The decedent’s mother had requested a welfare check on her son after being unable to enter her home where she lived with her son, after being discharged from a short hospital stay. Friends had not heard from or spoken to the man for two days and went to the home in an attempt to locate the man.

Police were called, arrived, and entered the secured residence to discover the nearly completely submerged and clothed man lying on his right side. His feet and a portion of his upper left arm were not submerged and appeared dried and partially mummified. His feet were resting on the shower curtain and the edge of the bathtub. A necklace had become entangled between the lips but was high up enough around the neck so as to not compress the internal neck structures and vessels.

Fig.1 A man was found with his head, torso, and most of his upper and lower extremities completely submerged in a bathtub.

The hot water spigot was still running (cold) without overflow of the bathtub due to drainage through the overflow outlet. A folded shirt was noted on the toilet, and a pair of worn socks was in one of the corners of the bathroom. Empty bottles of sleep aid medication and pain medication were found nearby. No suicide note in any form was found. The rest of the house appeared undisturbed.

This man had a history of heavy alcohol consumption and at times would combine alcohol with his mother’s sleep aid medication and his own pain medication, which had been prescribed for an unspecified chronic pain condition. He reportedly had been depressed for an unspecified period of time but had not been clinically diagnosed with a psychiatric condition or on any prescribed psychiatric medication. He suffered the loss of his father and brother within the recent decade.

He was the sole caregiver of his mother. A friend reported to the police that during a telephone conversation a few days prior to the man’s death, the decedent talked of a recent visit from a female acquaintance with whom he had a “good time.” The friend surmised that the man was intoxicated, noting his slurred speech and angry mood while describing the visit. Police investigators were unable to produce verification as to the identity and whereabouts of this female.

Fig.2 The decedent’s mother had requested a welfare check on her son.

Autopsy findings were that of a well-developed, well-nourished male with wrinkling of and pallor of the skin. Rigor was absent, and livor was fixed on the right side of the body. The corneas were cloudy, and there was a focus of skin slippage on the right thigh. There were a number of small abrasions of the face without a discernible pattern or clustering. Two abrasions were of the temple associated with acute subgaleal hemorrhage beneath, indicating blunt impact to this region. A slightly indented, red, and pale patterned mark extended over both lower cheeks corresponding to the necklace.

Internal inspection revealed voluminous, congested, and edematous lungs surrounded by pleural effusion. Foamy fluid was noted within the upper airways. There was a 1⁄4-inch contusion of the tongue. The heart was significantly enlarged with thickened chambers and dilation of the right ventricle. Gross anatomic examination combined with microscopic examination of the heart and kidneys revealed changes consistent with hypertensive cardiovascular disease. The liver was markedly enlarged with severe fatty change and scarring consistent with the history of chronic alcoholism combined with prescription medication abuse. The sphenoid sinus contained 5 ml of blood-red-tinged watery fluid.

The toxicological screening was positive for caffeine, and its presence was otherwise not significant. A subtherapeutic level of zolpidem (Ambien) was found. No ethanol was detected. An electrolyte study of the vitreous fluid was not requested. The cause of death is asphyxia by drowning.

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