Hey y’all, it’s Julie Mattson, your host of Pushing Up Lilies. In this episode, I’m diving into a heartbreaking and often misunderstood topic—deaths caused by asphyxia and choking. Whether it’s accidental, intentional, or the result of foul play, these cases are some of the most challenging and emotional to investigate.
I’ll share insights from my work as a forensic death investigator, exploring how these tragedies unfold, the evidence left behind, and the human stories at the center of it all. From dining accidents to more sinister scenarios, we’ll uncover the realities of these silent killers and discuss how they leave an unforgettable impact on families and communities.
You won’t want to miss this deep dive into one of the most sobering aspects of forensic work.
- Listener discretion is advised.
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EPISODE TRANSCRIPT:
0:06 Welcome to Pushing Up Lilies.
0:08 I’m your host, Julie Mattson.
0:10 Pushing Up Lilies is a weekly True Crime podcast with spine tingling, unusual and terrifyingly true stories from my perspective as a forensic death investigator and a sexual assault nurse examiner.
0:24 Do I have some stories for you?
0:26 Are you ready?
0:31 Happy Wednesday.
0:32 Everyone.
0:34 I am starting the day with my Dr. Pepper Zero.
0:39 I am addicted.
0:41 My husband always laughs because he said that I’ve got it running through my veins, but it’s a Texas thing and I always get so mad when we go to a restaurant, and they don’t have diet Dr. Pepper.
0:52 I mean, you can’t find Dr Pepper Zero in any of the vending machines very often.
0:58 But Diet Dr. Pepper should be everywhere in Texas before.
1:03 I worried about my weight too much.
1:04 I drank regular Dr. Pepper and still every once in a while, I’ll choose that over diet Coke.
1:11 If there’s no Diet Dr. Pepper, it’s an addiction.
1:16 The struggle is real, and I have to have one every morning or my day just doesn’t start out right anyway, it is cold in Texas.
1:27 Now, I am freezing, and I sit at the office all day long with my heater on under my desk because I don’t like to be cold this time of year.
1:39 I mean, I like certain parts of it, but this time of year I hate to get like outdoor deaths or car accidents because I can remember when I worked nights it was even colder in the winter and my fingertips would freeze to the point that I couldn’t even write with my pen anymore.
2:03 It is miserable.
2:05 And I know now they make those little heat packs that you can pop and put in your shoes and in your gloves and they even make the jackets.
2:14 I think that have, well, I know they do because I bought one for my stepson a couple of Christmases ago because he lives up in North Dakota.
2:22 But the jackets with the heaters in them and that’s probably something that I need to invest in.
2:28 And I know I’m whiny.
2:30 It doesn’t get that cold in Texas compared to other places.
2:34 I would as a death investigator never survive up north in places like North Dakota, Minnesota.
2:43 There’s no way, there’s no way I would survive.
2:47 It’s just the cold weather just gets me right now.
2:51 I am freezing and it’s probably 50 degrees.
2:56 But my struggle is real, I promise.
2:59 But I will have my heater on today at work under my desk.
3:04 I hope everyone had an amazing Thanksgiving.
3:07 I know that we ate way too much food.
3:10 I decided to cook like a traditional Thanksgiving dinner, or I’ll say, everyone contributed and brought food, both of my daughters.
3:19 And it was amazing.
3:21 But, oh, my gosh, several of us are on Semiglutide.
3:26 I think.
3:27 I’ve told you all that.
3:28 We sell that and can ship it from my med spa here in Texas.
3:33 But several of us are on it.
3:34 I personally have lost 50 pounds, but you just don’t eat very much.
3:39 And so I have nine-pound ham, and all this other food literally took three bites and could not eat anything else.
3:49 We probably like a lot of y’all have been eating Thanksgiving leftovers for a week and don’t get me wrong.
3:55 They’re good.
3:56 But after a while you get tired of it.
3:59 I’m curious of how many of y’all do traditional meals for Thanksgiving and Christmas because I’m thinking about doing something a little bit different for Christmas, like maybe Italian food or just breaking it up a little bit because I mean, you can only eat so much turkey and ham and dressing.
4:18 Anyway, I hope everyone enjoyed it.
4:22 And Christmas is right around the corner.
4:25 I have started my shopping.
4:27 We are personally leaving the day after Christmas to go to Mexico.
4:32 We are going to spend a few days there and just kind of, I don’t know, chill before the new year and we are going to be super busy next year.
4:47 We started another business.
4:49 It’s called Taps and Tunes.
4:50 It is a mobile beer trailer with 10 taps on it and it also has surround sound.
4:58 We can provide music at events, corporate events, weddings, whatever it may be that is up and coming.
5:06 And so that will probably also keep us busy when the new year starts.
5:11 Med spa is up and going strong.
5:14 And of course, I’m still at ME’s office.
5:17 My last assignment for this semester in grad school is due on Saturday.
5:24 I’m going to try to work on that today as well and get that turned in.
5:29 And then I think my next class doesn’t start till January 6th.
5:31 I get a tiny break and I could enjoy my time in Mexico without having to do homework.
5:39 I wanted to talk to y’all a little bit about choking deaths and asphyxia yesterday at the office, we had a doctor that signed a death certificate, and he put that it was a natural death.
5:56 He put that it was caused by asphyxia.
6:00 Well, of course, you know, this warranted a call from me.
6:06 The thing is, of course, we have to call and educate these doctors when they put that on there, Asphyxia.
6:12 The word itself can make me think of many possibilities.
6:18 One being compression or too much force applied to someone’s chest, making it hard for them to breathe.
6:26 I know years ago when I worked in Houston, I had a case like this.
6:31 It was a very young guy driving a convertible, he changed lanes on the freeway and drove his convertible up underneath a semi.
6:41 He didn’t see the truck beside him.
6:44 Don’t know for sure how fast he was going.
6:47 But the weird thing is y’all, he did not have any visible injuries at all, which you would think.
6:54 Oh my God.
6:54 You know, drove up under a semi, did the semi run over the car, whatever.
7:00 He had no visible injuries.
7:02 The only injury that I saw was the seatbelt mark that was on his chest.
7:08 The seatbelt cut off his air supply and caused him to die from asphyxia.
7:16 It’s strange to think that you could be young and not be able to get yourself out of that situation, but he simply could not breathe and there was no way for him to get the seatbelt off.
7:28 EMS got there, and it was too late.
7:31 He died of that compression or too much force from the seatbelt against his chest.
7:38 And it was just so sad cause you know; he didn’t have internal injuries.
7:44 The only mark on his body was the seatbelt compression like that can cause asphyxia where you can’t breathe, your lungs can’t expand.
7:54 There’s too much pressure or compression on your chest.
7:57 Also injuries like strangulation, obviously cuts off your air supply or drowning.
8:04 You can’t breathe because there is no oxygen you breathe in water and then you drown.
8:09 But also illnesses like asthma or croup or pneumonia.
8:15 I don’t know if y’all have seen it in your area, but we have seen a lot of pneumonia here and have had a lot of hospitalizations, especially kiddos getting pneumonia right now.
8:26 You can’t breathe, you can’t get a good deep breath of oxygen when they put that little thing on the end of your finger that tells the oxygen saturation in your blood.
8:36 I mean, it’s supposed to be high, it’s supposed to be above 95.
8:41 Illnesses can definitely cause that.
8:45 And croup you know, in the little ones, it’s a problem.
8:48 Even, you know, epilepsy, those that have seizures are more susceptible to asphyxia from choking and those types of things overdosing on opioids or other drugs.
9:01 A lot of people will choke on their own vomit because they’re unconscious and they might be laying on their back, exposure to toxic substances as well, traumatic brain injuries, cuts off your oxygen supply.
9:17 But also another cause of asphyxia is if your airway is blocked by a foreign object.
9:24 That can be a LEGO, it can be a coin.
9:29 It can be a battery which, you know, kids put in their mouth a lot.
9:33 When I worked pediatric telephone triage, we got a ton of calls, kids eating things and luckily not choking, but parents just freaked out because they ate it and wanted to make sure they were ok.
9:48 Of course, eating a battery is very dangerous.
9:51 And so we always sent those kiddos to the but many times if they ate a penny, you know, I mean, thank God it didn’t get lodged, but it can, if the airway gets blocked by a foreign object like that, it’s going to cut off the air supply, but also food.
10:10 Many of us.
10:11 And I know I was thinking about this during the holidays, we eat fast.
10:16 We’re in a hurry, we’re talking, we’re laughing and the risk of choking on food is so much higher when you’re talking or laughing while you’re eating.
10:27 And I’m not saying, don’t do that.
10:29 I’m just saying too good.
10:31 You know, I always watched my kids and made sure that they chewed their food, and I just always said chew, chew, chew. You know, and so they thought that was funny.
10:39 But really, I was telling them, you know, chew it up good because I don’t want you to choke in the US choking deaths.
10:49 There are around 4000, 500 to 5000 a year.
10:53 Choking is the fourth leading cause of unintentional injury deaths in the country.
10:59 This happens a lot.
11:02 Now you can see why this doctor putting asphyxia as the cause of the unlike, you can’t just say that someone died of natural causes and then list asphyxia.
11:15 There’s just no way.
11:17 So needless to say I did educate him, but when I called, I had to explain to him, all these different things can cause asphyxia.
11:28 And so I needed a little bit of an explanation.
11:30 Obviously, it turned out that this patient had been in the hospital for more than 24 hours, which would usually render his death not reportable to us.
11:43 However, the nurse left out the tiny tidbit of information indicating that while he was in the hospital, he choked and that’s what caused his death.
11:55 They removed a food bowl list out of his airway while they were trying to intubate him.
12:00 Now, those little pieces of information are super important when people are reporting deaths to the medical examiner.
12:09 I don’t know why people leave those things out, but it’s done a lot.
12:14 I don’t think that everyone understands that those details are very, very, very important.
12:19 And it’s true that if you don’t have a background in forensics, you may not know at all, you may not understand it and you may not care.
12:26 But in actuality, all those things matter.
12:30 I know my friend Jamie, who has since passed away.
12:33 Super sweet nurse that I used to work with in the emergency room.
12:37 I can remember when his dad was turning 100 and they went and got him out of the nursing home, and they took him on his 100th birthday to his favorite steakhouse and he choked on a piece of steak at his own birthday party in front of his entire family.
12:55 Jamie was devastated because he was an amazing nurse.
12:59 He knew how to perform the Heimlich.
13:01 He knew how to perform CPR.
13:03 He worked in the, with me for years and he was unable to save his dad.
13:09 But it was just so sad.
13:11 I mean, so elderly people are at risk as well as Children and research.
13:17 Well, you know, heck my age, I mean, I’m 56.
13:20 I’ve, like, swallowed before I was finished too and before, and who hasn’t?
13:26 And then I thought, oh, crap.
13:28 You know, you get food hung and you start to kind of freak out and you think you’re going to need the Heimlich, and you start to panic and it’s terrible.
13:36 It’s horrifying.
13:37 But research shows that hot dogs are the leading cause of food related choking in Children three years and under they were saying that you should cut the hot dog, you know, long ways like at least in half or in quarters so that the pieces are not big enough to get lodged when they take a bite.
13:56 I’m saying cut it up into tiny, tiny, tiny pieces.
13:59 I mean whole grapes.
14:01 You know, I’ve always been kind of scary.
14:02 We never really gave those to my granddaughter popcorn, things like that, they don’t dissolve and once they get hung in the airway, they’re not going to get any smaller, they’re going to, if they get stuck or lodged, they’re going to cut off the air supply.
14:20 But hot dogs are the leading cause of food related choking and little kiddos.
14:25 And even, I don’t know, if y’all know Daniella Larreal, she was a Venezuelan cyclist, and this just happened back in August, but she was like a five time Olympian strong young.
14:39 She set the record for women’s track time trial.
14:42 In 2000.
14:44 She had won over 35 international medals.
14:48 She began competing in cycling at the age of eight but in August of this year didn’t show up for work.
14:57 Her family or coworkers called for a welfare check, and she was deceased.
15:05 She was deceased at home at the age of 50. Her autopsy showed asphyxia from choking.
15:13 Now they did not go do the welfare check until the 15th.
15:16 Which kind of concerned me as I was reading that I was like, why would someone call for a welfare check and then the police not go for three days.
15:23 Yeah, that’s not acceptable, but she had choked on food.
15:29 And I mean, she was only 50 years old, very healthy in other cases where people overdose on opioids or have acute alcohol intoxication, you can choke on aspirated vomit, which we see a lot at our office, we see people surrounded in vomit, they might be laying on their back.
15:49 Jimi Hendrix was unconscious from barbiturates.
15:53 And at the age of 27 in 1970 he died by aspirating on his own vomit.
15:59 And so that is also a cause of asphyxia.
16:02 You can see where, you know, when the doctor put that on there.
16:05 I was just like, are you freaking kidding me?
16:08 Also, Bond Scott singer for ACDC.
16:11 He also choked on aspirated vomit.
16:15 I don’t remember if it was from alcohol or drugs, but it was from one or the other.
16:20 These are genuinely young, healthy people.
16:24 And when you’re alone, like the biker Daniella, you can’t really do anything.
16:31 I can remember years ago I was alone in my office, and I was eating pork runs.
16:37 I choked on one and y’all.
16:39 No kidding.
16:39 I thought my days on earth were over.
16:42 I could not, and I mean, I was eating too fast.
16:46 I do know that I was eating too fast, but I was by myself.
16:49 I literally did the Heimlich to myself on a desk.
16:54 I was starting to literally pass out.
16:57 I mean, I thought it was over.
16:59 I thought it was, it, it scared me to death.
17:01 I still get nervous.
17:02 Now when I eat pork runs, I chew them really, really well, I make sure I have a drink with me.
17:08 It just makes me nervous.
17:09 I have PTSD from that event.
17:11 Let me tell you.
17:13 But whenever they do autopsy, many times we’ll see pic hemorrhages or the little red dots on your eye, which are indicative of straining.
17:26 And they will also sometimes see those on organs when they do autopsy.
17:32 If someone has choked or asphyxiated, also, blue discoloration and congestion, you’ll see the little hemorrhage marks on like the chest or the upper body and most importantly, the actual presence of the obstruction, whatever object they choked on is pulled out of the airway, that’s going to be a pretty good indication that someone choked, especially if it’s large and especially if the airway is completely blocked.
18:01 That is why when people report deaths to us, it is important for EMS or whoever provides life saving measures to make note that a bolus was removed, that a food bolus was removed.
18:18 And you know what I mean?
18:19 It may be gross, but save it, we want to see it.
18:22 We want to see how big it was.
18:24 We want to know where it was.
18:27 We want to know if you feel like you got it all.
18:30 If it came out in one piece, if there may have been more left, like those kinds of things are so, so important.
18:37 And again, I know that you don’t really think about them when you’re performing life saving measures.
18:43 But after the fact, it’s so important to report that to a death investigator or hospital staff.
18:52 I mean, if they survive, it’s important to know that their airway was blocked for a certain amount of time because irreversible brain damage can occur within 5 to 10 minutes of an obstruction.
19:06 When they do the autopsy though, they’re going to dissect the larynx and the trachea and they’re going to look at it to see if there’s any pieces.
19:14 And many times when we’re unseen, if somebody’s vomited, we’ll look to see, is there a lot of pieces of food in the vomit things that we’re going to observe?
19:23 Of course, unseen is also going to be, are they sitting at a table, is there a plate of food next to them?
19:29 You know, were they by themselves so that no one could hear them cough or whatnot?
19:35 But if you’ve ever choked on something, it’s horrifying and I could see where you could pass out really quickly.
19:41 And again, that irreversible brain damage does not take long, that particular patient that they had reported to us again, he was at the hospital, so he was not left alone for very long.
19:54 He was recovering from being there and the plan was for him to be discharged home.
20:02 And yeah, anyway, it’s a scary, scary thing that happens every day.
20:09 Again, many, many people that we see have aspirated on vomit, you can tell they might be unconscious again from alcohol or drugs or maybe they had a seizure, maybe they have epilepsy, and you know, they’re lying on their back, they vomit and they choke on it.
20:28 It’s just super sad and it is not discriminatory as far as age.
20:34 Like I said, Jimi Hendrix was only 27.
20:37 That’s why, you know, they always say lay people on their side, put a pillow behind their back so that they don’t roll over onto their back.
20:47 So if they do vomit in their sleep, they don’t choke on it.
20:51 But anyway, so you can hear in my voice the alarm when this doctor put asphyxia on the death certificate and thought that that was just ok.
21:01 It definitely throws up red flags when we get a request for a cremation permit and that is on it, then we discover that the death was not natural and then we do have to get involved.
21:12 And so that’s the reason we review those before we allow someone to be cremated is just to make sure that the death was accurately and completely investigated as it should have been and that there is no foul play and that it’s not accidental.
21:29 We catch a lot of those, we catch a lot of those.
21:33 So anyway, I had a little talk with this doctor and explained to the hospital staff how important it was to report anything that’s not natural.
21:45 If it’s not a natural disease process, then it’s not a natural death.
21:50 It’s not natural to choke, it’s not natural to aspirate on your own vomit.
21:58 Yeah, to just thought that I would use this little episode to maybe educate a little bit.
22:05 And I mean, it’s interesting because I mean, we could go on any scene where there’s vomit and they could have aspirated.
22:13 But those cases are usually drug overdoses or people who have seizures or epilepsy or opioid or alcohol intoxication, acute alcohol intoxication, which we see a lot of two, I’ve been on a lot of alcohol related deaths lately.
22:32 I think I told y’all that one time I went on one that was alcohol related, and the guy couldn’t get alcohol.
22:38 And so he was drinking vanilla and vanilla extract is actually 95% alcohol.
22:44 And I didn’t realize that I was like, what is this guy like cooking?
22:48 There’s freaking empty vanilla bottles everywhere and he was drinking vanilla.
22:56 Yeah, anyway, people drink mouthwash.
22:59 If we go to scenes and we see a lot of mouthwash, then we know that they may have been drinking mouthwash if they can’t get alcohol.
23:08 But the one I went on the other day, there were several empty bottles of vodka, and they were scattered along the house.
23:14 I mean they weren’t only on the counter; they were on the floor and the thing is she was decomposed and so it was hard to tell if she had vomited and aspirated.
23:24 She was laying on her back, but she was decomposed.
23:27 We had insect activity, and we had just, you know, let me just say you can tell those cases are so sad though because you know, little, sometimes elderly people live alone and drink a lot and many times they are estranged from their families because of that, and they end up at home by themselves.
23:53 And yeah, so anyway, I don’t know why I got off on that kick, but alcohol is something that we had been dealing with a lot lately at the office because we go on so many scenes and it’s like everywhere.
24:06 And of course, that’s one of the questions that’s important for us to ask families when we ask medical and social history.
24:14 Did they use illegal drugs?
24:16 Are they drinkers?
24:17 If so, would you say they’re heavy drinkers?
24:21 What is their drink of choice?
24:22 You know, and many family members will say she will drink mouthwash if that’s all there is.
24:28 But yeah, she had heavy, heavy, alcohol usage.
24:32 The vanilla thing just threw me for a loop though.
24:35 I was like, what is this guy cooking?
24:38 It was crazy.
24:39 And then when I looked at the bottle, I saw that it was 95% alcohol, and I could not believe it.
24:45 I was like, man, no idea.
24:47 Had no idea.
24:48 Anyway, I hope the educational episodes don’t bore y’all.
24:52 But I know that those of us who are truly interested in forensics and investigation, it’s just so learning is so interesting and the more, you know, the more angry you get when you watch the TV shows and you catch something that you know is impossible or yeah, like DNA on an iPad in 15 minutes and that kind of thing.
25:15 But the more, you know, the more aggravated you get when you watch the shows and you know, I am available on my website for consultations for TV productions and that’s the reason, I mean, I get so mad when I watch a TV show, and the injuries are nothing like the way they describe them.
25:34 And I’m like, dude, y’all could have done such a better job of showing that, you know, and making it look more real.
25:41 I mean, you don’t want to make it look too real sometimes, but at least making it make sense would be nice.
25:46 Anyway, I’m going to head to work guys.
25:50 I hope that you have an amazing day.
25:52 Don’t forget that my Patreon is up and running and you can always email me if you’re interested in being on the air.
26:00 If you have a story to talk about.
26:01 I love to hear from you.
26:03 A website pushing up lilies.com and there is a way on there to reach out to me.
26:09 You can also email me at Julie at PushingUpLilies.com.
26:12 I look forward to hearing from y’all.
26:14 I hope you have an amazing day and try not to hurt anybody when you’re Christmas shopping.
26:21 I know that I do love that.
26:22 Now, we have Cyber Monday, and we can buy online because let me tell y’all, I went to the grocery store during the Thanksgiving rush, and I will never do it again. No.
26:33 And then, every once in a while, I’ll go shopping like I went to home goods the other day.
26:38 No, I almost had an anxiety attack.
26:40 There are too many people in there and I’m not standing in line for an hour. Anyway, have a lovely week and I look forward to talking to y’all next week.
26:48 Bye y’all.
26:50 Thank you so much for joining me today on Pushing Up Lilies.
26:54 If you like this podcast and would like to share with others, please do me a quick favor and leave a review on Apple podcast.
27:01 This helps to make the podcast more visible to the public.
27:05 Thanks again for spending your time with me and be sure to visit me at PushingUpLilies.com for merchandise and past episodes.