The unexpected death of acting legend Gene Hackman rocked Hollywood, but the mysterious circumstances of his and his wife’s deaths have gripped the nation.
Mr Hackman, 95, was lying dead in the mudroom off his kitchen in his Santa Fe home, while his wife Betsy Arakawa, 65, had been found on the floor of a bathroom with pills spilling from an orange canister on the counter.
Police reported finding the over-the-counter pain reliever Tylenol, an unspecified thyroid medication, and diltiazem, commonly used to treat high blood pressure and certain heart conditions.
Since the couple’s surprise passing, which could have happened weeks ago given the mummified states of their bodies, speculation has been rife about whether one or both of the deaths were self-inflicted.
Diltiazem is a far cry from fast-acting narcotics, including prescription painkillers and benzodiazepines, more typically associated with suicide, but doctors told DailyMail.com that it is no less lethal.
Dr Jack Rubinstein, a cardiologist and internal medicine professor at the University of Cincinnati, told DailyMail.com: ‘If somebody wanted to hurt themselves by overdosing themselves or others with diltiazem, it is definitely one hundred percent lethal.’
The lethal dose of diltiazem varies based on the person’s weight, age, and overall physiology, but past reports of overdoses to poison control centers and medical journals have included a wide range of 200 to 1,000 milligrams.
Suicide and suicide attempts using diltiazem are not unheard of, though there is no indication yet that either Mr Hackman’s or Ms Arakawa’s deaths were suicides or that either had taken any of the drugs found.
Autopsies and toxicology reports are underway but could take weeks to be made public. One of the first theories to arise came from Mr Hackman’s daughter, who posited they could have died as a result of carbon monoxide poisoning.
Further examination concluded that the couple had not been exposed to carbon monoxide, ruling that out as a possible cause of death.
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Early details include the states in which the bodies were found. Law enforcement reported that both had likely been dead for days or even weeks, writing in the search affidavit that Ms Arakawa had ‘mummification in both hands and feet.’
Natural mummification happens when the body dries out, causing the tissue to shrink and become firm. This process usually occurs in either dry, hot, or extremely cold conditions.
It is not clear yet whether Ms Arakawa had taken the medicines found in the bathroom or if Mr Hackman had, or whose name was printed on the canister.
Diltiazem relaxes the muscles around the blood vessels and the heart. It slows down the electrical signals that control the heart’s rhythm, making the heart beat more steadily and with less force.
This lowers the heart rate and reduces the amount of work the heart has to do. It also helps blood flow more easily by relaxing the blood vessels, which can lower blood pressure.
Dr Rubinstein said: ‘It sort of slows down the body by blocking these calcium channels that are needed for the heart cells to communicate with each other.
‘Your heart starts slowing further down. And then different heart cells start picking up the slack until they can’t do it either, and then the heart just stops.’
Dying, Dr Rubinstein added, can take hours ‘to potentially a day.’
Thyroid medication is less likely to prove fatal. The most common thyroid medication is levothyroxine, a synthetic form of thyroid hormone.
Dr Jared Ross, an emergency medicine physician in Missouri, told DailyMail.com: ‘Levothyroxine overdoses are uncommon and tend to cause symptoms lasting for weeks.
‘Even an adult taking an entire month’s supply of levothyroxine is unlikely to cause life-threatening symptoms.’
Details surrounding the couple’s death continue to emerge, as well as that of one of their dogs, a German Shepherd.
Dr Ross added: ‘There are multiple case reports in the medical literature of patients successfully and unsuccessfully committing suicide using diltiazem. Including a 57-year-old woman who took 1,600 mg of diltiazem and died, a 60-year-old man who took 8,000 mg of diltiazem and died, and a man who took 4,200 mg of diltiazem and survived.’
