Understanding the autopsy
Understanding Bella’s Autopsy
This guide explains the findings listed together in Bella’s cause-of-death statement. The findings should be read together, rather than as separate, independently established causes of death. The recorded findings below come from the Massachusetts Office of the Chief Medical Examiner’s report, case 2025-3197, pages 1–2 and 7; the plain-language explanations provide general medical context.
Autopsy: February 23, 2025 · Final report signed: June 26, 2025 · Explanation reviewed: October 13, 2026
Cardiopulmonary arrest
Recorded finding
The cause-of-death statement begins with cardiopulmonary arrest.
Plain-language explanation
The heart and breathing stopped functioning effectively. This describes the final physiological event; the rest of the statement supplies the medical findings associated with it.
MedlinePlus: cardiac arrestUpper airway obstruction by a foreign body
Recorded finding
The report lists an airway obstruction and, in its final diagnoses, a foreign body consistent with chewing gum recovered from the airway, according to medical records.
Plain-language explanation
A foreign body is material that does not belong in the airway. An obstruction can prevent air from reaching the lungs. This finding does not, by itself, establish how the material entered the airway or anyone’s intent.
MedlinePlus: airway obstructionInflammatory process of the lungs
Recorded finding
Microscopic examination describes marked inflammatory cells in the airways and areas of blood-vessel inflammation. The examiner says the appearance may represent asthma and/or a response to an infectious process.
Plain-language explanation
Inflammation is the body’s tissue response to injury or irritation, including infection. The examiner’s wording preserves more than one possible explanation; it is not a confirmed diagnosis of pre-existing asthma.
Pleural effusions
Recorded finding
The report documents fluid around both lungs: 200 milliliters on each side.
Plain-language explanation
A pleural effusion is fluid in the space between the lung and chest wall. It is different from pulmonary edema, which is fluid within the lungs. The report also records pulmonary congestion and edema among its final diagnoses.
MedlinePlus: pleural effusionCoronavirus NL63
Recorded finding
A swab from the back of the nose and throat was positive for coronavirus NL63. The report lists SARS-CoV-2 as negative.
Plain-language explanation
NL63 is a common human coronavirus that can cause respiratory illness. It is a different virus from SARS-CoV-2, which causes COVID-19.
CDC: human coronavirus typesLeuconostoc lactis
Recorded finding
The lung culture showed heavy growth of Leuconostoc lactis. The blood culture separately identified Leuconostoc species.
Plain-language explanation
Leuconostoc lactis is a bacterium; human infections have been reported. A culture grows organisms from a sample so they can be identified. The report includes this result in its cause-of-death statement, but does not assign it a separate share of responsibility for the death.
Emerging Infectious Diseases: Leuconostoc lactisStaphylococcus aureus
Recorded finding
The lung culture also showed heavy growth of Staphylococcus aureus.
Plain-language explanation
Often called staph, this bacterium can cause infections, including pneumonia. Its presence is a recorded finding; the wording does not establish when or how it was acquired. This page does not reinterpret the culture as either contamination or a sole cause of death.
CDC: Staphylococcus aureusWhat the toxicology findings establish
The expanded postmortem blood screen is listed as “none detected.”
The report also describes no reportable findings under the listed ethylene-glycol, anticoagulant-poisoning, and acute metals/metalloids-poisoning procedures, apart from separately listed measurements. It records mercury at 3.8 mcg/L and selenium at 86 mcg/L. Those measurements are not presented here as proof of poisoning.
The toxicology results should be read within the scope of the tests performed.
Laboratory reference comparison
| Substance | Bella’s result | General reference stated by NMS Labs |
|---|---|---|
| Mercury | 3.8 mcg/L | Typically below 10 mcg/L |
| Selenium | 86 mcg/L | 60–230 mcg/L |
For context, NMS Labs describes typical blood mercury concentrations as below 10 mcg/L and reports a general blood selenium reference range of 60–230 mcg/L. Bella’s measured concentrations—3.8 mcg/L and 86 mcg/L, respectively—fall within those descriptions. These are laboratory reference comparisons, not universal thresholds for poisoning.
Source: NMS Labs toxicology attachment, page 2 of 3, workorder 25099358, signed March 17, 2025 (page 13 of the autopsy file). The laboratory notes that its reference information is general guidance and interpretation depends on the full case information.
Cause and circumstances
Cause and manner answer different questions
Cause of death concerns the medical conditions or injuries leading to death.
Manner of death classifies the circumstances in which the death occurred, using the medical findings together with the available investigative evidence.
An examiner can identify medical causes while remaining unable to establish a manner of death. Those conclusions are not contradictory.
Why “undetermined” rather than “natural” or “accident”?
A natural classification generally means death resulted from disease. Bella’s report also identifies an airway obstruction by a foreign body, so describing her death as solely disease-related would require further explanation.
An accidental classification would require sufficient evidence that an unintentional event caused the death—for example, accidental choking. Documenting an obstruction does not, by itself, establish the circumstances in which it occurred.
The National Association of Medical Examiners explains that an undetermined classification can be used when the available information does not sufficiently favor one manner over competing possibilities. It does not mean that every possibility is equally likely.
One possible explanation for Bella’s classification is that the medical and investigative evidence did not sufficiently resolve the circumstances needed to choose a manner of death. However, the report’s cause-and-manner statement does not identify which uncertainty was decisive. That explanation would need to come from the examiner.
The presence of several medical findings alone does not explain the classification. “Undetermined” reflects uncertainty about the circumstances of death. It is a medical classification, not a finding about any person’s responsibility.
National Association of Medical Examiners: manner-of-death guide, pages 3–6 (2002)A father’s perspective
As Bella’s father, I want to understand what happened to my daughter. The report gives us medical findings, but it does not answer every question.
I believe those limits deserve to be respected. What is documented should be stated accurately. What remains unknown should remain a question—not be turned into an accusation.
Case source: report by Janice Y. Grivetti, D.O., Massachusetts OCME, pages 1–2 and 7. External medical references explain terminology; they do not assess Bella’s case. This guide is not a replacement for the autopsy report or an independent medical opinion about Bella’s death. Read the non-graphic findings summary.