By Judy Melinek, MD

When actor Gene Hackman and his wife, pianist Betsy Arakawa, were found dead and decomposed in their Santa Fe, New Mexico home on February 26, much of the media fixated on a phrase in the police report describing "mummification" of their hands and feet. People who hear that phrase tend to immediately think of embalmed cadavers from ancient Egypt, as seen in bad movies. The medical term, however, describes a natural process of postmortem change. Mummification of the extremities occurs as a process of desiccation: the skin dries out, turns brown, wrinkles up. We usually find it in a warm, dry environment, and though it can happen over the course of weeks, it might also set in as quickly as a matter of days.

Given that these two decedents were found indoors in arid Santa Fe, and that there was a space heater in the bathroom near Arakawa's body, the finding of mummification is not surprising. Subsequent interrogation of Hackman's pacemaker indicated that the last cardiac activity was on February 17 -- 9 days before the bodies were found -- and that workers had last been to the residence approximately 2 weeks prior. Meanwhile, Arakawa was last seen on the gated community CCTV and was communicating via e-mail on February 11.

It's these circumstantial bits of information from the scene that are often the most helpful clues in narrowing down the time of death in the early phases of a death investigation. Let's dive deeper into the role of a forensic pathologist and other key players in a mysterious case like Hackman and Arakawa's.

Narrowing Down Time of Death

Time of death estimation is a complex process that depends on multiple factors both intrinsic to the body and found in the immediate environment around it. These variables can include the body's weight and clothing, the ambient temperature, whether the death occurred indoors in a controlled environment or outdoors where temperatures fluctuate, the health status of the individual just prior to death, and the presence or absence of animals (including insects) that can feed on the body. Experienced forensic pathologists carry around a mental library of cases that inform us over the course of a career of what a decomposing human body will look like after 24 hours, 48 hours, weeks, and months -- and in all different ambient conditions. Death scene investigators can also take a measurement of the core body temperature at the scene that we can compare to published data to help narrow down a tighter death interval using nomograms.

Post-mortem interval estimation isn't perfectly empirical, but its reliability increases with each bit of information gleaned about a case, the forensic expertise of the person doing the assessment, and the thoroughness of the police investigation. It's often our role early on to help the police focus their investigation on a reasonable time frame by providing a ballpark estimate of when the person died, and to help them dismiss incompatible testimony or unlikely suspects.

The Cause of Death

What about the cause of death? You have to be concerned about an environmental toxin like carbon monoxide or natural gas when two people and a pet are dead in the same enclosed residence. So, hazardous-materials crews would need to assess such a scene prior to arrival of medical first responders, who might otherwise be putting their own lives at risk. Environmental testing was performed at the residence of Hackman and Arakawa, and additional carbon monoxide testing was also performed on the human remains. All these tests were negative.

The deaths remained a mystery until Friday, March 7, when the medical examiner held a news conference to report that Arakawa had died from hantavirus, a rare pathogen that can be transmitted from rodent droppings, and that Hackman, who had been suffering from Alzheimer's and cardiovascular disease and had relied on his wife's care, likely died of heart disease in the same house a week later. It's not clear if Hackman knew his wife was dead.

This is a heartbreaking conclusion. It came after extraordinarily intensive and quick work by New Mexico's state Office of the Medical Investigator (OMI), and underscores their dedication and professionalism. The New Mexico OMI has extensive experience with infectious diseases, and is one of the select death-investigation facilities in the U.S. with a BSL-3 biosafety level morgue where they can handle infectious agents that spread through airborne transmission. I suspect that there might have been signs at autopsy that pointed to a lung infection, and that hantavirus was then detected by identifying its genetic signature through polymerase chain reaction (PCR) testing of a nasopharyngeal or lung tissue swab. The Hackman-Arakawa property was in a remote area of Santa Fe, and there was evidence of rodent activity there. The couple had three dogs, and sometimes pets can come in contact with wild rodents and bring them into the house. The necropsy on the dead dog is still pending, and may answer more questions about the source of viral exposure.

The Risk of Isolation

I know a lot of gut-wrenching death stories, and the worst ones always involve either the feeling that death may have been preventable, or that the decedent suffered. Everyone who's been following this shocking and complex public mystery should be grateful to the New Mexico OMI for giving us -- and the Hackman-Arakawa family -- a speedy and decisive resolution.

If you have people in your lives who are the sole caregivers to a medically fragile patient, please reach out frequently to give them as much help and support as you can. Balancing their need for privacy with your own concerns for their wellbeing is never simple, but maybe these public deaths will open conversations with them about a less isolated environment for their end-of-life care.

Judy Melinek, MD, is an American forensic pathologist currently working as a contract forensic pathologist in Wellington, New Zealand.