continued According to court documents, Frishberg also testified at trial that he did not prescribe any further administration of morphine. Nevertheless, trial transcripts reveal that someone turned Carol's morphine pump back on between the time she received the Ativan dose and the pronouncement of her death at 7:00 a.m. But this information did not appear on Carol's nursing log.
In consulting with doctors in Sweden, Eklund has come to believe that a combination of Ativan and morphine in his wife's body is what killed her. Eklund put me in contact with Bengt Nellgard, head of the neuro intensive care unit at a university hospital in Gothenburg, Sweden.
Nellgard wrote me that an unconscious patient given morphine must be monitored at all times. "If an unconscious patient is given Narcan to reverse morphine treatment, that patient should be transferred to an [intensive care unit] and not be given Ativan. Ativan given after morphine can decrease breathing drive and in a meningitis, supposedly with higher intercranial pressure than normal, this may be deleterious."
I took the issue of morphine and Ativan interaction to several local pharmacists and to Professor Gordon McGuire at UCSD's School of Pharmacy. The pharmacists requested anonymity but agreed that nothing they know forbids Ativan from being given patients already on morphine. One of them, however, said that the situation can be similar to someone drinking heavily and then taking sleeping pills, which also depress the central nervous system. That combination has had fatal consequences, she said. Both Ativan and morphine depress the central nervous system too.
McGuire told me it is not uncommon for hospital patients already on morphine to be given Ativan to relax them. He also states that Narcan, even though its action lasts only an hour, permanently reverses the effects of a morphine dose.
In appealing the trial's verdict, Eklund may only be acting out his grief. But most medical experts contend that viral meningitis is rarely, if ever, deadly. Steven Campman, of the San Diego County Medical Examiner's Office, testified at trial, however, that an autopsy of Carol Eklund's body revealed the cause of her death to be "meningoencephalitis." He explained that the Coxsackie B2 virus that had caused her meningitis had entered her brain.
Eklund remembers the only time he spoke with Campman. The doctor called him nine days after Carol's death, according to Eklund, to say there was no evidence of the virus having entered her brain and that he was puzzled as to the cause of her death. Several weeks later, Eklund received the autopsy report. But it was a report on the death of a 65-year-old man. After notifying the medical examiner's office of the mistake, Eklund said he finally received Carol's autopsy report. He observed immediately that it was dated the day after her death, yet it identified the cause of death as meningoencephalitis. "So apparently Campman declared the cause of her death," said Eklund, "well before he called me to say he couldn't explain it."
Campman, said Eklund, "never returned the eight or nine calls I made to his office to get clarification of the inconsistency." The next time Eklund saw Campman, he was testifying from the witness stand.
Reached by phone, Campman told me that in their conversation he told Eklund that he couldn't "see" meningoencephalitis as the cause of her death. But that's because the naked eye cannot detect it in the brain. Later, when results of microscope analysis came back, he learned that the cause of death was meningoencephalitis. The medical examiner's toxicology report did show that morphine was present in Carol's body but not in excessive amounts, said Campman. And he maintained that a combination of Ativan and morphine could not have killed her because her body had no remnants of the Ativan.