BODY WATCH : ‘Natural’ Death Is No Stranger to the Young

When ballet dancer Alexander Godunov was found dead last week in West Hollywood and his physician attributed death to natural causes, many people wondered: Isn’t 45 much too young to succumb naturally?

The scary truth is, you’re never too young to die a natural death, according to pathologists, coroners and other health professionals.

People “can die of natural causes at any age,” says Scott Carrier, a spokesman for the Los Angeles County coroner’s office. In fact, most deaths handled by the coroner’s office are determined to be “natural.”

When someone is said to have died of natural causes, it simply means he or she died of a disease process, explains Dr. Stephen Romansky, a pathologist at Long Beach Memorial Medical Center and UC Irvine clinical professor of pathology. “It means there was no accident, suicide or homicide involved.”

On Monday, Godunov’s physician, Dr. Maurice Levy, signed the death certificate listing the cause of death as chronic alcoholism. He says there were two possible scenarios leading to the death of Godunov, who was discovered May 18: He either choked on regurgitated alcohol that also entered the lungs, or he had a seizure after drinking excessively, then abruptly stopping.

Deciding how and why some deaths occur is not always easy, even for coroners and pathologists. They must consider “cause of death,” “manner of death” and “mechanism of death.” (Natural is one of five manners of death, the other four being accident, suicide, homicide and undetermined.)

For example, if a 2-year-old’s illness is diagnosed as leukemia and the child dies from it, the cause of death would be disease and the manner of death natural, Romansky explains. “We confuse natural and normal,” he says.

The mechanism of death is loosely defined as the interaction or cascade of conditions leading to death. For instance: a man whose condition is diagnosed as alcoholism develops liver damage and dies. The cause of death is disease, the manner is natural, and the mechanism is alcoholism leading to liver failure.

If, on the other hand, the man with the failing liver had been hit by a bus and killed, the cause of death would be injury, the mechanism massive trauma as a result of the accident and the manner of death accidental.

The dividing line between natural and unnatural manners of death can be a thin one. Someone “who has moved their death along or had it moved along” would be considered dead of unnatural manners, says Dr. Joel Geiderman, co-chairman of emergency medicine at Cedars-Sinai Medical Center.

In investigating deaths, “50 is used as a presumptive age for natural death,” says David Campbell, an acting spokesman for the L.A. County coroner’s office. “If a person collapses and is under age 50, we’re going to look more closely in the absence of disease history than if the person is over age 50.”

Last year, 13,248 of the 19,521 deaths investigated by the L.A. County coroner were declared natural. Accident was the next most common manner of death, accounting for 2,953, followed by homicide, 1,913; suicide, 1,222, and undetermined, 185. (Nearly 58,000 deaths were reported in the county in 1994.)

In Orange County, 7,065 of the 8,137 deaths investigated in 1994 by the Sheriff-Coroner Department were declared as natural, says a representative. Accidents accounted for another 335; suicides, 256; traffic accidents, 197; homicide, 182, and undetermined, 30.