A sailor’s mysterious death

“NCIS,” Tuesday, Feb. 13; 8 p.m.; “Friends and Lovers.”

The premise: In an abandoned warehouse in Georgetown, a man is proposing to his bride-to-be when he discovers the dead body of a sailor covered with maggots. The Naval Criminal Investigative Service is called and uses the maggots to determine that he has been dead for almost five days. NCIS medical examiner Dr. Donald “Ducky” Mallard (David McCallum) finds no signs of trauma or injury but discovers a blood alcohol level five times normal, a worn-out (cirrhotic) liver and multiple organ failure. Other recreational drugs, including Ecstasy, are found in the man’s bloodstream. At first, the team believes that the sailor must have died of a combination of drugs and alcohol. But forensics expert Abby Sciuto (Pauley Perrette) uses a mass spectrometer to identify high levels of a mystery compound that turns out to be a poison derived from the oleander plant.

The medical questions: Does the presence of maggots help a coroner determine time of death? Was a drug overdose a logical first theory? Are the toxins from the oleander plant an effective poison that can be ingested? Does this poison cause multiple organ failure and liver cirrhosis, or are these autopsy findings unrelated?

The reality: As awful as it sounds, maggots, which are the larvae of flies, can indeed be used to determine time since death. The size of the maggot indicates how old it is, which suggests how long ago the person died.

The medical examiner first considers suicide and is correct in doing so, since there is no sign of trauma and since initial tests suggest alcohol and recreational drug use. It’s also plausible that what at first seems to be a suicide or accidental death can later be determined to be a murder. The continued search for toxins using laboratory techniques such as mass spectrometry, which separates out the chemicals in the blood, is one of the reasons autopsy reports are sometimes delayed.

The oleander plant is a leafy evergreen, native to Asia and the Mediterranean. It is quite common in Southern California, and in 2000, two toddlers died from eating leaves plucked from a neighbor’s bush. The plant contains the cardiac glycosides oleandrin and nerioside, which are quite toxic. Its potent poisonous effects have been known for centuries, and a single leaf might kill a child, causing irregular heartbeat (arrhythmias)and cardiac arrest. The toxins also cause vomiting, abdominal pain, diarrhea and neurological problems including seizures and coma. However, deaths in the U.S. attributable to oleander poisoning are rare.

The sailor’s cirrhotic liver is most likely due to longtime alcohol use rather than oleander, a pathological red herring that isn’t explained on the show.

Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. He is also the author of “False Alarm: The Truth About the Epidemic of Fear.” He can be reached at marc@doctor siegel.com.