Medical mysteries surround Warmbier
Level of medical care he got was unheard of for most N. Koreans
An unresponsive Otto Warmbier survived months in North Korean care, returned June 13 and died six days later. His brief life offers mysteries on the mixture of medicine, geopolitics and the will to live.
On Tuesday, the Hamilton County, Ohio, coroner reported no autopsy was performed on the 22 year old’s body at the Warmbier family’s request. In her statement, coroner Lakshmi Sammarco deferred a ruling on the cause of his death.
“No conclusions about the cause and manner of Mr. Warmbier’s death have been drawn at this time as there are additional medical records and imaging to review and people to interview,” her statement said.
Warmbier’s funeral is scheduled for Thursday at his alma mater, Wyoming High School in Ohio.
University of Cincinnati Health doctors treating Warmbier declined Tuesday to answer further questions. Warmbier stayed at University of Cincinnati Medical Center since his arrival at Cincinnati’s Lunken Airport from his 18 months of captivity.
His family had not heard from him since he had been convicted of a state crime in March 2016 and sentenced to 15 years. After all that silence, the Warmbier family and the world learned last week that Warmbier lived for at least 14 months in a state of unresponsive wakefulness, or persistent vegetative state.
Unresponsive wakefulness occurs after a severe brain injury. The damage leaves a person unable to respond to commands, move or respond to stimulus although that person can yawn, sleep on cycle and breathe without mechanical assistance.
The length of Warmbier’s survival while in unresponsive wakefulness is remarkable because of the meager state of North Korean health care. The nation lives with the legacy of the “arduous ordeal,” a famine in the 1990s that killed as many as a million people. While the World Health Organization says food production appears to have improved, the health care system is devastated, and hospitals lack the basics.
Upon Warmbier’s release, the official story from North Korea is that shortly after his March 2016 conviction, Warmbier became ill with botulism and was given a sleeping pill. Untreated and out of control in the body, botulism attacks the nervous system, breathing and heart function. A sleeping pill would not counteract botulism.
Last week, Daniel Kanter, a University of Cincinnati Health neuroscientist, described Warmbier’s brain as severely damaged everywhere. From the magnetic resonance images taken in Cincinnati, Kanter said Warmbier’s injury most likely occurred because his heart stopped, cutting off oxygen to the brain.
It’s possible that botulism damaged Warmbier’s heart and lungs, but Kanter said no trace of botulism was found in Warmbier. There was no indication that Warmbier was treated with the customary antitoxin to halt the nerve damage.
In another hint about the level of medical care available in North Korea, Kanter mentioned a data disc of medical information about Warmbier collected in North Korea, including test results and scans of his brain dated April and July 2016 showing progressive damage. Tests at UC Health showed no traces of trauma or physical abuse. One conclusion from the condition of Warmbier’s body: He got a level of medical care virtually unheard of for most North Koreans. He survived unable to communicate or move for 14 months, so someone took care of him. He came home in what Kanter called a “well-nourished” condition, so someone made sure he got nutrition and water. Kanter was able to review contemporaneous medical records, so someone knew the information was worth keeping.