Hey y’all, it’s Julie Mattson, death investigator, and host of Pushing Up Lilies. Today we're taking a sobering look at the growing number of sudden and unexpected deaths among young people. With years of firsthand experience in the field, I share what I've seen behind the scenes, from vibrant teens and 20-somethings whose lives ended without warning, to families left devastated and searching for answers. We dive into the causes no one likes to talk about, fentanyl-laced pills, silent suicides, even seemingly harmless illnesses like a cold that turns deadly. Why is this happening more often? What signs are being missed? And how can we start asking the right questions before it’s too late? Join me for a heartfelt, unflinching conversation that shines a light on this troubling trend, and reminds us how precious life truly is. * Listener discretion is advised.
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00:06
Welcome to Pushing Up Lilies. I'm your host, Julie Mattson. Pushing Up Lilies is a weekly true crime podcast with spine-tingling, unusual, and terrifyingly true stories from my perspective as a forensic death investigator and a sexual assault nurse examiner.
00:24
Do I have some stories for you? Are you ready? Hey guys, we're back for another week pushing up lilies. And it's been kind of an exciting week. I put in my notice for retirement. And although I'm a little nervous because I do love, love, love my job, I want to pursue my podcast more.
00:51
I want to pursue some speaking events, and I am also still trying to run my med spa and go to grad school. So, there's a lot going on and I'm working on my book as well. It is just going to be another way to continue my forensic experience by passing it on, educating and speaking and talking about cases.
01:16
I think it's going to be a lot of fun. I'm in that point in my life where I needed to just make a few changes. So, it's all good. It's all good. I wanted to talk this week about some kind of complicated cases.
01:33
And one reason why, I guess, is because I've noticed in the last month or two, we have had a lot of young people pass away. And it's kind of unexplained. We had a 23-year-old college student who had been coughing.
01:50
Yesterday, I had a 40-year-old whose only history was bipolar disorder. And so, it makes you wonder what's going on. And I guess a couple of weeks ago, I had a 32-year-old college professor who was a doctor pass away unexpectedly in his apartment.
02:12
And so, I kind of, I guess, want to educate a little bit because these cases are complex or they can be. And I know it's not something that everyone sees, but these are really the most difficult category of this.
02:31
And they involve people who should still be here. So, we're talking about people in their teens, 20s, and 30s who just die with no warning at all. And these cases change you, and they definitely change families, and they change the investigators who walk into the room and see a life cut short with no explanation.
02:58
I've handled hundreds of sudden, unexpected deaths in young people, and some were caused by medical problems, some were from environmental issues, some were self-induced, and some were violent. But every case teaches something, and every case carries weight.
03:22
So today I want to kind of take you through the patterns and the red flags and the forensic process and then the stories families always want answered. Why did this happen? Could it have been stopped?
03:38
What happened in those final moments? You know, a lot of people ask, were they in pain? Did they suffer? That's always kind of an important question that I get asked very frequently. So, when someone under 40 dies without warning, the causes kind of fall into a few different groups.
04:00
We can see cardiac or heart-related events. We might see overdoses. We see silent medical issues that really haven't been diagnosed because the person is too young. We've seen colon cancer in 20 and 30 year olds, and they don't even recommend colonoscopies until you're 50.
04:23
So, a lot of them are medical issues that just haven't been diagnosed because the diagnostic tests aren't even supposed to have to be done at that age. We see trauma from accidental injuries, and we see environmental risks that no one notices until it's too late.
04:43
One thing is, you know, we've always heard stories of young people passing away at football practice. Maybe they're outside in the heat. Maybe it was caused by a heat stroke. But they could also have a genetic condition where the heart muscle thickens, and it makes it more difficult to pump blood.
05:04
So, this is called hypertrophic cardiomyopathy. We could also see undiagnosed arrhythmias. That's when the heart's electrical signal fires out of rhythm and it causes the ventricles to stop pumping, at least not effectively.
05:22
This causes blood flow to the brain to stop and then the person collapses and then the breathing stops. The heart goes into pulseless rhythms which are incompatible with life. And this can be caused by a lot of things.
05:39
Structural heart disease that's unrecognized, a silent heart attack or coronary artery disease. A lot of people don't know it, but electrolyte imbalances like low potassium or magnesium can cause arrhythmias.
05:57
Stimulants, which we see a lot and we pay attention when we go to a scene, if their person's young and there are any energy drinks, or that's one question we ask, do they drink a lot of energy drinks or pre-workout type stuff?
06:13
It can be caused by drugs like cocaine, methamphetamines, and even diet pills. Medications can also trigger it, as well as this is one that I need to listen to, sleep and stress. Getting enough sleep is super important.
06:31
And your stress level, keeping your stress level down and self-care, taking care of yourself is also super important. Now, a lot of post-viral inflammation can also be a cause. And sometimes it's just genetics.
06:48
I have seen a 40-year-old, perfectly healthy, seemingly young man come into the ER while he's playing racquetball and just die of sudden cardiac arrest. And I feel like even though he exercised, he did still have a history of high cholesterol and hypertension.
07:09
And he did everything he could to manage those. Symptoms can sometimes be vague and brief or even absent. The sad part is routine physicals don't really include cardiac rhythm monitoring. And the fact is, arresting EKG is normal in most people who have these electrical channel disorders.
07:38
When an autopsy is done on a young person who has a genetic predisposition or an electrical channel disorder, the heart looks structurally normal. And investigations will see a clean toxicology report with no injuries, negative structural findings, maybe a little bit of an enlarged heart.
08:03
Sometimes we see a history of recent illness, or stimulant use or sleep deprivation or emotional stress. And witnesses will sometimes report a sudden collapse with no apparent distress. And this is what makes it hard because it's like they weren't suffering.
08:23
They were fine. They were healthy. And yes, people of all ages die suddenly and unexpected. We might see myocarditis, which is an inflammation of the heart muscle. And this makes the electrical pathways unstable.
08:40
And then it results in your circulation failing. So this can lead to death by causing fatal arrhythmias and sudden pump failure. It can be triggered by something as simple as a viral infection, autoimmune disorders, toxins or medication, and even post-vaccination immune responses.
09:03
The scary thing is that this can be triggered by a flu-like illness that may last weeks or days. And then also unexplained fatigue. If you are extremely tired and you don't know why, something's wrong and your body's trying to tell you that something's wrong.
09:21
We also see stimulant use on top of an already stressed heart and stimulants surge adrenaline and norepinephrine, raising your heart rate and your blood pressure and causing your heart to demand more oxygen.
09:36
And then your arteries actually tighten or constrict. And repeated stimulant use causes scarring that can trigger arrhythmia. And a lot of people don't know that. They think that just because they do it regularly and they're not having any symptoms, that there are no long-term effects.
09:59
Now we see sleep-related deaths, and this can cause the heart rate and the blood pressure to drop and breathing becomes shallow. And death can happen during sleep from arrhythmias and heart inflammation and seizures and airway obstruction and the use of substances that cause respiratory suppression, like mixing opioids with alcohol, cardiac channel disorders.
10:26
This leaves no structural findings on autopsy, and it appears peaceful. There's no struggle and there's no trauma. And on autopsy, the heart structure appears normal with maybe a little bit of inflammation.
10:40
The tox panels are completely normal. And sometimes we'll find maybe there's a history of recent illness or energy drink use or complaints of fatigue prior to death. Young adults who go to bed and never wake up and the cause looks invisible, and the person never gets a chance to ask for help.
11:03
We see unrecognized infections. I've had cases where the person thought they had the flu and they were dead within 24 hours. Sepsis does not care how old you are. And this is when bacteria enters the bloodstream, the blood vessels widen, and your blood pressure drops, and your oxygen delivery fails.
11:28
You can also form microclots. We see a lot of recreational drug use in young people. Not every overdose looks like an overdose. Pupils are pinpoint with opioid use, and they're dilated with stimulant use.
11:45
And a lot of times we'll see foam in the mouth if we feel like they've overdosed and that's from pulmonary edema. And in those cases, the autopsy is going to show their lungs filled with fluid. We always look on young people for needle marks.
12:03
Look for fresh ones. Look for older ones. We've even seen scars from injection sites that had become infected. I had a guy who had little raised, dark, calloused sores all over his body from injecting himself with a needle where he has had infections.
12:22
We see nasal irritation if drugs are snorted. We'll see burns on the lips or fingers if they're smoking substances, and many times they will vomit. We look for clues at the scene, drug paraphernalia.
12:37
Are there any lighters? Is there a spoon? Is there foil? Any scattered pills? Any syringes, tourniquets, white powder, crushed pill residue, empty alcohol bottles. Some look like peaceful sleep, and some look like someone collapsed walking from the bathroom to the bedroom.
13:00
We see in young people suicides that happen, and their families never saw it coming. That's one of the hardest parts. Parents swear their child was fine. There were no signs. Sometimes the signs were subtle.
13:16
Sometimes there were none. We see accidents, falls, crashes, alcohol, a single moment that changes everything. So, when dispatch calls, investigators already know one thing. A young person is dead. And that information alone changes how we think.
13:40
So, we start to ask ourselves a lot of questions. And these seem they're always hard. When you get the call, it's like, ugh, how old are they? Oh, God. Okay. 16, 18, 23, 32. Young people. So, you wonder a lot of things.
13:57
Is the family on scene? Are there other children at home? You prepare yourself for anything because young people don't fit these normal patterns. So, we get to the house and the world inside the home feels frozen.
14:13
There's TVs on and clothes laid out for the day, and food half eaten and signs of a routine that suddenly stopped without warning. And families meet us at the door and they're shocked. They don't even know how to feel yet.
14:30
They haven't processed what happened. And they look for hope even though they've already heard the words. And their first question is always the same. And they ask us why. So, a couple of cases I've had, the first case is a 29-year-old and healthy, athletic, male, no medical history, went on a morning run, neighbors saw him jogging.
14:57
He was waving, smiling. He looked totally normal, and he never made it home. A passerby finds him on the sidewalk. There's no trauma, no signs of struggle. EMS tried to save him, and nothing worked. When I performed the scene exam, his shoes were untied, and his watch was tracking his run.
15:20
Autopsy showed the hypertrophic cardiomyopathy that we talked about, and it had been silent for 29 years. So, his parents blamed themselves. They thought they missed something. And of course, they asked, did he feel pain?
15:37
Most of these deaths are instant and the heart just flips into a fatal rhythm and the brain shuts down within seconds. And many families need to hear that. They need to know that there was no struggle.
15:50
I've even had a new mom who was only 24, three months postpartum. Her husband found her in bed. The baby was asleep next to her. And she just didn't wake up. The families expect postpartum complications to end right after delivery, but they do not.
16:09
You can have postpartum cardiomyopathy. The symptoms kind of look like exhaustion. She had some swelling, some fatigue, some shortness of breath, but every new mom feels those things. And she never told anybody because we want to be tough, right?
16:26
We're moms. We think this is normal. An autopsy showed an enlarged heart that failed during sleep, and she never felt the final moments. And her mother kept asking why no one warned her. But the truth is simple, because many young people develop this condition quietly.
16:50
And unfortunately, the first sign is sudden death. You don't really get a chance to make lifestyle changes to prolong your life. Another one I remember is a 22-year-old college student who missed class.
17:04
Roommate found him unresponsive on the couch. He just basically looked like he was sleeping. And many times people will leave people alone. You know, they'll be like, yeah, they're sleeping. I'm just going to let them sleep.
17:14
And they're not breathing. Two vape pens and a single pill that someone gave him the night before. He thought it was a pain pill, but it was fentanyl pressed to look like hydrocodone. So, his respiratory rate slowed until it stopped.
17:31
His phone showed that he'd been texting friends about a party. We always look at the phone. He never knew he was in danger. Toxicology showed a lethal level of fentanyl. No other drugs in his system.
17:45
He had no intention of taking his own life, but one pill took his life. And his parents kept saying, you know, he was smart. He did well in school. He never bought drugs. But the one time he did, it was contaminated.
18:04
A lot of times when a young person dies, there's minimal external signs. So, the story kind of sits inside the body. And we do pay close attention to our surroundings, obviously drug paraphernalia, those types of things.
18:20
Are there any cold medicines or cough medicines in the room that might indicate that the person has been sick? But the story's really inside the body. So, on cardiac deaths, we're going to see thickened heart walls, enlarged heart chambers.
18:35
When it's from infection or sepsis, we're going to see fluid in the lungs and pneumonia and swollen tissues. And for overdoses, again, we're going to see pulmonary edema and this pink, frothy fluid. Their heart's going to be heavy.
18:51
For suicides, of course, we're going to see ligature marks and gunshot wounds and toxicology results if it was from an overdose or self-inflicted injuries. Families always ask me, were they in pain? Did they suffer?
19:07
But most fatal self-harm events are fast. Some are not, but it's important when we notify family to let them know that most self-harm events are fast. Families always want facts, and they also need compassion.
19:24
So we have to kind of balance both, but we have to explain what happened using clear language and trying not to use medical language. And they want to know what the person felt. And then we tell them they likely did not feel.
19:39
And we answer the questions families ask over and over, was this preventable? And sometimes yes, and sometimes no. Sometimes someone was just sick and had no idea. We help families understand the difference between blame and biology.
19:56
Most parents want someone to fault. Most partners want answers because they feel guilty. So, my job is really to give truth without cruelty. It's no one's fault. We've had, I can remember, the hardest cases are the ones just where the person shows no symptoms.
20:16
The heart looked fine on the outside. The lungs looked fine. The person acted normal the night before. Sometimes the first symptom is death, and that reality breaks families and investigators. We kind of learn to accept that biology doesn't really follow rules, and youth doesn't guarantee protection.
20:36
Perfect diets and workouts don't guarantee longevity. People die at 18, they die at 22, and they die at 35. Sometimes science finds the answer, but sometimes it doesn't. Each sudden young death triggers a full investigation, though.
20:56
We're going to do a scene exam. We're going to do a medical history review. The doctors are going to do an autopsy. They're most likely going to do toxicology. And we're going to interview. We're going to talk to families.
21:08
We're going to talk to friends. We're going to try to find out what's been going on. We look at medications. We look at lifestyle. We look at recent illnesses, anything that might explain why a healthy person collapsed.
21:23
And the report becomes the family's record, and they read it for years, and they use it to process grief. And they also can use it to warn other family members if the cause is genetic. A lot of people ask me, I don't want them to do a full autopsy.
21:41
And I know that it sounds cruel, but sometimes they find genetic disorders that other people in the family can get checked for and can get treated for that could save their life. So, in those ways, it is very important.
21:58
My case yesterday, the last thing the mom told me when I asked her if she's been sick because she was 40 was that something was wrong with her throat. She was having trouble talking. She could speak.
22:10
So she could have been having a stroke. I'm not sure because I, you know, wasn't there and didn't see. But I can remember the case of a 27-year-old teacher who had a sore throat, went to urgent care.
22:22
They sent her home with instructions to rest, and she died the next morning. She had very aggressive group A strep that moved into her bloodstream. Her blood pressure crashed, her organs shut down, and she did not get help in time because the symptoms looked like a cold.
22:41
Her autopsy showed widespread infection. Her family blamed the urgent care for missing the diagnosis. But the truth is really hard to accept when someone is so young and the infection moved faster than her body could cite it.
23:00
Sudden young deaths leave holes that never close, and they leave a lot of unanswered questions, and they leave guilt and confusion, but they also leave lessons. So, this is one thing. My big takeaway, my husband used to say when we first met, you go to the doctor too much.
23:21
Take your symptoms seriously. If you're having chest pain, no matter your age, 18, 80, don't ignore it. If you passed out for no known reason, like if you're giving blood, that's one thing because a lot of people pass out.
23:39
I have a few people that pass out at the med spa when I'm doing their Botox. But if you faint for no reason, don't ignore it. If you are short of breath and you're having trouble breathing, don't ignore it.
23:53
Know your family history, and this is important too. Ask your parents, and a lot of people are adopted, so sometimes we have no knowledge of family history on people, and that makes it more difficult.
24:05
But know your family history. We ask that a lot, young boys or young men, is their father living? Does he have a history of heart problems? Are there any genetic diagnoses in the family? So, knowing your family history is very important.
24:24
Know your mom's history. Know your dad's history even further back. Siblings. Get checked if something feels wrong. One appointment can save your life. Yes, they can miss the diagnosis. Yes, it can be mistreated.
24:42
But don't ignore the symptoms. One appointment can save your life. So, if you've lost someone young, you're definitely not alone. Families around the world face this same nightmare, and investigators like me walk into those homes every day.
25:00
I wish I could say that those cases got easier, but they don't. I mean, after 20 years, they're not any easier. It's devastating to walk into the home after anyone dies, much less a young person who's only been sick for 24 hours or experimented with a pain pill that was laced and died.
25:24
But they don't get any easier. But sometimes sharing these stories helps honor the people who should still be here and could maybe save a life. I do think that it's super important, though, to recognize your symptoms.
25:42
If you're feeling bad, if you're short of breath, don't think that you're being dumb. If it's not an emergency, don't go to the ER. But you can go to your family practice doctor. You can go to an urgent care clinic.
25:54
It doesn't matter your age. I know this is a little bit different than some of my previous episodes, but this past month, we've had so many young people pass away. So, I like to use this platform to educate a little bit.
26:10
And I am going to start an education platform for everybody, people who love true crime, people who are interested in forensic nursing, nurses in general, and then also law enforcement, because there's so much to know.
26:26
And I mean, obviously, I don't know it all. I learn something new every day, every single day. I just kind of felt the need this week to educate a little bit because I see way too many young people who, you know, they don't go to the doctor.
26:43
They're not treated with antibiotics. The infection takes over their body, and they just can't fight it. It's flu season. And I mean, just don't ignore your symptoms. A lot of people, older people, not old, but I mean, I had someone, last week die, 45, most likely a heart attack.
27:01
Family history of heart disease. Dad died at the same age. Get checked out. You know, go see a cardiologist and tell them your family history and kind of try to stay on top of it. Make sure that you're healthy and stay healthy for your family.
27:17
Again, I just felt the need to educate this week. We just have seen a lot in these cases or real cases that I've seen, the ones I talked about, and some of them preventable, some are not. But I think that we can all learn from them regardless.
27:35
And again, the symptoms are just, they're so important. If you are super fatigued and you don't know why and it's unexplained, please go to the doctor. Just get checked out. If you're having chest pain, don't assume that it's just heartburn because when they find you deceased in bed and I see an empty bottle of Tums, I pretty much know that someone's been experiencing heartburn, had a heart attack and just didn't know it and never got checked out.
28:06
Those things are just so important. Again, I'm not saying be paranoid and be a hypochondriac and run to the emergency room every time something happens, but it is important to listen to your body and understand that sometimes those symptoms are your body trying to tell you something.
28:24
So anyway, I'm super excited about retirement, a little scared, but I'm excited to continue forensics in the aspect of education. And then also I'll be doing some part-time investigations and finishing school.
28:43
I had one class left. And then I'll start clinical in May of 2026. So, I don't graduate till spring of 27, which seems like forever, but I know it'll go fast. So anyway, I hope that y'all have an amazing rest of your week.
28:59
And to all my new followers, welcome. We are so glad to have you here. And I do answer every message personally. So, if you have any questions, always feel free to message me. Julie at pushinguplilies.com is my email.
29:15
You can also send me a note on the website, pushinguplilies.com. And don't forget to visit the murder merch store. All right, I'll see you all next week. Bye. Thank you so much for joining me today on Pushing Up Lilies.
29:31
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