SIREN WAILS The surprise death of Anna Nicole Smith. The modern-day Marilyn Monroe slipped into unconsciousness in her Florida hotel room. Just 39 years old. What happened? At 2.49pm on February the 8th 2007, Anna Nicole Smith ` Playboy cover-girl, fashion model and tabloid target ` is pronounced dead in Florida. A sudden shocking end to a turbulent life lived in the tabloids and touched by tragedy. A small-town girl, she modelled her rise to fame on Marilyn Monroe. She idolised her in life and emulates her in death ` apparently ending in excess and overdose. In wake of her sudden and mysterious death, police launch an investigation. No illegal drugs in her hotel room. No sign of trauma. No evidence of a crime. But it is Anna Nicole herself who, in death, gives us the vital clues. An autopsy begins tomorrow to try to determine the cause of death. Within hours, her body is pored over by a team of medical experts trying to discover what really killed her. TENSE MUSIC World-renowned forensic pathologist Professor Richard Shepherd has been conducting high-profile autopsies for more than 25 years. The fascinating thing about an autopsy is it doesn't just tell you how a person died; it can tell you even more about how they lived. It is non-judgemental. It is a scientific acquisition of facts. And the fact that an individual is a celebrity makes no difference at all. There are no celebrities on a mortuary slab. PEOPLE CHATTER, SHOUT Anna Nicole Smith's rapid rise to fame seemed to be the embodiment of the American dream. A small-town stripper who became a Playboy sensation, international fashion model and a star of the silver screen. But she also found fame for her wild lifestyle, acrimonious court battles and, in one of the most bizarre episodes in her colourful life, marrying an oil billionaire 63 years her senior. Could events in her remarkable life also hold the key to understanding her sudden death? This is a coroner's autopsy report on Vickie Lynn Marshall ` more famously known, of course, as Anna Nicole Smith ` and if you know how to read it, it pretty much tells you the whole story of her life, but, crucially, it can tell you about the days and hours leading up to her death. February the 5th 2007. Anna Nicole Smith has had the most traumatic six months of her life. She'd given birth to a baby girl but then experienced the emotional turmoil of losing her son, Daniel. Now she's on a break in Florida with her boyfriend and lawyer, Howard K Stern, and her psychiatrist, Dr Khristine Eroshevich. TENSE MUSIC But since arriving, she's been feeling nauseous and is burning up. OMINOUS MUSIC She's gripped by a vicious fever, and her temperature has rocketed to a potentially life-threatening 105 degrees. A temperature of 105 degrees Fahrenheit is a marker of a very serious illness and requires very rapid treatment, preferably in a medical facility. To ease Anna's symptoms, Dr Eroshevich gives her some tablets of paracetamol. OMINOUS MUSIC By the time Anna arrived at her hotel, her condition had deteriorated even further, and her bodyguard, Big Moe, instantly realised she was in grave danger. I remember telling them that we needed to take her to the hospital, because, oh man, she was burning up. I had her screaming, 'No, I don't need to go to the hospital!' I said, 'Look, you need to go to hospital.' But Anna is adamant she won't go. Her main reason why she didn't want to go was because she said the paparazzi would be all over it, 'They're watching me. I just can't have this.' Anna's career thrived on the oxygen of publicity. Anna was one of those rare creatures who loved the cameras, and the cameras loved her. There were times when she would just transform into this glowing creature, this glowing beauty. It was an incredible moment in Hollywood history, and it really helped with her rise to fame. With the press on her side, her career took off. Through her modelling and acting, she was earning millions of dollars every year. But then in 1994, the paparazzi turned against her. TENSE MUSIC They exposed a near-fatal overdose from alcohol and prescription drugs. Overnight, modelling contracts were cancelled, and she lost millions. And what she did next sealed her fate with the press. REPORTERS CLAMOUR She married 89-year-old oil billionaire J Howard Marshall. She was labelled the ultimate gold-digger. It suddenly becomes a media joke. The world is laughing is at her, and everyone is having jokes at her expense. From that moment on, she was seen as fair game by the press. They were climbing up the walls. They were looking into windows. There were people on the other side of the mountain with big lenses trying to get her` I mean, she had no privacy. So, yeah, you would get paranoid. No, no! Since arriving in Florida, Anna is burning up with a high fever. But her mistrust of the press means she is refusing to seek medical help. Fevers are caused by a number of factors ` a virus, alcohol withdrawal, sunstroke and some diseases. And if whatever is causing that temperature isn't diagnosed and treated, then there is a very real possibility that she is actually going to die. Oh! (GROANS) Her fever shows no signs of abating. So with her temperature at a near-fatal 105 degrees, her friends take matters into their own hands. OMINOUS MUSIC I said, 'Well, I'm gonna give you a couple of hours to get right.' So I picked her up and put her in the cold water. TENSE MUSIC Come on. That's it. OK. < You're burning up, baby. You're too hot. I said, 'If the temperature doesn't go down, you can hate me, but you're going to the hospital. 'I'm taking you no matter what.' Gradually, Anna's temperature starts to fall. But it isn't just the cold water that is aiding her recovery. It would've reduced her temperature, but we know from the toxicology report that she'd also been given acetaminophen ` simple paracetamol. And it's likely that that drug was far more effective in lowering her temperature down than the dramatic immersion in cold water. Yet in just three days' time, Anna will be dead. Could the key to her mysterious death lie with the stresses she put her body through to achieve the fame she so desperately craved? TENSE MUSIC The most striking feature of the examination of Anna Nicole Smith's body was the size of the breasts. And further examination revealed scarring beneath the breasts, which, of course, is typical of breast enlargement surgery. Of course, many people have breast enlargements, but few people go to this extreme level. Determined to become famous, Anna didn't have just one set of implants but two, inflating her bust to a 38 double-D. Anna then enters a competition to become a Playboy model. Although she doesn't win, Hugh Hefner sees something that he likes about her and next thing splashes her across the cover. She became an overnight sensation and moved to LA, where everyone wanted a piece of this blonde bombshell, including fashion brand Guess, who awarded her one of the biggest modelling contracts of all time, worth millions of dollars. She freaked out, like, 'Oh my God, I'm` I've done it. I` This is what I came here to do. 'I came to Hollywood to be a star.' Her whole world changed. She was hailed as the new Marilyn Monroe. Her double breast augmentation had had catapulted Anna to fame, fortune and comparison with her idol. But this physical transformation also pushed her body to extremes. 1 TENSE MUSIC (SIGHS) BEEPING, INDISTINCT SPEECH LOUD CLANGING CLATTERING CAR ALARM CHIRPS TENSE MUSIC UPBEAT MUSIC This room is properly insulated, and it's at a temperature of 20 degrees. And this one's the same size. It's also properly insulated, and the temperature is 20 degrees. So what's the difference? This home is costing at least twice as much to heat... as this one. And it's all down to the choice of heating. Traditional heaters like this can warm a room, but you use a lot of electricity doing it, while energy-efficient heating systems like Energy Star flued gas heaters, modern wood burners, wood pallet burners and Energy Star heat pumps produce heat more efficiently and cost less to run. Go to energywise.govt.nz for advice on choosing an efficient heating system. Here's a tip ` if you do use electric heaters, make use of the timer and thermostat features. Heating is about a third of your energy bill. Energy-efficient heating helps to give you a warmer, drier, healthier home. That means we're all using less energy too. See you next time. But this physical transformation also pushed her body to extremes. Once you start pursuing volume and size and ignoring natural anatomy, that's when you run into problems. You're crossing the line from enhancement to distortion. Anna's twin implants were a step too far. Eventually, her skin on her breasts split in the nipple area. It was oozing. It was sore. It was hurting her. There was pus coming out of her breasts, and I had to rush her to the hospital. She had to have them removed, put back in, removed, put back in. I mean, she had so many different surgeries. And the size of her implants also caused Anna painful physical problems. There's the sheer physical weight of carrying two implants this size around. This is nearly 1400ml of fluid, which must weigh in the region of 1.5kg to 2kg. It just started hurting her lower back. It started hurting her middle back and her upper back. It got to the point where it was so severe, she would just wake up in the middle` just in tears. 'Ray, I can't take it. I can't take it.' Rather than risk her career with a breast reduction, Anna turned to Vicodin, a prescription drug containing the painkillers codeine and paracetamol, to ease the agony. Soon she was hooked. Addiction begins with one simple pill. The reality is you take one; it makes you feel good. You take another because it makes you feel even better. And in the end you recognise that it gives you relief from emotional and physical pain. And if you've got that kind of personality, the likelihood is you look to numb it further and further and further. The autopsy reveals that by the time of her death, Anna had been prescribed an even more powerful painkiller. One drug really stands out in the toxicology, and that's methadone. Methadone is a very powerful opiate drug. It's used often to wean people off their use of heroin. It can be used for treating very serious chronic pain, but it is addictive. And it's also been known to cause sudden death. TENSE MUSIC Like all opiates, methadone slows down the lungs. At high doses, it can cause breathing to stop altogether, and death is inevitable. But methadone can't be Anna's killer. The toxicology report shows that there are traces of methadone found in her bile but not in her blood and not in other samples taken at the body, which shows that she has taken methadone but some days before her death. So she's not taken methadone during her time in Florida. Tuesday the 6th of February 2007 ` after a good night's sleep, Anna's mystery fever has returned with a vengeance. Her temperature has rocketed once more, and she has been vomiting and has diarrhoea. When the coroner performs his internal examination, he does notice that she's got a mild gastroenteritis. Infections like gastroenteritis cause the release of chemicals into the blood. These reset the body's thermostat in the hypothalamus of the brain, making the body run hot. But with gastroenteritis, this only happens in virulent infections, and Anna has a mild case. It's nowhere near severe enough to cause the symptoms that she's been showing. But her symptoms are about to escalate. Anna. Anna. (LAUGHS) Anna. (LAUGHS) Look, I` Come on. She starts to behave erratically, leaving her boyfriend and lawyer, Howard K Stern, to deal with an increasingly out-of-control patient. And the autopsy reveals a clue about this strange behaviour. The toxicology report shows that Anna Nicole Smith was taking Valium. Valium's a benzodiazepine drug that's commonly used to treat anxiety and depression. But what's unusual is that she was also taking three other different types of benzodiazepines. Usually, these drugs sedate, but at high doses they cause a strange reaction known as the paradoxical effect. The paradoxical effect of a drug is the opposite of what you'd expect it to do, and with benzodiazepines the paradoxical effects leads to aggression. It leads to disinhibition. It leads to bizarre behaviour. Howard, let's dance. Howard, I wanna dance. Howard, let's dance. Howard, I wanna dance. No, Anna. I'm so sexy. Anna has relied on these powerful anti-anxiety drugs for nearly 12 years. Come on. In 1995, after just 13 months of marriage, 90-year-old J Howard Marshall died, leaving Anna devastated. J Howard Marshall was the man she loved more than anything on this earth, as far as men were concerned, cos she knew he would never harm her. He would always protect her and always take care of her. But Marshall's family saw Anna as an opportunist and stood in the way of her inheriting his millions. Anna was frozen out of his fortune, and the media felt that was the moment the gold-digger had had her comeuppance. She started a court battle for her inheritance, which became increasingly acrimonious. It was destroying her. She said, 'Ray, I don't care any more. 'What happens now is I gotta go through this crap again.' To cope with the lawsuit and losing Howard, Anna turned more and more to benzodiazepines. By the time of her death, she was taking them in massive quantities. It's very unusual to take four drugs to treat the same set of symptoms, and it's a very strong indication of benzodiazepine addiction. These drugs can be killers. Just like methadone, at high doses they can stop the lungs from working altogether. So could these have killed Anna Nicole Smith? We know there were a cocktail of benzodiazepines in Anna Nicole Smith's system. And these are drugs that will cause depression of respiration, and taken at sufficient levels may actually stop respiration. But they weren't high enough on their own to cause her death. But the autopsy didn't only find benzodiazepines in Anna's system. She relied on numerous prescription drugs. When you walked into the bathroom, it was like a pharmacy from one cabinet all the way to the other, lined up of all these different prescriptions. In the two years leading up to her death, Anna's medical records reveal she was taking over 70 different prescription meds. The problem with prescribed drugs is that it gives people a sense of legitimacy. They imagine that because their doctor gives them them, they must be safe, and they separate themselves from people who take crack or cocaine. They see them as different. 'They're addicts. We're people with prescriptions.' And that causes a psychological issue. It means that they don't recognise the damage that those drugs are doing. Anna Nicole Smith! With Anna's many addictions came a spell in rehab, and some very public moments of weird and unpredictable behaviour. SLURS: If I ever record an album, I want this guy to produce mine. Make me beautiful duets, cos he's freakin' genius! And worse was to follow. This home video was shot when she was eight months pregnant. I think I just have a little gas. I think I'm just` I think I'm having some gas trouble. The emergence of the notorious clown video is extraordinarily disturbing. I need some gas poot stuff so I can poot it out. The sight of Anna looking so whacked out, so off her game, raises so many questions about how she was being looked after, who was doing this to her, how she was getting access to drugs. So, she's addicted to popping the pills, addicted to putting stuff in her body. She thinks that anything that she gets in her body is gonna make her feel better. That's what addicts do. TENSE MUSIC In the hours leading up to her death, Anna was openly taking at least 10 different drugs. This cocktail caused her to be delirious and uncoordinated. OMINOUS MUSIC Anna? Benzodiazepines have a number of side effects, which includes confusion, dizziness and instability. And if you're taking more than the prescribed dose, and if you're taking several different types of benzodiazepine together, these side effects are much more likely to be present and to cause problems. Injuries from even small falls, like Anna suffered, can contribute to death. So could this accident be key to her demise? The coroner's autopsy identified bruising to her back and her neck. They are minor injuries, and these are consistent with a fall and have not led on to cause any serious effects or contribute to her death. (GASPS, GROANS) For three days, Anna has been gripped by a fever, sending her temperature soaring to a potentially lethal 105 degrees. But the reason for this illness remains a mystery. Forensic pathologist Richard Shepherd is searching for possible causes in Anna's autopsy. When the buttocks were examined, there were multiple tiny scars scattered across both cheeks, and scars of that type are typical of repeated injections. Anna was an expert self-injector. By the time of her death, she only had one source of income ` a marketing deal with a dieting company, TrimSpa. She had to stay slim or lose this contract, and she was under the impression that vitamin injections were the answer. Anna would shoot herself with vitamin B12. In a short period of time ` when I say 'short period of time, in a four hour span ` maybe shoot herself three or four times. And the damage Anna Nicole's injecting habit caused to her skin is picked up in the autopsy. Looking at Anna's left buttock, it becomes clear that there is a large abscess associated with one of her injection sites. The needle has damaged the tissue of her buttock and allowed an infection to take hold beneath her skin. The immune system fights off this infection. The dead white blood cells collect as a ball of pus, forming an abscess. She showed me her abscess, and it looked very very infected. It was pussy, very red. That abscess would have caused intense pain and is the reason why she was feeling so unwell. SOMBRE MUSIC Anna's autopsy reveals that her infected abscess was probably the main cause of her mystery fever. In addition to the damage from self-injecting, Anna's skin tells another story. Her life was written all over her body. Tattoos can be decorative or they can have some symbolic meaning for someone and give a good marker as to things that have occurred in their life. And so tattoos can provide a lot of information to the background of an individual. Anna had religious symbols next to Playboy bunnies. There was a tattoo for her 5-month-old daughter Dannielynn. But this wasn't her only child. Aged just 18, she'd given birth to a boy, Daniel. She had Daniel when she was a teenager, so they kinda grew up together. Daniel was Anna's world. Then on September 2006, in the Bahamas, Anna Nicole Smith gave birth to her second child, a baby girl. Daniel was 2500 miles away in Los Angeles. TENSE MUSIC Daniel was terrified of flying. Unfortunately, you can't drive to the Bahamas. But Daniel overcame his fear. Anna could finally hold the two people she cared most about in the world. But this moment of joy would be short-lived. I got a phone call from Howard and Anna, screaming, crying and yelling... GRIM MUSIC ...that Daniel had died. SOMBRE MUSIC Moments after his arrival, Daniel had fallen asleep next to his mother and sister. He never woke up. What do you say to somebody`? There's nothing you can say to somebody at that moment, because you've got this` she'd just had this new, beautiful baby, and then she's dealing with the death of her son. I just took her in my arms, and she slept in my arms all night. What had caused Daniel to die at just 20 years of age? For Daniel to fly, he felt that he needed to be in some kind of sedation. He'd taken too many of the anti-anxiety drugs he'd been prescribed to conquer his fear of flying. She was devastated. She blamed herself. She blamed herself. She felt that she, uh, gave him no choice but to come over, knowing how he did not like flying. It was just` It was just too hard on her. Too hard on her. The day that Daniel died is the day she started dying. It's not OK to control your partner with threats. It's not OK to control who they spend time with,... ...how they use their phone or Facebook or how they dress. It's not OK to make them live in fear. It's not OK to say it's none of our business. Because it is our business. And it's not OK. Ever. But it is OK to ask for help. TENSE MUSIC In her grief, Anna began to suffer from insomnia, so Dr Eroshevich prescribed her the heavy-duty sedative chloral hydrate. Chloral hydrate's an old-fashioned sedative drug that was very common in Victorian times and was sometimes used to be slipped into people's drinks to cause sedation, when it was known as Mickey Finn. And Anna started taking more and more of this powerful sedative. A normal dose of chloral hydrate to help with sleep is between 1 and 2 teaspoons ` 5ml to 10ml ` but when we look at the level of the drug and the metabolite of the drug present in Anna Nicole Smith's blood, it's quite clear she's been taking far greater quantities than that and over a prolonged period of time. Chloral hydrate can cause nausea, vomiting, confusion, convulsions, slow and irregular heartbeats and even coma. Sometimes she would drink chloral hydrate out of a baby's bottle. She took the chloral hydrate because she would see Daniel in her sleep. And she says, 'Daniel ` he really needs me. I see him. And` I-I` He calls to me every night. 'That's why I have to go to sleep. I` That's the only time I have to see him.' Anna fell into a deep depression. SOMBRE MUSIC And the autopsy reveals that she also had an undiagnosed medical condition that would have exacerbated her misery. Anna Nicole Smith is suffering from chronic Hashimoto's thyroiditis, which is a very unusual disease of the thyroid. The thyroid gland in the neck produces hormones that regulate energy levels and mood. But in Hashimoto's thyroiditis, the body's own immune system attacks and destroys this gland. It's associated with depression and lethargy and a whole constellation of symptoms. But sometimes when it makes the gland underactive, it can cause weight gain. And Anna had well-publicised problems with her weight. In the early 2000s, she gained over 4 stone. Hashimoto's thyroiditis could explain this sudden change in her body shape, but the condition had gone undiagnosed during her life. So even though she didn't know she had the disease, we know from the autopsy that it was present, and it would have been having an effect upon her and causing changes to her body and her mood that she wouldn't have been able to predict or understand in the last years of her life. This condition would have magnified the depression she suffered after the death of her son. Her way of coping left damage picked up by the pathologists. On the internal examination, what catches the coroner's attention is the size of the liver. It's nearly double the normal weight ` over a kilogram heavier than it should be ` and this is a very strong indicator of long-term alcohol abuse or drug abuse. Despite extensive testing during the post-mortem, no alcohol was found in Anna's body. But many prescription medications were present. So, we know there were a cocktail of drugs in Anna Nicole Smith's system, which the toxicology shows she's been taking a lot of over a long period of time. Her growing dependence on these drugs began to worry some of those close to her. So, when I would go to Howard and tell him that she was taking too many drugs, he would say exactly what she would say ` 'She has a high tolerance to-to drugs, 'so she can take a lot of drugs and it won't affect her like normal people.' When people say they have a high tolerance, they're saying they have a high use of a drug. Of course, if you take something regularly, the effects are not going to work in the same way as they did initially. And that's why people take more and more of the same drug ` essentially to get the same effects. But many prescription medicines have side effects, especially if taken in high doses. People become very tolerant of particular drugs but aren't aware of the damage that it's doing to their internal organs, for example. That's why people die. Please! Please don't leave me! Come back! Where are you going? Why are you leaving me? Don't go! I'll be in touch. I'll be in touch. Don't leave me! No! By 2007, her escalating addictions meant that she became more and more reliant on her entourage, especially Howard K Stern and Dr Eroshevich. She even began to take drugs prescribed in their names. OMINOUS MUSIC What Anna wants, Anna gets. And if you didn't get it for her, she would get someone else to do it for her. So, you have to wonder why the people around her at the time of the last` last portion of her life, why` why they would want to do that. What did they stand to gain? Howard was a lawyer that's only client was Anna. He would do nothing else. Anna, as most people would say, was his meal ticket. Anna had surrounded herself by people who enabled her addictions. And the problem is that when your whole support network ` your friends, your allies, your colleagues ` are supporting your addiction, firstly, you don't have to face it, and secondly, the support network that is intrinsic to you does not exist. It's a powerful combination. In this case, it's a lethal combination. TENSE MUSIC Midday on the 8th of February 2007 ` Anna Nicole Smith is suffering from a high fever. Howard Stern leaves for a business meeting. Anna? Anna? But Anna is in a deep sleep. Let's go. Moe leaves her under the supervision of his wife, Tasma. I had something to do, and I had my wife, who's a nurse, just sit in the room and watch over her while she was asleep. Just after 1pm, Bridget, a family friend, arrives. Anna is slumped in bed. Her mouth is open and lips blue. Anna? She's not breathing! Anna! Anna! Anna? Anna! Anna! Come on, baby girl. I'm not gonna lose you. Anna! Come on, baby. Come on, girl. Hello, Moe? I get a frantic call from my wife saying that Anna's not breathing. She says, 'I'm doing CPR.' I just drop everything that I'm doing, and I'm hauling butt back. Come on, Anna, baby! Anna! Come on, girl. Tasma tries desperately to revive Anna, but she shows no signs of life. Come on, baby girl. You're gonna live, Anna. I get to the hotel, and I see my wife doing CPR. Come on, baby girl. I pick Anna up off the bed and put her on the floor, and I continue CPR, trying to bring her back. When Howard returns, Anna is still not breathing. Oh my God! What happened? Moe! Come on, baby. Come on, baby. Call 911. Some` Call 911! Somebody do something! Anna! Anna! Anna! Do something, Moe! Do something! Save her! Please, please, God! Where is she? Where is she? Get in here. Please. Rescue gets there. They show that she's, uh, flatlined. No pulse is found. I get in the ambulance with them. We ride over to the hospital. They work there` They work for another 45 minutes. So, I said a prayer over Anna while they were doing the CPR, and... she was gone. SOMBRE MUSIC At 2.49pm, Anna Nicole Smith is declared dead. I call my brother Pat, and I say, 'Pat, what's wrong? What's up?' He said, 'Ray, Anna died.' I said, 'What?' I just pulled over to the side, and I threw up. SOMBRE MUSIC I told her to take care. I gave her a kiss on the cheek. And she was gone. My friend, my little sister ` I called her my little sister ` was gone. All I kept on thinking is, 'You're right where you wanted to be. Maybe you're with Daniel now.' SOMBRE MUSIC But for the press, her sudden and tragic death left many unanswered questions. When a famous person dies in such mysterious circumstances, as a member of the media you have to question ` was it homicide, suicide or something more mysterious? The previous year had been the most turbulent in Anna's colourful life. The joy of giving birth to a daughter had been blown apart by the sudden and tragic death of her 20-year-old son, Daniel. GRIM MUSIC She sank into a deep depression and a growing dependence on prescription medications. By mid-October 2006, she'd been near breaking-point. A couple of days after Daniel was buried, she went out to the pool. And then next thing you know, I heard a splash. I looked down, and she floated down to the bottom of the water, so I dove head-first down 15ft in the water, pulled her out. She wasn't breathing at the time. She had drowned, and I immediately started CPR and brought her back. But despite this incident, in March 2007, the coroner decided her death couldn't be suicide. Her friends had stated that her depression had improved in the months before her death, and there was no suicide note. But could it have been murder? TENSE MUSIC There were no bruises on the body to suggest she'd been attacked and no trauma round her mouth to suggest she'd been force-fed anything. Given the combination of factors and events that led to the death of Anna Nicole Smith, suicide and homicide can't really be possibilities. And so the coroner's conclusion that her death was an accident must be correct. So how had this accident happened? In terms of the cause of death, the first thing to consider is ruling out any underlying natural disease processes in the main organs of the body, and all of those organs were examined. The brain showed a slight abnormality but not enough to cause a stroke or her death. The heart similarly showed some very minor changes, but, once again, these were not sufficient to cause her death. An examination of the lungs showed no evidence of any significant disease, and so we have to turn to other things. And in Anna Nicole Smith's case, it's the drugs. In the three years leading up to her death, Anna had been taking dozens of different drugs. She didn't really want to be seen as the victim, so she would numb herself, and she would self-medicate. We know there were a cocktail of drugs in Anna Nicole Smith's system. And the identification of four different types of benzodiazepines in the bloodstream, when added together with chloral hydrate, all suppress her respiration. When these drugs reach the lungs, they slow breathing and critically reduce their ability to oxygenate the body. At high levels, they can stop breathing altogether. But none of these drugs, either singly or combined, are at a level that have caused her death on their own. But if the body was weakened or compromised, this level of drugs could be lethal. Of course, we know there were other factors that were affecting her. She's got a mild gastroenteritis. And Anna didn't have just one infection. A constant self-administration of vitamins... meant that virulent bacteria had multiplied at the injection site. TENSE MUSIC This infection had started to spread. (SIGHS) The abscess cavity is fine when it's confined, but if the pus and the bacteria leak into the bloodstream from that abscess, they spread throughout the body. The infection caused septicaemia, or blood poisoning. Anna went into septic shock, sending her blood pressure plummeting. Blood flow slowed around her body, and less oxygen got to the tissues. The combination of four benzodiazepines and chloral hydrate had already critically slowed her lungs, meaning Anna couldn't supply enough oxygen to her body, and she died. There's the combination of factors combined together as a sort of perfect storm to act in unison to cause her death. RT CHATTER SIREN WAILS For Anna, dealing with the fame she had always craved proved to be her downfall. She always loved life. She loved life in excess, because she had the capacity to do it and because the red carpet was always available for her. Everybody deals with things differently, and it doesn't make you a bad person for that. She fell into a trap that only masked the situation, and she never quite dealt with all the problems. I talked to doctors. I talked to friends. I talked to people. 'Please let's get her institutionalised. 'Let's get her` She's not gonna live.' It was` It was a hopeless situation. You know, they say Anna died of a drug overdose, and I know she died of a broken heart. She just could not live without her son. To this day I do believe she just` just gave up on life because she didn't have her baby boy with her. SOLEMN MUSIC What's really poignant about Anna Nicole Smith's death is that it could've been avoided. The bacterial infection that tipped her over the edge could have been easily treated with antibiotics, but her mistrust and fear of the paparazzi meant she refused medical help. No! No hospital! No! Her main reason why she didn't wanna go was because she said the paparazzi would be all over it. She would not go. Ultimately, that decision cost Anna her life. (GROANS) Perhaps the sad thing about Anna Nicole Smith's death is that she seemed to have what many other people aspire to ` all the money and all the fame. And yet her lifestyle and her life choices meant that, sadly, this was an accident waiting to happen. Captions by Philip McKibbin. Edited by Pippa Jefferies. www.able.co.nz Captions were made possible with funding from NZ On Air. Copyright Able 2014