1 FOREBODING MUSIC Singer Karen Carpenter died of cardiac arrest today in a Downey California Hospital. Karen Carpenter was 32. Karen Carpenter was the voice of a generation. Karen and her brother, Richard, sang as The Carpenters, and they sold more than 60 million albums. The Carpenters' classic pop songs won them millions of fans worldwide. We detected a very slight pulse, weak pulse in her heart, but a pulse was not detectable. We called it cardiac arrest, and we're not saying she had a heart attack. For years, she was dogged with the rumours of an eating disorder. So why did Karen Carpenter die at the age of just 32? Autopsies are used to provide cold hard facts, not just about how someone died, but also about how they lived their life in the days, hours and minutes before their death. Copyright Able 2015 World-renowned forensic pathologist Dr Richard Shepherd has been doing high-profile autopsies for more than 25 years. His expertise has been called on in cases including Princess Diana, 9/11 and the Bloody Sunday inquiries. This is the extensive 25-page report produced by the coroner into the death of Karen Carpenter. Within these pages, if you know how to read them, is pretty much the whole story of her life. And in particular, the events of the last days and hours. INTENSE MUSIC 14th of January 1983, Karen and her brother, Richard, were at Hollywood restaurant Le St Germain with family friend Dennis Heath. After a long break, the Carpenters are in the studio again and are excited to be on their way with a new album. And as always, they were obsessing over the detail. I saw her at Le St Germain, just Rich, Karen and me. Yeah. And, uh, she seemed happy. She was, sort of, making jokes sometimes about Rich being very picky, but she was just as picky. She wanted it right. The Carpenters burst on to the music scene in the late 1960s. Well, our first contestants tonight come from California State College at Long Beach. They're The Dick Carpenter Trio. Then, as a duo over the next decade, they had a string of hits, including 'Goodbye To Love', 'Close To You', 'Please Mr Postman' and 'We've Only Just Begun'. Karen's homely voice captivated America. Her voice was extraordinary. And, you know, there are people who will tell you that that was one of the great voices of popular music. Sometimes she'd sing in the limousine when I was sitting with her, looking after her. She'd start singing, telling her story and start singing about something. And I'd be like that. Whoa! And it wasn't just Karen's voice that the American public fell in love with. She was ordinary, the girl next door. She was pretty; she wasn't a sexpot. She was relatable. This is what made The Carpenters a mainstream band. If she'd have been, you know, a busty girl in a bikini singing those songs, it would have been a different kind of audience. She didn't sing about sex; she sang about love. That's the image that everyone bought into. And this is basically what carried her so far in her career. But after a decade of success, recent record sales had been on a downward spiral. Their last number one was eight years ago, in 1975. For Karen and Richard, this was their last chance at a comeback. Sadly, that comeback would never happen. Karen Carpenter's autopsy report shows that she died as a result of the complications of anorexia nervosa. But she was 162cm in height ` that's 5'4", and she weighed 108 pounds, which is just on 7.5 stone, which means her BMI was 18.5, which for a woman of 32 is perfectly normal. So on the face of it, this doesn't add up. Despite being a healthy size at the time of her death, during her career, Karen had been dogged by speculation about her ever-fluctuating weight. Look at Karen performing here in concert in 1974. And then compare her appearance here in the early '80s. The weight loss is dramatically obvious. Within the showbiz world, there had been rumours for years that Karen was suffering from anorexia nervosa. Anorexia nervosa is a psychological disease with physical signs. The individual believes they are much fatter than they actually are. And they try and overcome this by dieting, by purging, excessive exercise and by taking laxatives. We unfortunately got caught in an era where you had to be super-skinny. All of a sudden, the hourglass figure went out, Twiggy came in, Cher came in. Karen took it to the extreme. She wanted to be pop star, but she also wanted to look like a pop star. And her vision of a pop star was thin as a stick. Unfortunately, she got caught in this syndrome where she just couldn't stop losing. FOREBODING MUSIC TYPING Just a week before her death, Karen is at home in her apartment, in the bathroom, investigating a sudden leak. Karen shared with a friend that she had been trying to fix, um, something under the sink in her condo, and while she was down there and working on that, she said that her heart was pounding so hard that it felt like it was gonna come out of her chest. (PANTS) The effects of anorexia nervosa can be catastrophic. Either you're not eating and taking nutrients, or you are eating and perhaps purging or taking laxatives to clear the nutrients out of your system very quickly. However you get there, the effects can be dehydration, dizziness, heart arrhythmias. And the autopsy shows there is damage to Karen's heart. So, what had Karen Carpenter done to her body that was causing such profound heart palpitations, and what was it that took this superstar from being apparently healthy to dead in less than a week? 1 On the 4th of February 1983, singing sensation Karen Carpenter collapsed at her parents' home in Downey, California. On arrival at Downey Community Hospital, she was pronounced dead. The world was shocked by her passing, asking why the voice of a generation had been lost at just 32 years old. Now, leading forensic pathologist Dr Richard Shepherd is unlocking the secrets of Karen Carpenter's autopsy and investigating rumours that she suffered from slimming disease anorexia nervosa. We can see from the autopsy report that she had a cyst on one of her ovaries called a corpus luteum cyst. This shows that she was continuing with her menstrual cycle. Commonly, severe anorexics stop their menstrual cycle, and the fact that Karen was continuing with her periods shows that she was not in a severe state. Similarly, her lungs, liver and kidneys were all the correct size and appeared to be working fine. Normally, you'd expect to see much more damage in the organs of someone suffering from anorexia nervosa. TRAFFIC WHOOSHES Just three days before her death, Karen and her brother, Richard, are meeting with stage producer Joe Layton to continue planning their musical comeback. There were talks of a summer tour, and she had said I'm back, I wanna be recording, I wanna be touring, and we wanna come back and, um, you know, make the same kind of statement that we did when we entered the 1970s. But behind the optimism, the autopsy reveals that Karen is keeping a deadly secret. While her body seemed healthy, the toxicology report shows that there were traces of a drug, emetine, present within her liver. Emetine is the active ingredient of ipecac syrup. And ipecac syrup is commonly used in casualty departments to get children to vomit if they've swallowed a poison. Ipecac syrup acts by irritating the lining of the stomach, causing the individual to vomit. (RETCHES, VOMITS, COUGHS) (COUGHS) We know that emetine can affect the heart when taken frequently or in excess. (PANTS, VOMITS) (COUGHS) For an anorexic to repeatedly use ipecac syrup with the emetine in it is extremely dangerous, and there have been reported cases of deaths due to emetine poisoning. But the levels of emetine found in Karen Carpenter were not enough on their own to cause her death. The most significant deduction from the presence of emetine shows that while Karen is back up to a good weight and she's apparently healthy, psychologically, she is still affected by anorexia nervosa and is still taking the drugs to cause her to vomit. In other words, she has not broken free from this terrible disease. Anorexia nervosa is a disease that is frequently connected with feelings of low self-esteem. But Karen Carpenter was an international pop star adored by millions, wealthy and from an apparently loving family background. So how did she succumb to this pernicious disease? Its roots could track back to childhood, where they may have felt, um, less than, and they may have felt that they weren't good enough as they were. And this kind of messaging can sow the seeds for lateral behaviour that leads to the anorexic disease. Karen Carpenter was a chubby little girl. She was nicknamed Fatso by the other kids in the neighbourhood. I remember her telling me that she felt she was fat when she was at school and people picked on her, you know, for that. And I don't think she ever forgot it. But it wasn't just the childhood bullying that scarred Karen ` the complex dynamics of the Carpenter family also played their part. Richard was very much the favourite child. Uh, he was pushed front and centre, especially by the mother, and Karen was very much in the background. Agnes Carpenter adored her son, Richard, so much that she moved the family to Los Angeles from Connecticut to nurture Richard's musical talent. And this gentleman right here, this handsome boy, is the leader. He is Dick. He plays the organ. Actually, it's not an organ, is it? Electric piano. Electric piano. And, of course, the young lady on the drums is Karen, his younger sister. Now, Karen used to hear Dick play, and she used to get so filled with rhythm that she'd play on the kitchen chairs and the table, and finally she decided, 'Well, I'd better get some drums.' She did that, decided to play along with Dick. So that was two of them. And she's been going strong ever since. Incidentally, she's a fine singer too, you're gonna find out. Richard cast a very big shadow. That was always the case. Growing up, Karen really looked up to him. From the time that they were little kids, Karen really just idolised and worshipped her older brother. She may have felt less than when compared with her brother, she may have struggled for her mother's attention, and all these different factors may have shaped how she saw herself. From the start of The Carpenters' career, Karen had been fighting two inner battles ` one with her weight and the other with her confidence. Karen really considered herself a drummer first and foremost, and the singing was sort of the extra. I know that Karen naturally was shy and that she forced herself out there. And she happened to have one of the most beautiful voices of all time. There's this great voice, but she's hidden behind a full set of drums. And so management starting talking about the need to get Karen to front the group. I think she'd have rather stayed behind the drums. (CHUCKLES) In fact, she once said that to me. She said, 'I think I'd rather stay behind the drums.' You can see the beginnings of not being in control of what's happening to her. So she may have felt, 'What have I got control of? Where can I be me?' And something like restricting food, controlling your own body may have been her vice. INTENSE MUSIC The roots of Karen's illness may be traced back to her childhood, but for her and many anorexics, it can be one specific event that triggers their descent into this devastating illness. 1 1978, and The Carpenters were global stars. They had 12 top-10 singles under their belt and had sold millions of records worldwide. But behind the clean-cut image, Richard, the golden boy of the family and Karen's best friend and hero, was falling apart. Like Karen, he was keeping a dark secret. Richard had also developed an addiction. Quaaludes were a drug that was used to treat insomnia and were known to be highly addictive. These things were fairly new, and the doctor prescribed them for my mother. And she said, 'Why don't you try one?' As the years went by, I started to take more. So what would happen is I'd take five or something like that. Uh, and within 15 minutes, I was gone. An hour later, I was up. Really? Take a few more. An hour later, a couple of hours later ` up. Uh, it was no good. INTENSE MUSIC It became a huge problem, to the point that they couldn't really function as a duo for a certain time. In 1978, The Carpenters were playing the MGM Grand in Las Vegas. And, uh, by this point, Richard was having such an ordeal with the addiction to Quaaludes that he was shaking quite a bit, and he was really unable to perform in the manner that he had done in the past. So at one point between shows, he came and announced to the band that they were quitting. INTENSE MUSIC WHOOSH! TYPING On the 10th of January 1979, Richard, accompanied by Karen, checked himself into a chemical dependency unit for his addiction. Karen was not known to make good decisions for her own health, but in the case of her brother, she took matters into her own hands and took him by air to, um, help with his addiction. If she'd perceived him as her rock and he's falling apart, what that might have done for her is also hold a mirror up to how she was feeling. INTENSE MUSIC Holding up a mirror is also showing up your cracks, and she may have begun to feel her desperation or feel emotional distress. And one of her coping mechanisms is to go further down the anorexic route, you know, restrict her food and use it as a way of coping with her distress rather than confronting her feelings. INTENSE MUSIC CONTINUES (SIGHS) MUSIC CONTINUES Anyone could just look at Karen Carpenter and see how bad things were going for her. You could see something wasn't right. I wasn't aware that she was suffering. I was aware she was awfully thin. I used to say to her, 'You've gotta eat something.' She'd say, 'Yeah, yeah.' She was melting away before our eyes. Everybody in show business knew that The Carpenters were in big trouble, personally and professionally as well. It later emerged that Karen Carpenter was, uh, taking, uh, a whole amount of, uh, dieting, uh, products. This came to light in New York, when Karen was staying with close friend Itchi Ramone, wife of legendary record producer Phil Ramone. Itchi ending up finding laxatives hidden in, uh, pillowcases, in Karen's shoes in the closet, and, um, even in the fruit bowl. And, um, once she confronted Karen about this, Karen was furious and felt that, you know, she had ruined the relationship, she had definitely ruined the trust. What happens with that kind of disease, it's in control of you. So whatever's available to hand, whatever they read about, hear about that will restrict weight gain or will accelerate weight loss, they will do it. According to friends, Karen was taking 80 to 90 Dulcolax a day. Dulcolax is a laxative. It's a drug that acts on the bowel to speed the passage of food through the bowel, and so lessen the absorption of food and aid weight loss. Toxicology labs don't routinely test for laxatives. And it's a drug or set of drugs that actually affect the bowel directly and don't enter the bloodstream. However, the autopsy does show that Karen was dehydrated. And one cause of dehydration is the purging of the body of fluid and food. So it's possible she was taking the untraceable laxatives at the time of her death. Karen always hid the fact... that she had anorexia. She would push her food around on her plate, she would hide it from everybody ` she never admitted it. It was very hard to say to Karen... you know, to talk to Karen about it if she didn't want to admit that she had a problem. INTENSE MUSIC You could see something wasn't right. And if I went out to eat with her or I was around looking after her, and suddenly I noticed she was pushing food around her plate and not really eating anything. The one thing she did like, she confessed to me, was Snicker bars. (CHUCKLES) She liked chocolate. Which sounds bizarre. I mean, she'd eat that, but she wouldn't eat anything else. With body image issues an everyday struggle, Karen turned to another drug, but one which seemingly had nothing to do with weight loss. Along with emetine, another drug found in Karen's body was lorazepam, which is prescribed as Ativan, a drug used to treat depression. And we know from the autopsy report that Karen suffered from depression. Karen's family didn't necessarily want to admit that she had an emotional or possibly psychological disorder. And luckily, she had several good friends. Frenda and Frenda's mother and father would very often take care of her. But the depression was really really deep. There were times that Frenda's mother would cradle Karen like a baby and hold her and rock her. There were times that Frenda fed there, that she spoon-fed her and, you know, 'Come on. Here comes the airplane,' like you would do with a baby. It was rough. And they knew for sure that she was depressed when the last thing she wanted to do was make music. But according to Dr Shepherd, what Karen was prescribed for her depression and the amount of pills she was taking doesn't add up. What's interesting is if we look at the report, we see that Karen was prescribed 100 Ativan tablets on the 10th of January to be taken at three per day, which means that she should have taken 75 tablets by the time she died, leaving just 25 in the bottle. But in fact, 60 tablets were present in the bottle, meaning that she hadn't taken 15 tablets during that time ` that's a whole five days without taking her antidepressants. Not taking Ativan regularly impairs their effects and leaves the individual much more likely to relapse back into the depressive state. And for Karen, battling with her anorexic behaviour, this might make her much more vulnerable to its catastrophic effects. However, on the eve of her musical comeback, Karen is presenting an excited front. But away from the public eye, The Carpenters were crumbling, as Karen fought a daily battle with anorexia and Richard was recovering from his own addiction to prescription drugs. We know that Karen had taken two drugs in the days leading up to her death ` emetine as part of the ipecac syrup, part of the purging; lorazepam or Ativan part of antidepressant treatment. This is very revealing in terms of her emotional state, but I don't think that either of these drugs directly caused her death. The key to understanding her sudden demise is actually a dramatic medical emergency that took place some four and a half months earlier. DRAMATIC MUSIC 1 Dr Richard Shepherd has been piecing together the last days of Karen Carpenter's life from the evidence listed in her autopsy. Autopsies by their nature are non-judgemental. They're simply an investigation into the medical facts behind a death. And they allow you to look at the situation behind the headlines. Karen and Richard Carpenter are planning a musical comeback. It's several years since their last record was released, and during this time, both had been struggling with dark secrets. Richard has been fighting an addiction to sleeping pills, and Karen has been plagued with weight issues, depression and addictions of her own. Together they have almost brought The Carpenters to an end. SIREN WAILS September 1982, it's four and a half months before her death, and Karen's weight has now plummeted to dangerous levels. To save her life, she's been admitted to hospital. When Karen died, she'd put on 30 pounds and weighed a reasonable 108 pounds. But just months previously, she'd been admitted to hospital weighing just 5.5 stone. At New York's Lenox Hill Hospital, severely dehydrated and dangerously underweight, Karen undergoes intense emergency treatment in an attempt to increase her weight. When Karen was admitted to hospital, she was treated by being fed intravenously through a tube. This is a process known as hyperalimentation. INTENSE MUSIC At the time Karen was admitted to Lenox Hill, she was 77 pounds of dehydrated skeleton. MUSIC CONTINUES Until you actually see someone, it doesn't really hit you. To see her live and very thin was a little bit shocking. Being fed intravenously and almost forced to gain weight to save your own life could be one route that people do take, because, you know, anorexia kills. But over the course of a week, the intensive treatment started to bring Karen back from the brink of death. Karen's family and friends were ecstatic to hear that she'd gained weight. She was up over 100 pounds. And she was, um, really, in their eyes, I think, making progress. And that was something that meant a lot to her. She could finally say, 'Look at me, look what I've been doing, and I'm getting better.' But for the anorexic, it's not treating the psychological problems that are lying beneath that. And that may just trigger them into another cycle of wanting to take control. 'You are doing this to me, 'and I'm going to fight you, cos I'm determined to do things for myself. Don't tell me what to do.' SIREN WAILS INDISTINCT CONVERSATIONS It's the night before Karen Carpenter's death. Out of hospital and back in Downey, Karen is staying with her parents. Now glowing at a healthy 108 pounds, she's out having early supper with Agnes and Harold. She orders her usual shrimp salad, and then, unusually, asks for an extra serving. As is evident in this interview recorded shortly after Karen's death with her mother, Agnes, even though Karen appeared to be back to a healthy weight, Agnes had no idea that her daughter was still engaging in anorexic behaviour in the days leading up to her untimely death. Anorexia is a secretive illness, because they spend a lot of time hiding their thinning body, and they hide from other people, in plain sight, what they're actually up to. And they do everything to mask that. They can sit down to a family meal, for instance, with a plate full of food and play all kinds of tricks and games to distract people from what they're actually up to, because the anorexic is incredibly clever at hiding their condition. One of the strangest parts of the report is the presence of material in her stomach that's described as dry and hydrous material, like tea leaves, which was distending her stomach. But there was no evidence of any significant residue of the evening meal that she'd had the night before, which raises the possibility that she may have been vomiting to get rid of the food and taking the filler to replace it or she may actually still have been taking significant quantities of the laxative to speed its transition through the bowel. TYPING It's the early hours of Friday morning. Karen speaks to her friend Frenda. They're due to meet up at noon for a manicure, but Karen complains that her chest feels tired. We can see from the autopsy report that apart from some minor changes in the heart that can only be seen under the microscope, all of the vital organs are in pretty good shape. As we know, due to the poison in the ipecac syrup, the muscles in Karen's heart showed significant thinning, which is very unusual. And this may well explain her breathlessness. POIGNANT MUSIC Later that evening, a worried Frenda rings back to check on Karen, so Agnes looks in on her. It's the last time she'll see her daughter alive. POIGNANT MUSIC It's the early hours of Friday morning. Karen Carpenter is awake, but still not feeling well. She heads to the kitchen to make coffee. POIGNANT MUSIC The fact that she was able to go and make coffee that morning is hugely important, because it shows that something very sudden must have happened to her body to cause her to collapse and die at that moment. What's evident is that Karen's mother was oblivious to how ill her daughter had become. FOREBODING MUSIC Agnes awoke that morning and went down for coffee. DRAMATIC MUSIC But her concern grew when Karen didn't answer her calls. Karen, coffee's ready! What are you doing? Karen? Karen, darling? Karen! Karen? (SOBS) What are you doing? (SOBS) (SOBS) Karen! Karen! No! Come here, honey. (SOBS) The autopsy report shows there are no bruises associated with the fall, and this is important, because it suggests that Karen crumpled to the floor rather than collapsed like a felled tree. And this would be consistent with some sort of cardiac event. Karen! Oh! Agnes calls for help and attempts to resuscitate her daughter. Florine Elie, the housekeeper, arrives and tries to help the distraught Agnes. Karen! Oh! Harold! Harold! Help me! Harold Carpenter calls 911. Stand back! Stand back! As paramedics from the Downey Fire Department arrive, Karen is unconscious, but they detect a slight pulse. (SOBS) (SOBS) Karen? They move her to the middle of the floor and begin CPR. Karen? We detected a very slight pulse, weak pulse within her heart, but a pulse was not detectable. We called it cardiac arrest, and we're not saying she had a heart attack ` her heart had stopped beating. So we started basic life support systems, which is cardiopulmonary resuscitation. A distressed Agnes calls Richard. PHONE RINGS He immediately gets up and hurries to her side. TENSE MUSIC Karen is rushed into Downey Community Hospital, stops breathing and goes into full cardiac arrest. MUSIC CONTINUES MONITOR BEEPS The emergency team spend 28 minutes trying to resuscitate Karen Carpenter. MONITOR BEEPS TENSE MUSIC MONITOR BEEPS MUSIC INTENSIFIES But their efforts come to nothing. MONITOR FLATLINES And Karen Carpenter is pronounced dead at 9.51 on February the 4th... 1983. SAD MUSIC And I was driving back to my place in Hollywood, and I heard it on the radio. Singer Karen Carpenter died of cardiac arrest today in a Downey California hospital. Karen Carpenter was 32. I mean, I practically drove off the road, you know? That night, we were supposed to have dinner together. I was travelling back to Los Angeles, and I got into the limo, and I was driving to the airport. And they announced on the radio that Karen had died. And I can remember falling on the floor of the limousine. I remember hearing it and being really sad and shocked, but somehow, I wasn't surprised. You know, I wasn't. Uh, but of course I wasn't. I mean, you know, she was a wonderful lady. Karen and her brother, Richard, sang as The Carpenters, and they sold more than 60 million albums. The suddenness of the death, the shocking nature of it, it really stunned the world. A lot of people in music were taken aback. It was a major shock to people and a major tragedy. And the fact that, you know, whatever they'd been doing in terms of record sales or whatever, it still brought to an end, uh, you know, an era. I mean, there would never be another Carpenters. POIGNANT MUSIC I was here in Los Angeles for her funeral, and, uh,... it was just awful. Because she was so young, and she shouldn't have gone that soon. POIGNANT MUSIC The world was stunned. People loved Karen Carpenter. What a huge turnout for her funeral! 1000 people, uh, just coming to say goodbye to Karen. When it was announced that Karen had died of heart failure, it was really puzzling how a 32-year-old woman who to most of the world was seemingly healthy ` a lot of people weren't aware of the eating disorder ` so it was definitely puzzling how someone her age could just die. The pathologist had carried out an extensive examination on the body of Karen Carpenter, and the findings weren't straightforward. And it would appear there were a number of contributing factors to her death, but there are reports that she had been taking a drug that was tantamount to suicide. 1 On the 4th of February 1983, singing legend Karen Carpenter was found unconscious in her bedroom by her mother, Agnes. Despite attempts by paramedics to revive her, she was pronounced dead at Downey Community Hospital at 9.51am. POIGNANT MUSIC She was a huge talent, I mean, massive. There's nobody can sing better. Never has been and never will be. She was unbelievable. She's a great loss to music, apart from a lot of other things. I think she could have produced some great stuff, but I think she was just insecure. Well, she will always be one of the best voices in music. You know, along with Edith Piaf, there's Karen Carpenter. Now forensic pathologist Dr Richard Shepherd is trying to discover what killed her. The autopsy report shows there were no bruises on Karen that would be associated with a collapse. And this is important because it suggests that Karen crumpled to the floor. At the scene, a slight pulse was detected by the paramedics, so clearly, her heart hadn't stopped working completely, but something had very seriously affected it. SIREN WAILS The autopsy report shows that she had some pink frothy fluid in her lung, pulmonary oedema, that's associated with acute heart failure. And we know from the toxicology report that Karen was taking emetine, a drug that you take to make yourself vomit and that's present in ipecac syrup. Emetine is a poison if it is taken frequently and to excess. Emetine's effect on the body is to damage the heart muscle. But emetine alone wouldn't have been enough to cause her death. So what was it that was dragging Karen Carpenter towards her grave? Just one year before she died, Karen, encouraged by her brother, Richard, decided to relocate to New York in a bid to start dealing with her weight issues. She decided to seek the help of renowned psychotherapist Steven Levenkron. It was there, during these confidential and very personal sessions, that Karen would reveal the last and deadliest of her secrets ` she was also taking another drug that would have had a very substantial impact on her heart. As Steven Levenkron went over all of Karen's medications with her, he discovered that she had been taking a thyroid medication. Karen was taking large amounts of this drug, even though under normal medical supervision, it is only prescribed in very small doses. Despite his years of helping anorexics, Levenkron had never seen someone abuse this potentially dangerous substance to such a degree. The drug was called Synthroid. This is a thyroid-hormone-type drug. Thyroid hormone is normally produced by the thyroid gland in the neck, and it controls the metabolic rate of the body. Synthroid would normally be given to people whose thyroids were underactive, but there's no suggestion that Karen suffered from an underactive thyroid. And so the use of Synthroid suggests that she was trying to speed her metabolic rate to assist in her weight loss. It just sounds like Karen was so in the grip of anorexic thinking. Other people around her would have said, 'Gosh, she's just a bag of bones.' To her, in her mind's eye, she was bigger than she actually was. So she would have done anything, taken any drug to reduce that perceived size. So she would engage in any behaviour that led her down that path. Karen privately confessed to Levenkron that she'd been ingesting 10 times the recommended dosage of thyroid pills a night. This would potentially take her heart rate up to a staggering 150 beats per minute. Playing round with thyroid drugs can be very dangerous. The effect of the increased metabolic rate also causes an increase in the heart rate, and the effect on a weakened heart can be catastrophic. Hearing that anorexia kills you, to somebody in the grip of an illness like that, and the illness is in control, they may hear it on an intellectual level, but on a psychological and emotional level, they may still be in a grave state of denial ` it won't happen to me. Both thyroid hormone and the synthetic thyroid hormone Synthroid are very rapidly metabolised by the body in life, and so the absence of the drug in the body after death doesn't mean that Karen wasn't taking it. However, routine toxicological testing probably wouldn't have detected the presence of Synthroid. Levenkron took the drugs from her and ordered her to stop taking it immediately. Yet just nine months later Karen was in hospital being fed intravenously, as her weight had plummeted. In anorexia and starvation, the body initially starts using up the body fat to maintain the energy it needs. Once all the body fat is gone, it starts metabolising the internal organs, using up the protein that's present there, and that will cause damage to those internal organs. In Karen's case, her heart is somewhat smaller than one would expect for someone of her stature. And it seems likely that the damage that was caused to her heart occurred while she was losing weight down to the 5.5 stone that she was at her lowest point. And that damage to her heart, once it was caused, was going to be there forever. With her heart now feeling the full force of the cocktail of drugs and her body fighting malnutrition, the countdown clock on her life had begun. I believe the reason that Karen Carpenter died was due to a combination of the elements of her anorexia nervosa. Her heart had shrunk as a result of her dramatic weight loss, the emetine had thinned the muscle fibres of the heart, and the Synthroid had overstimulated the small but vital organ, so that at 0951 on the 4th of February 1983,... the heart developed an arrhythmia, and then stopped. FOREBODING MUSIC I think Karen unknowingly was doing a lot of really dangerous things to her body. I don't think she had any clue what all of these things might come together to be, that perfect storm that took her from us. She was a trooper, total trooper. The show must go on at all cost. She'd put on her make-up, put on her fur coat and say, 'Let's go and do another interview.' And she was probably throwing up two minutes before, I have no idea, but, you know, that's what she was like. She was on it. She was, you know... When she was on stage, nobody would have a clue what she was going through or what she was doing ` she would just be lights, action, on it. Of course, back in the '80s, the treatments for anorexia were much less developed. And I'm sure if Karen had been around now, she may well have survived this dreadful illness. Anorexia and the management of the illness has changed substantially since then. We have learned a lot more about the condition, what can really help a person struggling with it. It made people aware of anorexia. POIGNANT MUSIC That's a lot right there. Because, um, by... recognising the problem, people can get help. In the years following Karen's death, I think that she was remembered more for being the singer who died from anorexia than for the, um... the great contributions that she made to music. And it was her death that brought a heightened awareness to the severity and the dangers of an eating disorder, like anorexia or bulimia. Karen Carpenter's death was a complex puzzle, but the missing piece undoubtedly was a synthetic thyroid hormone, Synthroid. Combined with her anorexia and the toxic effects of the ipecac syrup, to me, it says that her body, in the end, just gave up. And it was really only a matter of time before the inevitable happened. Captions by Faith Hamblyn. www.able.co.nz Captions were made possible with funding from NZ On Air. Copyright Able 2015