Is It Possible That a Pregnant Teenager Was Buried Alive in Honduras?

Yesterday, a story surfaced about a Honduran woman who had been found buried alive near the western city of Copan in early July. According to the Guardian, the 16-year-old Neysi Perez was forcibly broken out of her concrete tomb and white coffin a day after her funeral after someone who is either her husband or her boyfriend reported hearing screaming coming from inside.

Perez was buried in a wedding dress and three months pregnant at the time; there is a video of men destroying the concrete mausoleum, pulling out a white coffin, and then fanning a woman's body inside. According to reports, after Perez's family broke her out of the tomb, they rushed her to the hospital, where she was pronounced dead. However, her relatives claim that the glass portion on the top of her coffin was shattered and her fingertips were bruised—both of which seem to indicate a struggle.

As the story has been picked up following a Univision report, two conflicting versions of exactly how this happened have emerged, casting serious doubt onto basically every aspect of the story. Was it a grave error on the part of a medical professional? Was Perez really alive in the coffin?

The first explanation is that Perez suffered a panic attack after hearing gunfire—she lives or lived in an impoverished area—and was pronounced dead of a heart attack at a local hospital; the actual condition that could explain Perez's death-like state is catalepsy, which can cause weak breathing, unresponsiveness, and rigidity. The second, more cinematic version is that Perez became ill, her family suspected that she had been possessed by the devil, and after efforts from a pastor failed to exorcise what her husband or boyfriend referred to as "another voice" inside her, she was pronounced dead at a local hospital. Either way, while the story is equally compelling and horrifying, "it sounds very unusual or unlikely," says Dr. Judy Melinek, a forensic pathologist and co-author of the New York Times-bestselling book Working Stiff about forensic investigation.

How could this have happened, really? In the 19th century, the lack of medical technology to accurately determine death meant people were occasionally interred aware, but now it almost never happens. Because people were occasionally pronounced dead when they were just in comas, wakes, often held in the home, would last for days, so relatives could confirm the possibly dead body was actually dead. (How you could tell: It would start to decompose.) "This was part of the grieving process and the confirmatory process," Dr. Melinek says. "Coffins were specially formed to help [make the process easier.]"

Before a body can be pronounced dead, it usually goes through two sets of checks, says Dr. Melinek. The first—a "very basic determination of death"—comes from paramedics, physicians, and/or hospital staff: An officially dead body must 1) be unable to breathe on its own, 2) have no heartbeat or pulse, and 3) have no heart rhythm. This last test is the most important one, Dr. Melinek says; even if a paramedic can't feel a pulse—because heartbeats are too irregular, say—a heart rhythm can be detected with an electrocardiogram, or EKG. Dr. Melinek says most hospitals will also do a "determination of brain death," which requires an electroencephalogram, or EEG, that involves attaching electrodes to the scalp to detect any electrical activity that might indicate life. Even if a body is obviously dead, paramedics and physicians are required to complete these checks. This is why you'll sometimes see paramedics stick EKGs on a decomposed body, Dr. Melinek says—it "looks absurd," but you have to make sure.

However, it's likely that one or more of these measures wasn't enacted if and when Perez was brought to the hospital, if she actually was buried alive. "Most rural areas they don't have EEGs, so they're making decisions based on the top three [categories]," Dr. Melinek says. The area where Perez lives is one of the poorest regions in Honduras, which is the second-poorest country in the Western Hemisphere and suffers from extreme gang violence.

In an ideal situation, after a body is officially pronounced dead, it will make its way to a morgue, where a medical examiner will conduct more checks. While not bound by an official, is-she-really-dead? protocol the way a paramedic or physician is, medical examiners notice signs of death "automatically." These are obvious and include the clouding of the eyes; lividity, or the pooling of blood in the back of the body, which causes the purplish-reddish dead color; and rigidity. If it ever got so far that the medical examiner pulled out a scalpel on a live body—and Dr. Melinek says this hypothetical medical examiner would have to be pretty bad at his job to do that—one cut would confirm the body as not dead. "A [blood vessel in a] live body pulses," Dr. Melinek says. "If you cut into a living person, it bleeds a lot more."

In the case of Perez, if she really was buried alive, Dr. Melinek says it is obvious that no one performed an autopsy on her, though they should have; it is very unusual for a young pregnant woman to die during pregnancy, and a post-mortem examination would be the first way to figure out what exactly happened. Dr. Melinek says it would be "a little early" for Perez to have high blood pressure, which can cause seizures later on in pregnancy.

Some other details from the story involve the appearance of the inside of the coffin; reports have called into question how the interior glass of the coffin could have been broken if she wasn't buried alive. A source in the Guardian story hypothesized that, "The coffin glass could have been broken by the gasses of the decomposing body," but as Dr. Melinek points out, there's no way Perez's body could have decomposed if she eventually emerged alive. "It usually takes several days for the body to decompose, for bloating," she says.

"You have to question [whether] it is possible that whatever damage to the coffin was already there, and a damaged coffin was used in the first place," Dr. Melinek says. "Throwing dirt on a coffin can damage it too, put strain on it. It doesn't necessarily mean she was alive in there."

When I asked Dr. Melinek how common it was for people to be buried alive, she said not very, at all. "Usually the conditions that indicate death and [require a person to be] brought to the hospital [mean they] eventually expire," she says. "I don't think I know of any cases where people have been declared dead and then went on to live long, healthy lives."

Ultimately, she says, the sinister implications of this story are not supernatural or religious, but political and serious. "This is an indicator of the issues with medical resources coming out to rural areas," Dr. Melinek says. "Really, autopsy and death investigation are part of public health. If a young woman dies during pregnancy, that's a public health issue."