FORT LAUDERDALE, Fla. - On the wall outside his office, the medical examiner who performed Steve Bechler's autopsy has an inscription hanging inside a frame. It reads: "Let conversation cease. Let laughter flee. This is the place where death delights to help the living."
Dr. Joshua Perper is a Romanian-born man with Baltimore ties who now serves as Broward County's chief medical examiner. For him, there's a point to all this talk about what caused Bechler - a 23-year-old Orioles pitching prospect - to collapse during practice and die of heatstroke.
Lessons can be learned. Other lives can be spared.
For now, however, the process is making Bechler's parents cringe.
Besides being outspoken about the role he thinks the drug, ephedrine, played in Bechler's Feb. 17 death, Perper has pointed to other factors, including hypertension, liver abnormalities and an enlarged heart.
"Any of that stuff that's being said that Steve had a history [of medical concerns], they're full of it," Bechler's father, Ernie, said this week from his home in Medford, Oregon. "My son was healthy as a horse."
To a large extent, Orioles physician Dr. William Goldiner agrees. "I didn't consider this kid unhealthy," he said. "The concept that he was morbidly obese was wrong. Absent this drug [ephedrine], I don't believe he suffers heatstroke."
Controversy over Bechler's death is still swirling as Perper awaits toxicology results after linking the death to Bechler's alleged use of Xenadrine RFA-1, an over-the-counter dietary supplement that contains ephedrine.
The mud-slinging started this week, when David Meiselman, an attorney hired by Bechler's widow, said Kiley Bechler intends to sue Xenadrine's parent company, Cytodyne Technologies. Meiselman also left the door open for a potential suit against the Orioles.
In one response, Cytodyne said: "It is unfortunate that the Orioles' organization has chosen to ignore the fact Mr. Bechler had various medical conditions, including hypertension, liver disease, an enlarged heart and a history of heat illness episodes and that he was allowed to exercise without proper hydration and nutrition until he had a core body temperature of 106 degrees before being removed from the field."
To this, the team's general counsel, Russell Smouse, said, "Any suggestion that the Orioles have any responsibility for Steve Bechler's tragic death is outrageous and absolutely without foundation. The Orioles stand behind our training, our procedures and how we deal with our players, and all these apply with regard to Steve Bechler."
With potential lawsuits pending, the medical information is scrutinized all the more.
Yesterday, Perper revealed that Bechler's liver weighed 3,120 grams, about twice the weight of a normal liver. Dr. Paul Thuluvath, a liver specialist and associate professor at Johns Hopkins Hospital, said it's "quite unlikely" Bechler's liver would double in size during the 23-hour span from the moment he collapsed to the moment he died. In other words, Bechler likely had a pre-existing liver condition.
Perper said medical records he obtained from the Orioles indicate Bechler saw a liver specialist about two years ago and told that doctor he was using ephedrine. Ernie and Pat Bechler said they knew their son had seen a liver specialist, but they never knew that was cause for concern.
Goldiner said it wasn't. "Can a person with a liver problem play baseball? The answer is yes," he said. "In everything I've read, nowhere can I find liver abnormalities listed as a cause of heatstroke. Ephedrine and amphetamines, however, are listed as causes of heatstroke."
Did a history of ephedrine use contribute to Bechler's liver condition? Dr. Thuluvath said medicine currently does not associate ephedra use with liver disease. But he did say, "One of the recommendations we make to liver patients is not to take any herbal preparations."
The label of Xenadrine RFA-1 warns users "who have a family history of or are being treated for heart disease, high blood pressure, recurrent headaches, liver, thyroid, or psychiatric disease."
Ernie Bechler said he has a history of heart problems. "My aorta's like 70 percent closed," he said. "I take medication and stuff for it."
A day after Bechler's death, his mother said he had two bouts with heat exhaustion in high school. This week, Pat Bechler clarified. "He was just dizzy or nauseated," she said. "He just got overheated on the field."
Perper said Bechler's blood pressure reading at his physical taken Feb. 14 was 140/90-95 - slightly above normal. Bechler's heart weighed 450 grams during the autopsy, Perper said, about 50 grams above average for a man of his size.
Perper found no solid food in Bechler's system, indicating he was probably on a diet. Perper also said Bechler weighed in at his physical at 249 pounds, about 10 pounds above his 2002 playing weight.
Still, Perper is a strong-willed man who doesn't mind making ephedrine the focal point. He was born in Romania, and, after moving to Israel, he served as a medical officer for the Israeli Army during the Six-Day War of 1967. He received a master of science degree from Johns Hopkins University in 1972 and soon went to work in the Baltimore City medical examiner's office.
"Ephedra is important," Perper said, "because this is winter time in Florida.
"So 85 [degrees] is hot, but it's not excessively hot. The humidity is high, but it's not 100 percent humidity. [Bechler] was not involved in the most severe kind of exercises. He didn't run for a long time.
"None of the other players, at least to my knowledge, complained or had any symptoms associated with heat. So you have to assume he was more prone to develop heatstroke than the others."
NOTE: People wishing to make donations to benefit Kiley Bechler can mail them to the Steve Bechler Memorial Account, U.S. Bank, 131 E. Main St., Medford, Oregon, 97501. Orioles players are planning to make their own donation, pitcher Pat Hentgen said.