What Remains

Summary

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Podcast Summary: The Knife – "What Remains"

Release Date: November 6, 2025
Hosts: Hannah Smith & Patia Eaton
Guest: Dr. Paul Uribe (Forensic Pathologist)

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Overview

This episode of The Knife: A True Crime Podcast dives into the complex and tragic story of Michael Cochran's death in Beckley, West Virginia. Through a meticulous blend of narrative and expert forensic insight, hosts Hannah Smith and Patia Eaton explore the ripple effects of crime on a family and a small community. The focus is the second investigation into Michael's suspicious death following his wife Natalie Cochran’s conviction for a multimillion-dollar Ponzi scheme. The episode features an in-depth interview with Dr. Paul Uribe, the forensic pathologist who performed a second autopsy for Natalie’s murder trial, revealing how circumstantial evidence and pathology intersected to bring justice.

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Episode Structure

• Background and Timeline of Cochran Case (02:41–14:10)
• Interview with Dr. Paul Uribe: Forensic Pathology & Evidence (16:29–52:32)
  • Initial investigation & autopsy
  • Insulin as the murder weapon and medical context
  • Challenges in the forensic process
  • Impact of circumstantial evidence in court
  • Reflections on the case’s significance
• Verdict and Aftermath (49:42–52:32)

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Key Discussion Points and Insights

1. The Case & Context (02:41–14:10)

• Natalie and Michael Cochran:
  Childhood sweethearts in Beckley, WV, who appeared to have a stable family with two children and strong local ties. Natalie, a pharmacist, later left her career to start two companies (TSG and TMG) with Michael—both ultimately revealed to be fronts for a Ponzi scheme defrauding friends, family, and other investors of over $2 million.

• Michael’s Unwitting Involvement:
  Text messages and behaviors show Michael had no awareness of the fraud, thinking the businesses were legitimate and expecting large government pay-outs, leading to stress over unpaid debts.

  "Michael was being extremely generous, thinking that... their companies were... thriving financially, because that's what Natalie had told him."
  — Hannah Smith (07:03)

• Timeline to Death:
  As the Ponzi scheme unraveled, Michael became increasingly worried and stressed. He discovered inconsistencies in Natalie’s accounts but was repeatedly assured by her that millions were imminent. His sudden, inexplicable illness and death in February 2019 (age 38) raised suspicions, especially as Natalie delayed seeking medical care and fabricated his seizure history.

2. Introduction to Dr. Paul Uribe & Forensic Pathology (16:29–18:23)

• Dr. Uribe’s credentials and role as a sought-after forensic pathologist, specializing in unnatural deaths and insulin-related homicide cases—leading to his recruitment in the Cochran investigation after his work on another notorious West Virginia case.

  "...we study death and see what we can learn from it. And we do that, namely by performing autopsies."
  — Dr. Paul Uribe (17:41)

3. Medical Investigation & Challenges (18:23–41:55)

• First Autopsy (7 months postmortem):

  • State autopsy failed to find clear cause; insufficient remains and limited analysis for insulin or injection evidence.
  • The challenge of detecting postmortem insulin was emphasized due to natural decomposition and the fact that insulin levels vary widely in life and degrade after death.

  "When you have a 38 year old male on hospice for reasons that aren't really clear... that's a legitimate reason for a younger person to be on hospice. But he didn't really have a great diagnosis."
  — Dr. Paul Uribe (19:49)

• Suspicious Circumstances Around Death:

  • Natalie left Michael unconscious for hours, sent photos to friends, delayed emergency care, and tried to put him on hospice immediately—raising alarm.
  • Michael’s blood glucose in the ER was <30 mg/dL (normal is 80–100), inconsistent with his health and unexplainable by infection or trauma.

  "[Natalie] took pictures of his unconscious body and sent it to friends and family, which is sort of bizarre and strange, very weird."
  — Dr. Paul Uribe (24:43)

  “His blood glucose was under 30... anything below 60, in an otherwise healthy person, there's usually something going on.”
  — Dr. Paul Uribe (24:43)

4. Second Autopsy & Forensic Hurdles (33:11–38:13)

• Second Exhumation (over four years later):

  • Dr. Uribe sought injection sites and tissue samples, but decomposition (adipocere) left virtually nothing viable for testing.
  • Family fully supported exhumation, seeking closure and justice.

  "There was significant decomposition... It was largely skeletonized remains... But... you don't know if you don't look."
  — Dr. Paul Uribe (37:20)

• No Direct Forensic 'Smoking Gun':

  • No insulin or injection-site evidence could be recovered from either autopsy.
  • All samples from the first autopsy had long since been destroyed.
  • The case thus relied on medical history, clinical facts, and circumstantial evidence.

5. Piecing Together the Circumstantial Evidence (38:13–49:42)

• Insulin as the Weapon:

  • The suspicion of insulin poisoning first arose when Natalie herself brought up insulin during a police interview, which investigators hadn't considered.
  • A vial of insulin (from a diabetic neighbor, under false pretenses) was found in the Cochrans’ fridge, with a single puncture and partly used, months after Michael’s death.
  • Natalie lied about medical needs (breast cancer treatment) and had no legitimate reason to possess insulin.

  "In the refrigerator, ironically, under a candy bar, they found a vial of insulin. With one hole punched in the top of it... it was not a full bottle."
  — Dr. Paul Uribe (42:24)

• Rule-Out of Alternative Explanations:

  • Michael was not a bodybuilder using insulin for performance enhancement; supplements he took were not steroids or insulin.
  • Compared to the Rita Mays case (where tissue evidence existed), Cochran’s prosecution relied entirely on inference.

• Power of Circumstantial Evidence:

  "Circumstantial evidence can be just as powerful as objective autopsy evidence if it's in the right context. And in this particular case, there was literally mountains of circumstantial evidence. Like, literally so many things that didn't make sense."
  — Dr. Paul Uribe (50:16)

  "It was my opinion that there was nothing else that could have killed him. There is no other explanation that makes even a shred of sense in this case."
  — Dr. Paul Uribe (49:41)

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Notable Quotes & Memorable Moments

• On the Importance of Considering the Whole Story:

  "The autopsy is just one part of it. We also have postmortem samples... But you have to look at the big picture."
  — Dr. Paul Uribe (31:13)

• On Natalie’s Behavior:

  "[Natalie's] reaction... is like, 'Let's just leave him there.' It's like, wait, no, that's not a normal reaction."
  — Dr. Paul Uribe (50:16)

• On the Jury's Verdict:

  "They found her guilty."
  — Dr. Paul Uribe (49:53)
  "She was found guilty of first degree murder for the murder of her husband, Michael Cochran, and she was sentenced to life in prison without parole."
  — Taisha Eaton (49:57)

• On Family Closure:

  "Once again, it's not gonna bring Michael back, but at least it provides some type of closure."
  — Dr. Paul Uribe (52:06)

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Timestamps for Important Segments

• Background & Timeline of the Crime: 02:41–14:10
• Forensic Pathology 101 & Dr. Uribe’s Background: 16:29–18:23
• Details on the First and Second Autopsy:
  • First Autopsy: 18:23–24:43
  • Second Autopsy: 33:11–38:13
• Medical Suspicion & Circumstantial Case Development: 24:43–41:55
• Insulin Evidence & Investigation: 41:55–46:56
• Legal Outcome & Reflections: 49:42–52:32

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Conclusion

"What Remains" presents a deeply human story about the limits and potential of forensic science in the criminal justice system. Through the tragedy of Michael Cochran and the tenacity of investigators and family, Hannah and Patia demonstrate how truth can be pieced together without physical evidence, thanks to skilled forensic analysis and careful attention to circumstantial details. Dr. Paul Uribe’s expertise and candid explanations make the complexities of the case approachable, while the hosts’ empathetic storytelling brings listeners behind the headlines to the heart of a family's search for justice.

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For story submissions, listeners are encouraged to email The Knife at thenifexactlyrightmedia.com or follow them on Instagram @theknifepodcast or Bluesky @theknifepodcast.bsky.social.

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Transcript

[Taisha Eaton]

This is exactly right.

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[Taisha Eaton]

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But who's the monster and who's the bad neighbor? That's another story.

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It's a game of cat and mouse that sets them on a collision course with fatal consequences.

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[Taisha Eaton]

This story contains adult content and language. Listener discretion is advised.

[Dr. Paul Uribe]

It was my opinion that there was nothing else that could have killed him. There is no other explanation that makes even a shred of sense in this case.

[Taisha Eaton]

Welcome to the Knife. I'm Patia Eaton.

[Hannah Smith]

I'm Hannah Smith and today we have an interview for you with a forensic pathologist who worked on a murder trial. But before we get into the interview. We're going to give you some information about this case. It's winding and intriguing, and we've both been following it for a couple of years now.

[Taisha Eaton]

Yeah.

[Hannah Smith]

So we're gonna start the story. On March 18, 2021, a woman named Natalie Cochran from Beckley, West Virginia, was sentenced to 135 months in federal prison, which is over 11 years. And the reason that she's sentenced to prison, she's charged with wire fraud and money laundering. She's been running a Ponzi scheme. She orchestrated this scheme that defrauded victims over $2 million. And she was ordered to pay $2.5 million in restitution, and she would also serve a term of three years of supervised release after the 11 year sentence. You know, but this is actually just the beginning of Natalie's problems. Right. Like she's sent to prison, she was caught for this Ponzi scheme, but once she's already been, you know, charged and convicted, other things start to come out. So she was arrested in October of 2019 on this indictment for her PON scheme. But earlier that year, in February of 2019, her husband Michael died suddenly. He was only 38 years old, and his death was very confusing and heartbreaking for his friends and family because he had been this healthy young guy, and then he suddenly died.

[Taisha Eaton]

Yeah. And Natalie and Michael had been married since the early 2000s. They had two children. Natalie worked as a pharmacist, Michael as a computer specialist. I even read that they were actually childhood sweethearts.

[Hannah Smith]

Wow. Yeah.

[Taisha Eaton]

So they'd made for themselves in a small town where you truly feel like, you know, everyone. And when Michael passed, the community really rallied around Natalie because she was suddenly this widow in her 30s. But leading up to Michael's death in February of 2019, there was a lot going on for Natalie and Michael. Natalie had left her career as a pharmacist. She and Michael had registered a company called Tactical Solutions Group, or tsg. And this idea for the company was that it would bid on contracts to sell weap other goods to the US Government. She needed to raise capital, so she's bringing on investors. Now, this was a company that they jointly owned, but Natalie had the majority stake, and she was definitely the person at the wheel, and Michael trusted her implicitly. So she leaves her career as a pharmacist and she goes all in on tsg. They also open another company, tmg, which is Technology Management Systems, similarly working with the US Government. So both of these companies were fraudulent. And Natalie would later admit in court that she never invested any of the money, and she instead spent that investor money on things like, you know, real estate, a fancy car, personal items, Classic. Classic. So Michael was totally unaware of this, which I'm going to get into, which was revealed later in text messages.

[Hannah Smith]

He thought that these companies that they'd started were legitimate and probably thought they were doing really well.

[Taisha Eaton]

Yeah. Or he would have never consented to them having their friends and family invest.

[Hannah Smith]

Right. Yeah. So in the meantime, Natalie's living this high life, buying real estate, jewelry, a sports car. Michael is unaware that all of this is a Ponzi scheme. But in 2019, the walls are starting to close in. You have to imagine there's probably an investigation starting to happen behind the scenes. And In February of 2019, Michael collapsed. He had a seizure. And Natalie told a friend who had been present that day that she was gonna let Michael sleep it off. So her friend said Michael should go see a doctor. And Natalie and her sister were both there. You know, Michael is unresponsive. He had fallen on the floor. And there's an account that Natalie and her sister changed his clothes because he'd lost musc control. So hours go by. By the time they took Michael to the hospital, he was unresponsive. And then he died in hospice a few days later. And the first cause of death was, quote, natural. It was determined to be a natural death. Natalie Cochran was then arrested for the Ponzi scheme months later, in October of 2019. She pled guilty to the charges against her in September of 2020, and she was ready to serve this 11 year sentence. But as the investigation unfolded, Michael's death became more and more suspicious to law enforcement as they started to look at all of the events that led up to his death and that eventually led to her murder trial. One of the things that came out through this investigation is that Michael had been totally unaware that either of these businesses were actually Ponzi schemes. And this was revealed during the trial in text messages that were exchanged between Natalie and Michael. Natalie was the majority owner, as you said, with the 51% stake in TSG. And she secured the startup capital through mostly friends and family, many of whom made investments repeatedly and then just never saw a return, which is heartbreaking, but not as heartbreaking as his death, obviously. I mean, it just gets worse and worse. So first she got all of this startup capital from friends and family, and then she got it through loans which were designed to help companies in trouble. So she portrayed her company was in trouble, she secured all of these loans Michael knew about the investors and about the loans, but Natalie told him that the loans were grants that they wouldn't have to repay. Michael was being extremely generous, thinking that they had been making a lot of money and that their companies were, like, thriving financially, because that's what Natalie had told him. And so he donated a weight room to a local middle school. He bought a house for a local youth pastor. Like, he was just, like, very generous, which was really sweet.

[Taisha Eaton]

Yeah. I mean, he truly had no idea. So that changes In August of 2018, when Michael gets into Natalie's phone and reads her text messages and starts to see the extent of the investors and the promises she's making to people about the returns on those investments. And he could tell that something was not right. So Natalie and Michael get together, and they. They put their heads together about this and try to come up with a way to pay people back. And at this point, the more that they discuss it, the more Michael realizes we will never be able to pay these people back. But Natalie has a solution. She tells Michael that they are on the cusp of receiving millions of dollars in grants and bonds and government contracts. So Michael is like, okay, well, great. Let's make sure that happens, and let's get these people paid back. And this is becoming very stressful for him because he doesn't want to, you know, have taken money from friends and family fraudulently or even not fraudulently, and then not being able to pay them back. Both options.

[Hannah Smith]

Horrible feeling, I imagine.

[Taisha Eaton]

Horrible feeling. So Natalie comes up with this grand plan and tells him that the money is on the way. But in September of 2018. So in August, he sees the text in her phone. He has this little bit of a reckoning with her. In September, Michael's noticing that Natalie's continuing to lie to people and tell them the money's coming in when he's never seen any proof of that. So Natalie then tells him, well, this is actually because of a government audit. So they're auditing the company, and it's just gonna be a while before they can pay us out. But the amount is huge. Michael believes they're waiting on $248 million.

[Hannah Smith]

That's wild.

[Taisha Eaton]

It's a lot of money. And so Natalie says, this is all gonna be in our account by October 29th. Okay, great. Things are looking up. Thank God. Well, then it doesn't happen on October 29th. She has some reason for it. This is super stressful for Michael. And on October 31st, he actually gets really sick and goes to now at the hospital, they're not sure what's going on, but he's sick and he gets sent home. Then he goes back to the hospital. On November 2, Natalie tells the hospital staff that Michael has a history of seizures. But no one else in Michael's life knows this about him, which, you know, probably means it's not true. They all now think in hindsight, this was Natalie laying the groundwork for Michael's murder because he was starting to ask more and more questions, trying to create.

[Hannah Smith]

This history of medical problems.

[Taisha Eaton]

Exactly. So in the fall, in November and into December, more lies, more lies. And then in December, there's a federal government shutdown. Great. They can't pay us. So sorry, Michael, we're gonna have to wait. Michael's really upset and stressed in not acting like himself. He's easily angered, he's irritable. But I think anyone who thinks they're waiting on hundreds of millions of dollars and has investors that want to be paid back, it is nerve wracking and it would be very stressful.

[Hannah Smith]

For sure.

[Taisha Eaton]

Yeah. And so they get through December, and the federal government is gonna open back up and release funds. This all, according to Natalie, in February. So they're gonna get everything in February of 2019, which we now know is the month that Michael was murdered. So there's an incident at the bank when Michael believes that the funds are supposed to be released. He goes to the bank where they have their business accounts, and he finds out they're closing these accounts. Cause these accounts don't have any money in them and they don't know what's. And they're going to close the accounts. Well, this is very upsetting for Michael because he's like, well, if you close the accounts, where are they going to put all of this money that they're going to pay us? So he actually becomes so distressed by this and so angry about this that he gets really upset. And the police are nearly called to sort of subdue him.

[Hannah Smith]

Wow.

[Taisha Eaton]

Yeah. And he's not like a violent person. He was just extremely stressed out about this and visibly angry that the bank was going to close these accounts. Well, of course, that's because there was never any money in the accounts. Natalie had lied about everything. So Michael goes home and he's very upset, and they have this heated text exchange. And Natalie knows he's about to find this out. So in the early days of February, Natalie goes to the doctor. She says she's not feeling well. She thinks she has the flu. The doctor says, you don't have the flu. She picks up her prescription that I believe was an antihistamine, but it was a prescription antihistamine, something that Michael was known to be allergic to. And by February 6th, Michael is unconscious. And Natalie sees that he's unconscious and does not immediately seek medical care for him. She has people move him to the sofa and lets him lay there for six to seven hours until one of his friends says he needs to go to the hospital. So Michael officially passes away February 11, 2019, on hospice. And we're going to talk today to Dr. Paul Uribe, a forensic pathologist who did the second autopsy on Michael Cochran's remains for Natalie Cochran's murder trial. Let's get into it.

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[Hannah Smith]

This is Georgia from My Favorite Murder with Karen Kilgariff and Georgia Hardstark. Don't miss Netflix new series the Beast in Me.

[Taisha Eaton]

It's a riveting psychological thriller from the.

[Hannah Smith]

Team that brought you homeland. The Beast in Me follows acclaimed author Aggie Wiggs, played by Claire Danes, who has withdrawn from public life. After the tragic death of her young.

[Taisha Eaton]

Son, she's unable to write and is a ghost of her former self. But Aggie finds an unlikely subject for a new book when the house next door is bought by Nile Jarvis, Played by Matthew Rhys.

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Horrified and fascinated by this man, Aggie finds herself compulsively hunting for the truth, chasing his demons while fleeing her own.

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It's a game of cat and mouse that sets them on a collision course with fatal consequences.

[Taisha Eaton]

The Beast in me on Netflix November 13th.

[Hannah Smith]

You will not want to miss this.

[Taisha Eaton]

Goodbye.

[Hannah Smith]

Goodbye. Today we're speaking with Dr. Paul Uribe about his work as a forensic pathologist and his role in a murder trial that was years in the making. The murder of Michael Cochran in Beckley, West Virginia, back in 2019. Paul, hi. Can you please start by introducing yourself?

[Dr. Paul Uribe]

Hi, My name is Dr. Paul Uribe. I am the current deputy chief medical examiner at the Fort Bend County Medical Examiner's Office, which is located southwest of Houston. I also work as a locum tenens forensic pathologist, which is a part time forensic pathologist in a couple jurisdictions, namely Clark County, Nevada, which incorporates Las Vegas and Southern Nevada, as well as the state of Mississippi. And as a third part time job, I have my own forensic consulting company, DMH Forensics, or Dead Man's Hand Forensics.

[Hannah Smith]

Wow. And so for people who might not be familiar, what is the sort of brief explanation of what a forensic pathologist does?

[Dr. Paul Uribe]

So how I explain it in court for juries is. Well, pathology is the study of disease. Forensic pathology is the specialization that studies unnatural, unexpected or violent death. So in a nutshell, we study death and see what we can learn from it. And we do that, namely by performing autopsies.

[Hannah Smith]

And so we're gonna get into Natalie Cochran's trial. The death of Michael Cochran. When you were brought onto this case, you know, before we get into your involvement, specifically how that happened, what did you know, like what had happened with the case so far? What was this sort of understanding of yours at that time of what this case was all about?

[Dr. Paul Uribe]

So I was contacted by the Raleigh county prosecutor who heard of me from my involvement in another high profile insulin case in West Virginia, which was the prosecution of Rita Mays. She was a nursing assistant who was accused of essentially poisoning VA patients at the Clarksburg VA with insulin. And this was a case that I did while active duty in the military. Military with the armed forces Medical examiner's Office. And because of my involvement in that case, which was relatively high profile, they reached out to me because, you know, I had done a lot of research and testimony in terms of insulin homicides. And they reached out to me saying, hey, can you help out with this? We think that she may have poisoned her husband with insulin, but we're not sure we can prove it. So I got involved probably two to three years. I think it was over three years after Michael's death. And they brought me in to take a look at everything that had been done at that point. The first autopsy was already done, and they just wanted me to take a look at it, to essentially see what I could see.

[Hannah Smith]

What can you tell us about that first autopsy? You know, as you opened it and looked at what had been done? Kind of walk us through what you saw there.

[Dr. Paul Uribe]

So the first autopsy was not done by me. And there's a little bit of a backstory here, because when Michael died, he was technically on hospice care already. And because he was on hospice care, that did not generate a flag for the West Virginia State Medical Examiner's office. Now, once again, I know a lot of the docs at West Virginia, I'm not saying this to throw shade at them or anything, but I do think the case was missed. When you have a 38 year old male on hospice for reasons that aren't really clear, it's different if someone has als, which is amyotrophic lateral sclerosis, the same disease that Stephen Hawking had, or Huntington's disease, or some progressive neurologic condition that causes someone of relatively young age to die when they're younger. That's a legitimate reason for a younger person to be on hospice. But he didn't really have a great diagnosis. But anyway, regardless of how that was missed, the prosecutors started looking into it in the months after his death, and they found his death really, really suspicious because at that point she was being investigated for the Ponzi scheme and so forth. So I believe about seven months after Michael's death, the state office in West Virginia went back and they exhumed Michael and they did an initial autopsy of him, and they found nothing particularly significant. The medical examiner of record who did it there wasn't really good sample to check for insulin or C peptide. We'll talk about the importance of those two things later. And he didn't really look for insulin injection sites either. Now, whether or not you can find insulin injection sites in someone who's been essentially buried for seven months, it's very tough.

[Taisha Eaton]

Yeah, that actually Prompts a question for me, which is, you know, this is all pretty morbid, but after seven months, because the initial autopsy happened after he was. So his remains were exhumed, is that correct?

[Dr. Paul Uribe]

Yes. I don't think he was buried in the ground. I think he was interred in a mausoleum. So basically above ground.

[Taisha Eaton]

Okay, and so seven months after his death, what state are someone's remains in?

[Dr. Paul Uribe]

It depends. It depends on the level of embalming. It depends on the environmental temperatures. It depends on if it's an above ground mausoleum or, you know, below ground under the earth. It depends on the humidity, it depends on the temperature. It depends on lots of things. From my review of the first autopsy, he seemed to be in pretty decent shape. There was some decomposition, which naturally you would expect, but it wasn't terrible. So there was some information that could be obtained from the primary autopsy, which, once again, any information is helpful in a case like this. But once again, if you have a body that's not embalmed and is in the ground, and then you have, you know, water that leaks into the gasket and everything, that just accelerates decomposition.

[Taisha Eaton]

In this case, for the first autopsy, Michael Cochran, they had remains that were in a state they felt like they could conduct an autopsy on and get strong results or decent results.

[Dr. Paul Uribe]

Yes. And when it comes to postmortem detection of insulin, that's where things get really, really tricky. Because insulin levels in blood are not stable. Insulin levels just normally in humans vary. Like, you know, it varies on what you eat. It varies with your circadian rhythm. Sometimes your pancreas secretes insulin. When you wake up in the morning, you have an insulin spike. So there is no, like, really tight, nice, normal range of insulin. Because if you have couple donuts in the morning, then guess what, your insulin's gonna spike after that. If you wake up in the morning, your insulin's gonna spike. So there's no real good range for normal.

[Hannah Smith]

I wanna go back actually to something that you talked about before where he was on hospice. Can you kind of explain what was going on? Because when I had read about the case, it seemed like he was healthy. And then there was an incident where he collapsed. He wasn't responding. It took a while for his wife Natalie, to actually call, you know, 911 or to bring him into a hospital way too late, some would say. And it was suspicious that he was this supposedly overall healthy 38 year old who died. So I'm curious if you can explain a little more about what the circumstances were of him being on Hospice, as well as how this idea of insulin ever arose in the first place.

[Dr. Paul Uribe]

So how he got on the hospice. So, going back to the circumstances that I understood this, and once again, these circumstances, when you look at them retrospectively, are incredibly suspicious, let's put it that way. The history that I received was that Michael was found down around 11:30 noonish in the morning one day. Natalie, she was the only one home at the time. Natalie suspected that he either had a seizure or hit his head on the counter on the way down, and she found him unconscious on the kitchen floor. Then she took pictures of his unconscious body and sent it to friends and family, which is sort of bizarre and strange, very weird. She had some contractors who happened to be doing some work at the house. I'm not sure when the contractors got there. I can't remember that detail. But she had them move him to the couch where he stayed there for approximately seven hours. The only medical intervention that she testified to was she reported checking his blood sugar twice and reported that those levels were normal, even though he's unconscious on the couch. She had one family friend who was in healthcare come by and. Or that friend came by anyway and said, you really need to take him to the hospital. This is not well. And she's like, oh, he'll sleep it off. That's fine. And then apparently one of Michael's friends, who couldn't get a hold of him, came by the house, found him unresponsive on the couch, basically ordered Natalie, we are taking him to the hospital right now. So he loaded him up in the car, got him to the hospital. When he got to the hospital, his blood glucose was under 30 milligrams per deciliter. Now, normal blood glucose ranges from like 80 to 100. So a blood glucose in someone, especially someone who's not a diabetic, anything below 60, in an otherwise healthy person, there's usually something going on, like, you know, hey, there might be septic or something like that, or have an overwhelming bacterial infection. There's a couple natural disease processes that cause that, but he wasn't demonstrating any of those. And one of the first imaging studies that they did, when they did do an mri, they saw no evidence of trauma. But the radiologist called it, and this is a really interesting term, he called it diffuse hypoglycemic encephalopathy, meaning he was having cerebral edema, likely related to the low blood glucose. So when you have blood glucose that's too low for too long, your brain starts to freak out and it starts to swell. And that's exactly what was happening. And when Natalie got to the hospital, I think it was probably within a matter of hours where she wanted him put on hospice care.

[Hannah Smith]

Oh, wow.

[Dr. Paul Uribe]

Which once again, your husband comes into the hospital. If you're not entirely sure why he's there, you just walk in and be like, yeah, we want to put him on hospice. Even though we don't know exactly what's going on. That whole situation just seems really weird.

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[Hannah Smith]

So I imagine when you're getting this information, you're assessing her behavior. Michael's blood glucose level when he died, the request from Natalie to put her 38 year old husband, who, you know, whatever, a day, two days before was completely healthy. That seems super weird. Like you would think you would be like, save his life, please. But she requests for him to be put on hospice. And so are you looking at all of these factors plus the medical autopsy when you're looking at the case?

[Dr. Paul Uribe]

Yes, absolutely. Because autopsy is only one part of the equation. There's the scene investigation, there's medical history. All of that goes into it. Like the autopsy is just one part of it. We also have postmortem samples that we can send out, like toxicology. We can look at tissue under the microscope for histology. And it's our job as forensic pathologists to take the autopsy and the scene investigation and the ancillary studies and put it all together to figure out what happened. So I had a lot of that history. Now, once again, you have to be careful and not let the history bias you too much. Right? And you know, the whole topic of cognitive bias, that's a whole separate thing that I lecture on. But that's outside the scope of this. But you don't want to let the scene investigation bias you too much, if you know what I mean. Because you have to look at the big picture. And like, an example of it is relying on someone's confession. If you're relying on someone's confession that they smothered someone but you have no other findings to go against, against that, then if they recant their confession, you're left with nothing. And you're just like, okay, what do I do with this? The bottom line is you have to look at the big picture, right? So in this, one of the things that I suggested to the district attorney was to take a second look at Michael, which meant a second exhumation. Because my, my thought process here is there are some things that they did not look at in the first autopsy. Like they didn't do soft tissue dissections of the arms and abdomen and legs to look for possible Injection sites. Once again, is it low yield or not? I don't know. I mean, my opinion also is you don't know if you don't look. So we had to exhaust all the options there. Yeah, I'm pretty sure that's the point in time when we decided, okay, I'm going to go out to West Virginia and we're going to do a second autopsy and a second exhumation.

[Taisha Eaton]

So, as you mentioned, the first autopsy was done seven months after Michael died. And at that point, the cause of death was listed as undetermined. So I was reading about how the case was actually dropped by the Raleigh County DA's office the first time around, because it's really hard to bring homicide charges against someone when you don't have the cause of death listed as a homicide, let alone any cause of death. But then two years later, the case was refiled when you were brought in to take a second look, You've explained how difficult it is to get physical evidence of someone being killed by insulin injections during an autopsy. So what were you hoping to find in the second autopsy that might have been missed the first time around?

[Dr. Paul Uribe]

So I don't mean this to, like, once again, throw shade at the West Virginia office, because postmortem detection of insulin, it's been problematic for forensic pathologists ever since the discovery of insulin over 60 years ago. So figuring out postmortem insulin levels and whether or not it's an insulin suicide or homicide, it's such a tricky issue. So one of the things they did not do in the first autopsy was they didn't do a soft tissue dissection, basically cutting into the skin, looking for subcutaneous hemorrhage that could be consistent with a insulin injection, because that's how insulin is administered. It's administered subcutaneously. It's not administered orally. It's not administered by IV, generally. But when you inject insulin, you inject it under the skin, and then it, you know, creates a little pocket of insulin that acts as a depot, and it's sort of released over time and usually works for, like, four to six hours. So there are ways where you can do soft tissue dissection to look for that. And if you see a possible injection site, then you can take that tissue, look at it under a microscope, and do a process called immunohistochemistry, where you can stain the slide for insulin. Now, this is the technique that we did in the Rita Mays investigation, and we actually had some success with it, even in patients who Were exhumed a year and a half after the fact. So that is a pretty decent way to do it. If you can find a suspected insulin injection site. But that was not done in the first autopsy. And they also did not send out special testing for insulin or C peptide. Just because I don't think the West Virginia office and actually most medical examiner offices Just don't have access to that.

[Taisha Eaton]

Yeah. The second autopsy that you end up doing, you have to exhume his remains. I'm curious if you heard anything about how his family felt about a second autopsy. How did they feel about it?

[Dr. Paul Uribe]

Did you ever hear they were absolutely on board with it, and they suspected pretty much from the beginning that she did something to Michael and they wanted to prove it. So could we have done it without the family consent? Yes, but generally when you do exhumations, it's usually good to have the family permission and consent on board. I really like providing reasonable expectations to family members too, because exhumations are incredibly traumatic. And I want them to be like, look, this is why we're doing this. This is what I hope to gain from this. This is what we're specifically looking for. Just so they are on the same page with what we're doing and why. But they were absolutely on board with this.

[Taisha Eaton]

Yeah. That's really good to know. So Michael, the date that he actually passed, and you mentioned he was on Hospice, was February 11, 2019. And you performed your autopsy in July of 2023. So, you know, there's a pretty significant passage of time between his death and the second autopsy. You told us a little bit about what the state of the remains were for the first autopsy. What was the state of his remains by the time you did your autopsy?

[Dr. Paul Uribe]

There were significant amounts of decomposition. And really the only soft tissue left was in a form that we call it adipocere, which is when skin and soft tissue turn into like a white, waxy, soap like substance. And there wasn't much to be gained from it. There wasn't much to analyze. It was largely skeletonized remains with some adipocere type soft tissue. So was not able to get that much information from it. But once again, if we're looking for something that wasn't done in the first autopsy, I'm generally of opinion if you're gonna exhaust all options. Exhaust all options. You don't know if you don't look.

[Taisha Eaton]

Right. And so you did look. You did test the remains for insulin, and what did you find?

[Dr. Paul Uribe]

I did not test the remains for insulin.

[Taisha Eaton]

You did not Test the remains for insulin.

[Dr. Paul Uribe]

I did not. There was nothing useful to test.

[Taisha Eaton]

Okay, so then in that case, because the prosecutor had called you and said, we suspect that he was given insulin and that to his death. So what do you do with the remains then? Since you couldn't test for insulin at that point.

[Dr. Paul Uribe]

So the remains got sent, they got reinterred, and, you know, at some point the prosecutor changed, so we had a different prosecutor. So once again, I worked on this case with both prosecutors and just to make sure we're on the same page. And the question that we had to answer was, well, we have a lot of circumstantial evidence, but do we have enough to get a conviction? Because we don't have the proverbial smoking gun. We don't have evidence of an insulin injection site, but we have really good medical history where you have someone who's 38 year old, male, otherwise healthy, not taking insulin, who comes in after being unconscious for seven hours, coming into the hospital with a blood glucose level of less than 30. There is not a whole lot of other things that can do that. And unfortunately, there was no samples that we could retrospectively send out for testing. All of the stuff that was collected from the West Virginia medical examiner office from the first autopsy, that was already destroyed because we were already a couple years out. So we realized this is a circumstantial case. And the question is, do you have enough circumstantial evidence to even try for a conviction in this case?

[Taisha Eaton]

Yeah. And so given that, how did that impact what you were able to testify about as a forensic pathologist that looked at his remains?

[Dr. Paul Uribe]

So going back a step in the Rita Mays case, we consulted with a clinical endocrinologist, Dr. Diane Krieger, who specializes in the treatment of diabetic patients. Her help in that case, and this case as well, was absolutely essential because she understands the clinical aspects of treating diabetics, the clinical aspects of hypoglycemia, and what causes this profound hypoglycemia in someone, which I don't necessarily see as a forensic pathologist because, you know, all my patients are dead. So we recruited her on this case too, and got her opinion. And she was of the opinion that, yeah, this is likely insulin related.

[Taisha Eaton]

Right.

[Dr. Paul Uribe]

And going back another step, because one of the questions that you asked is, well, how was insulin brought up to begin with? In talking with one of the main investigators about this, the first time insulin was even put on his radar was in one of his interviews with Natalie. She just brought up insulin Sort of out of the blue, really. And it kind of struck him as really odd because he wasn't thinking about that beforehand.

[Taisha Eaton]

Do you know what she said about it?

[Dr. Paul Uribe]

I don't remember exactly.

[Taisha Eaton]

Yeah. Okay, so that's interesting. So the first time investigators ever even took note of insulin was just from an interview with Natalie Cochran that she.

[Hannah Smith]

Had brought it up.

[Taisha Eaton]

Okay.

[Hannah Smith]

And then that is what got on their radar as, like, a potential cause of death? Potentially, yes.

[Dr. Paul Uribe]

And I believe it was a couple months after Michael's death, they finally got a search warrant for the house. Now, once again, you can argue, you know, well, how useful is a search warrant a couple months after the fact? And that is what it is. But. But in the search of the house, in the refrigerator, ironically, under a candy bar, they found a vial of insulin.

[Hannah Smith]

Wow.

[Dr. Paul Uribe]

With one hole punched in the top of it. And you could tell. It's hard to tell exactly how much was missing, but it was not a full bottle.

[Hannah Smith]

And was Natalie taking insulin?

[Dr. Paul Uribe]

So the story, how this goes is, per her testimony and her statements, she said that she got the insulin vial from her neighbor. Her neighbor had a child who was a type 1 diabetic and was prescribed insulin. She had asked the neighbor, hey, do you have any insulin? I ran out because I need the insulin for. For side effects of my chemotherapy for my treatment of breast cancer. Her neighbor says, oh, of course you can borrow one of these. That was, I believe, the day before Michael died.

[Hannah Smith]

Wow.

[Dr. Paul Uribe]

And it turns out she was not on chemotherapy for breast cancer. She was not prescribed insulin, and she did not have breast cancer. So, once again, just red flags all over the place. And it's circumstantial evidence, but circumstantial evidence in the right context can be incredibly powerful.

[Taisha Eaton]

Yeah. And you know something? That in the trial, the defense was really, at least from my perspective, leaning on, is that Michael Cochran was really into fitness and bodybuilding, and he took a lot of supplements and also supposedly took steroids. Did you take that into account when you were conducting the autopsy or speaking with the endocrinologist you mentioned?

[Dr. Paul Uribe]

Absolutely. And the substances that Michael was taking, they were tested by the FBI. It turns out they were other medications, not what he was supposedly taking. But I don't know. I think it was more inert substances than what he was prescribed. But I did take that into consideration. Now, one of the things that I have learned since the trial is that if you are on heavy anabolic steroids and actively bodybuilding, like actively building muscle bodybuilders who are in that Sort of cycling phase. They consume enormous amounts of calories, like we're talking 8 to 10,000 plus calories a day. And those higher end bodybuilders can take insulin to, you know, help with their insulin spikes or things like that. Because, you know, when you're eating like three full plates of pasta at a time to get the calories that you need to build the type of mass that you're talking about, that is a consideration. Michael, it doesn't seem like he was that type. He was never prescribed insulin. He wasn't doing heavy anabolic steroids. I believe he was on testosterone supplementation and got some other supplements from Mexico. One of them, I believe was something called Enclomophene or Clomid, which, you know, bodybuilders do use, but they use that to sort of kick in natural testosterone production. But to my knowledge, he was not a heavy anabolic steroid user. There was no evidence that he had used insulin before. And this sort of played into, I guess, one of the games that the defense was playing was that, oh, yeah, well, Michael was, you know, sick and had a bad heart and was very ill. But then on the other hand, he was actively health conscious and taking lots of supplements to take care of himself and actively bodybuilding. So it's like, okay, which one is it? Is he on the sick side and could have died at any time? Or is he actively health conscious and doing what he can to take care of himself and actively health, not body, but so it's like, which one? And I remember during the trial, the defense couldn't really make up their mind in terms of which way they wanted to go with that. So they were trying to play both of those cards at the same time.

[Taisha Eaton]

Yeah, and there's probably a more elegant way for me to ask this question, but given that you were not able to test for insulin because of the state of his remains and your role here as you're a forensic pathologist, why does the state then still bring you in to testify if you essentially couldn't come to a definitive like, hey, I tested for this and it's here because.

[Dr. Paul Uribe]

There was enough circumstantial evidence to go forward with it, even though you did not have the proverbial smoking gun, which is, you know, obviously the best smoking gun would be video of her injecting him. I mean, of course we're not going to have that. The next one would be, well, if there were samples that were taken and we can test for that and they would show evidence of. Of insulin poisoning. Something like that. And in that case, we didn't have that either. So my testimony was, well, this is what they could have done to look into it, namely on the clinical side, which is very tricky to pick up insulin intoxication or insulin overdose on the clinical side, because you have to suspect it immediately. You have to suspect it right. When the person walks in to the emergency room and they're crashing in front of you, that's when you have to test for it.

[Taisha Eaton]

I see.

[Dr. Paul Uribe]

And you know, that didn't happen, which is not terribly surprising at autopsy, from when he collapsed to when he died was several days. So post mortem insulin testing, you know, three to five days after the hypoglycemic event. So after your blood sugar tank drinks, it's very, very low yield. With that, your best option would probably be to try and find an insulin injection site. That wasn't done either. But even though you don't have the smoking gun, my testimony was, well, there's nothing else that really explains this, because when you have a blood glucose level of less than 30 in an otherwise healthy person, there's only a couple things that can do that. And some of them were able to rule out, like he was not rampagingly septic. He didn't have a huge bacterial infection that was overwhelming his system. There was no evidence that he was taking other drugs like some of the oral hypoglycemic agents. There was no history of that. But we have this weird history of insulin and how Natalie got it. And there was a used insulin vial in the house, even though no one was using insulin. And you have no other viable explanation for why a healthy male comes in with a blood glucose of less than 30. And based on that circumstantial evidence, I want to say that circumstantial evidence alone, because we didn't have the smoking gun evidence from autopsy, it was my opinion that there was nothing else that could have killed. There is no other explanation that makes even a shred of sense in this case.

[Hannah Smith]

Yeah, that's a pretty strong assessment, and I imagine that was impactful in the courtroom. And do you recall how long the jury deliberated and what was the outcome?

[Dr. Paul Uribe]

I don't recall how long they deliberated, but they found her guilty.

[Taisha Eaton]

Yeah. So she was found guilty of first degree murder for the murder of her husband, Michael Cochran, and she was sentenced to life in prison without parole.

[Dr. Paul Uribe]

Yep, that sounds about right.

[Hannah Smith]

Was there anything else about the case that stood out to you as strange, unusual, or notable from a forensic pathologist standpoint?

[Dr. Paul Uribe]

I think the most significant thing about this case in particular, and how it differs from the Rita Mays investigation is we got a successful prosecution for murder using insulin on just circumstantial information. Now, circumstantial evidence can be just as powerful as objective autopsy evidence if it's in the right context. And in this particular case, there was literally mountains of circumstantial evidence. Like, literally so many things that didn't make sense. Like, you find your husband down in the kitchen. What do you do? Oh, well, let's just leave him there. It's like, wait, no, that's not a normal reaction. You go to the hospital and be like, yeah, we don't know what's wrong, but we just want them put on hospice. And, oh, yeah, I got this insulin vial from the neighbor for the chemotherapy and breast cancer that I don't have. And ironically, the thing that astounds me the most is even months after Michael's death, when they searched the house, the insulin vial was still there.

[Hannah Smith]

That is bananas.

[Taisha Eaton]

That is like, someone who is so confident that they are just so smart that they can get away with anything.

[Hannah Smith]

Or, like, dumb. Like, I don't know. In what world would you not get rid of that?

[Dr. Paul Uribe]

I don't know. I really don't. But that's one of the little factoids about this case that just. It blows me away.

[Hannah Smith]

She was not careful to, like, cover her tracks. She really wasn't texting, going to the neighbors, and I guess, fortunately. Right. That all of that happened so that she was able to be found guilty for killing her husband.

[Taisha Eaton]

Yeah. Which I'm sure Michael Cochran's family was just, like, so relieved by that verdict.

[Dr. Paul Uribe]

Yeah, I think so. I've not spoken with the Cochran family, but I can imagine it's relief on all fronts from them. Once again, it's not gonna bring Michael back, but at least it provides some type of closure.

[Taisha Eaton]

Yeah.

[Hannah Smith]

Well, this has been really interesting. We really appreciate you joining us and walking us through, you know, all the technical aspects of this case and your involvement in the trial.

[Taisha Eaton]

Yeah, thank you so much.

[Dr. Paul Uribe]

Well, thank you for having me.

[Taisha Eaton]

If you have a story for us, we would love to hear it. Our email is thenifexactlyrightmedia.com or you can follow us on Instagram henifepodcast or blueskyenifepodcast.

[Hannah Smith]

This has been an exactly right production. Hosted and produced by me, Hannah Smith.

[Taisha Eaton]

And me, Taisha Eaton. Our producers are Tom Breifeogle and Alexis Amorosi.

[Hannah Smith]

This episode was mixed by Tom Breifogel.

[Taisha Eaton]

Our associate producer is Christina Chamberlain.

[Hannah Smith]

Our theme music is by Birds in the Airport.

[Taisha Eaton]

Artwork by Vanessa Lilac Executive produced by.

[Hannah Smith]

Karen Kilgariff, Georgia Hardstark and Danielle Kramer.

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