YULEE, Fla. – Janet Adkins, Nassau County’s elections supervisor, was leaving work October 21, 2022, when she got the call. 

Her daughter, Emily Adkins, was having trouble breathing. 

Janet told her she would call 911. On her phone, a video doorbell app showed ambulance attendants had beaten her to the house in Fernandina Beach and were carrying Emily out on a stretcher. Janet called her husband Douglas, telling him what had happened and to meet her at the hospital.

Emily died that night at Baptist Medical Center Nassau. She was 23. The cause was a pulmonary embolism caused by a blood clot, her family said.

More than 100,000 Americans suffer the same fate each year, according to the National Blood Clot Alliance. Now Emily’s parents have launched an all-out effort to determine what standards of care are being used to detect blood clots before they become fatal.

The Florida legislature has begun a volunteer study group to gather data and issue recommendations, the result of bipartisan legislation called the Emily Adkins Blood Clot Prevention Act. Many legislators who sponsored bills in the Senate and House already knew Emily through Janet Adkins, a four-term Republican state representative from 2008 to 2016. The goal of the work group is to get answers why so many preventable deaths due to blood clots go undetected and what can be done about it.

Douglas and Janet are also honoring their daughter by creating scholarships for healthcare students and low-income assisted living candidates in her name. They set up a Holy Land scholarship for fellow parishioners of Blackrock Baptist Church to visit Israel. 

Those things help, but cannot assuage a mixture of anger and grief over losing their daughter, who loved reading and travel, Hogans Heroes and I Love Lucy, angels and anime, Kelly Clarkson and Imagine Dragons.

That evening in October, she was still mostly living with her parents in Fernandina Beach. She had not quite finished moving into a brand new house in Yulee, which she had spent months designing. To this recent visitor, her imprint lingers, and intentionally so. Douglas and Janet have left the house mostly unaltered since she was last there. 

Emily’s 2017 Honda Civic still sits in the garage. Papers and notebooks from her job take up part of the interior. A health administration graduate from the University of North Florida, she was serving as the human resources director (or “success officer”) at DaySpring Village, an assisted living facility owned by her father.

Her keys hang on a rack in the entrance hall alongside a favorite cap, a scarf and a couple of hoodies for cooler weather.

Sea green walls open up to spacious views of the back yard in a way that makes each view feel like an opening, a clearing. Douglas decided to accept a delivery for $8,000 worth of Ethan Allen furniture that came after her death. The only other conspicuous change also speaks to a longstanding wish, one that walks on four legs. 

Gracee, a 9-month-old Aussiedoodle, throws her chew toy a foot or two and retrieves, jumps up on the couch and back down, a tireless fount of enthusiasm. Emily had been looking at the breed. 

“This house was part of her identity as she graduated from college and started on her career path,” Douglas said. “She had her whole life standing in front of her as a young woman.”

That trajectory would likely have carried her not only to one day succeed her father at the helm of his companies, but along the way, to take after her mother. Janet Adkins was 8 months pregnant with Emily when she ran for school board, her first political office. Emily also had her eye on a school board spot to benefit the children she planned to raise. Later, who knew? Maybe the legislature.

In the meantime she relished simple pleasures, including lunch after church at Gator’s Dockside, which specializes in wings and hand-breaded chicken tenders. That’s part of what makes Sundays the hardest for Douglas and Janet. Emily’s future seemed assured from almost any direction she desired, with nothing impeding it other than a couple of health-related setbacks, and neither of those seemed major at the time.

The first came midway through August, when an emergency room physician took out her gallbladder. Emily got back to work at DaySpring within a few weeks, but slipped on freshly washed floor and injured her ankle. 

She went to Jacksonville’s Mayo Clinic two days later, where Dr. Shane Shapiro diagnosed a break. Emily returned to the clinic Oct 13 to get her cast off. She left in a boot. In between she had a follow-up with Shapiro. The ankle was healing. 

Her phone call to her mother came eight days later. “I could tell she was in distress,” Janet said.

Janet parked at the hospital and inquired about her daughter. Hospital staff told her Emily had suffered cardiac arrest but had still had a heartbeat and that doctors were working on her. Doug soon arrived and was led to the waiting room to join his wife. 

At that point, they said, some hope permeated their shock. Yes, something bad had happened but she had a heartbeat and she was in the right place. 

Then a doctor entered the room. “He comes in,” Douglas recalled, “and he starts shaking his head.”

Through her shock, Janet knew one thing: She needed to be with her. 

They stood nearby her bed and prayed for Emily – prayed with her, as Douglas described it – and encouraged the doctors who were doing chest compressions.

As hope dwindled, unreality pervaded. “I just can’t think it,” Janet was thinking. “She’s 23.”

The next week entailed making funeral plans and trying to get answers from Emily’s caregivers at Mayo Clinic. Chief among his questions were how this death could have happened. The story on Monday, “Emily’s Medical Care,” examines Emily’s risk factors, the advice she received at the Mayo Clinic, and how a record by her orthopedist contradicts what Janet Adkins says she saw.

Dr. Shapiro did not return a call requesting comment for this story.

– Andrew Meacham covered obituaries and the performing arts for the Tampa Bay Times before his retirement in 2018.