Mayumi Spencer, 29, was found dead in a Melbourne apartment in January 2015, after a night out with her husband Peter, the Coroners Court was told on Tuesday.
Mrs Spencer was born in Sapporo in Japan and met Dr Spencer, a medical practitioner, when he was visiting the country in 2006.
On January 16, 2015, the couple went out for dinner and then to a bar, returning to their Docklands apartment just after 1am.
Counsel assisting the coroner Nicholas Ngai said about three hours later, at 4am, Mrs Spencer had a fit and began vomiting.
Her husband believed she had a "blockage" in her throat and used a kitchen knife and pen to surgically open it, he said.
"This procedure was unsuccessful and at 7.38am on the 17th of January, Dr Spencer contacted emergency services, on triple zero, and reported that Mrs Spencer was not breathing," Mr Ngai told the court.
When paramedics arrived, they found Mrs Spencer on the floor of their lounge room with her husband trying to perform "gentle" CPR on her lifeless body, he said.
She was declared dead, with an autopsy later finding she died from cocaine toxicity. She was found with bruises, track marks and cuts to her neck.
A forensic pathologist found Mrs Spencer did not have a chronic history of drug use and did not have a seizure disorder, Mr Ngai said.
Dr Spencer, who appeared in court unrepresented despite being told to obtain a lawyer in prior hearings, objected to giving evidence on self-incrimination grounds.
"Please make your findings without my submission," he told the court.
State Coroner John Cain said he was concerned that Dr Spencer waited more than three hours to call for an ambulance after discovering his wife was unwell.
"Two things arise from that, one is whether there has been some criminality involved," Judge Cain said.
"If I believe it was a homicide, then I'm obliged to refer that matter to the Director of Pubic Prosecutions so that they can consider whether further investigation or charges should be laid."
He also questioned why a medical practitioner would delay calling emergency services when someone was "very unwell", flagging he could also refer Dr Spencer to the Australian Health Practitioner Regulation Agency.
"If a medical practitioner does that, is it appropriate for that person to remain a medical practitioner?" Judge Cain said.
He gave Dr Spencer two weeks to respond to these issues.
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