04x12 - Deadly Lovers Quarrel

[bunniefuu]

[ominous music]

[dramatic music]

All you had to do was--

NARRATOR A lovers' quarrel suddenly turns deadly.

She picks up a butcher Kn*fe and stabs him in the arm.

NARRATOR But the evidence isn't adding up.

He has a wound that probably shouldn't have k*lled him.

But somehow, he still ended up dead.

NARRATOR And then a man turns up dead on the side

of the road.

That is not something I see every day.

NARRATOR And Dr. G may have a m*rder victim on her hands.

No wallet was found.

He could have been mugged, assaulted.

[dogs bark]

Who knows?

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

These are the everyday cases of "Dr. G--

Medical Examiner."

[piano music]

OK, what's this guy?

Do we have any history?

Ugh, what is this guy?

Alcohol and cigarettes?

That's a bad combo.

SANDY Look at me when you say it.

JAN GARAVAGLIA I'm always on Sandy's

case about her bad behavior.

Just drinking, I fall on the floor.

JAN GARAVAGLIA I'm worried.

NARRATOR Dr. G has reason to worry.

During her tenure, she has seen hundreds of people who

might have lived longer if they hadn't

abused alcohol and tobacco.

Dr. G's next autopsy doesn't seem to be an exception.

[ominous music]

It's early evening, and paramedics are rushing

to respond to an emergency call from a private residence

in Converse, Texas, about miles from San Antonio.

WOMAN Who's next?

NARRATOR When they arrive, they find a disturbing scene--

a crying woman, and a man bleeding heavily from his arm.

The woman is too distraught to be of much help.

But the injured man, Eddie West, immediately

explains what happened.

He was having an argument with his girlfriend.

And during this argument, she stabs him.

[woman screams]

[police siren]

NARRATOR Soon police arrive and question

the girlfriend, Julia, who's still too upset

to recall any of the details.

Meanwhile, paramedics transfer Eddie

to the hospital, where he undergoes

surgery to repair the wound.

They felt the surgery went well.

NARRATOR His family breathes a huge sigh of relief.

But his stability doesn't last long.

Within days, Eddie inexplicably takes a turn for the worse.

And I'm not sure at this point what didn't go well.

But he ends up needing to be intubated.

NARRATOR Doctors fight to improve his condition.

But to the horror of his loved ones,

he eventually slips into unconsciousness.

Sorry, son.

NARRATOR And two weeks after entering the hospital, he dies.

Eddie's family members are beside themselves.

How could a -year-old man go into the hospital

with a simple s*ab wound and never come home?

To find some sense of closure in the wake

of this sudden, incomprehensible loss,

they first need to understand exactly what k*lled him.

They strongly suspect the hospital is at fault.

And now they're turning to the autopsy for the evidence.

They thought that the doctor possibly

did something wrong or something went

wrong with the hospitalization.

NARRATOR As always Dr. G will keep an eye

out in the autopsy for signs of negligence

or an egregious error.

One possibility is that the wound

developed a deadly infection.

An infection, if you let it go,

can get into your bloodstream, which can actually be fatal.

NARRATOR But then, as she reads further into Eddie's file,

Dr. G discovers a number of potential threats to his life.

He's got a history of alcohol abuse, drug abuse.

He smokes.

He's got a lot wrong with him.

All of that plays a role in how well he does

during his hospitalization.

Maybe he's got, you know, some lung disease already from his,

you know, cigarette smoking.

And so that would make it more difficult to him

to get over the surgery.

NARRATOR But there's also another possible explanation

for Eddie's untimely death, one with dire consequences.

His death could have been a direct result of the s*ab
[ … ]

wound, in which case, the blame would

fall on his girlfriend, Julia.

If you do something to injure somebody that ultimately causes

his death, no matter how frail they are,

you're responsible for their death.

NARRATOR Now it's up to Dr. G to untangle the clues

and identify the truth.

We have to see if there is maybe

some problem with the hospitalization or the surgery

or if his death is all of a result of that s*ab wound.

Or is there some natural disease that's

playing a role that has nothing to do with the s*ab wound?

NARRATOR Dr. G's findings could determine whether someone--

Eddie's girlfriend or his doctors--

is held responsible for his death.

[funky music]

JAN GARAVAGLIA Let me get this guy moving.

NARRATOR Dr. G embarks on the external examination.

OK.

NARRATOR Immediately, the gash on his upper left arm

commands her attention.

Yeah, I probably need a ruler of that.

Otherwise--

NARRATOR At and / inches long and more than an inch

wide, the wound seems devastating, even on the arm.

But when she examines it with a magnifying glass,

she discovers the original injury is surprisingly small.

They have taken a one-inch s*ab wound

and extended it for another and /

inches to do surgery on it.

MAN So what are we going to do?

I can tell where the one-inch s*ab wound was,

because it's slightly more irregular

than the scalpel incision.

She also notes that the entire laceration

has been left wide open.

This may look like a serious oversight that could

lead to a deadly infection.

But Dr. G recognizes it as a technique known as healing

by secondary intention.

Instead of the customary stitches or staples,

this allows the wound to heal by natural means.

And it looked pretty good.

It didn't look like it was actively infected at all.

NARRATOR But to be sure, she needs to dig deeper,

using her scalpel to check the damage inside the wound itself.

Let's open up this first.

NARRATOR It goes deep, two inches into the arm.

It looks like a nice clean in and out.

NARRATOR But there's no festering

infection that she can see.

Still, it's clear that this was no ordinary s*ab wound.

The Kn*fe had completely severed Eddie's

brachial artery, the largest vessel of the upper arm.

The brachial artery is quite a big artery.

One of the main vessels coming off your heart

is your subclavian.

And your subclavian, it will go directly,

basically, into your arm.

And it changes names.

It goes from subclavian to axillary to brachial.

So it's-- as it's going into the upper arm,

we call it the brachial artery.

It's, you know, a good diameter.

And you can lose a lot of blood very quickly.

NARRATOR But in Eddie's case, the surgical team

stopped his bleeding by reattaching

the two ends of the severed artery,

and he lived for another two weeks.

Clearly, he did not die simply from excessive bleeding.

And the wound, while serious, appears

to be well-treated and healing.

So far, the findings are good news for Julia

and for Eddie's doctors.

But for Dr. G, the mystery of his death

is more troubling than ever.

He has a wound that probably shouldn't have k*lled him

with prompt medical attention.

But somehow, he still ended up dead.

[ominous music]

NARRATOR Dr. G cuts down the torso

of -year-old Eddie West.

Eddie's family believes that for him to die of a simple s*ab

wound to the arm, hospital doctors

must have done something wrong.

But Dr. G isn't making any assumptions

until all the facts are in.

Peel that, and then you can do your side.

NARRATOR Now, peeling back Eddie's skin,

she can see how two weeks of post-surgical intensive care

has affected his body.

And we open up the abdominal cavity,

and he's got about a liter of fluid.

Now I knew they were giving him a lot of fluids.

They were trying to maintain his blood pressure.

NARRATOR But then she notices something highly abnormal

in the stomach, the kidneys, the pancreas.

It's everywhere.

Everything has kind of a yellowish appearance.

NARRATOR Eddie's organs are jaundiced, a symptom
[ … ]

of natural disease where a yellow chemical called

bilirubin accumulates in the blood.

And when she examines the liver, she quickly identifies

the source of his problem.

Hm.

It's very cirrhotic.

It's very lumpy, bumpy, regenerative nodules.

It's a very sick-looking liver.

NARRATOR Cirrhosis, or the scarring of liver tissue,

can impair the organ's ability to filter

bilirubin from the blood.

Often, it's the end result of alcohol

abuse, which Dr. G suspects is the case with Eddie.

And it looks like he drinks very heavily.

He obviously wasn't taking care of himself.

NARRATOR Over time, cirrhosis can lead

to liver failure and death.

I got my--

NARRATOR But Eddie was clearly active

prior to his injury, which means it's unlikely that it suddenly

k*lled him in the hospital.

He was tooling along with his liver disease.

And he was able to drink and keep up his alcoholism

when he got the s*ab wound.

NARRATOR But if he didn't die of liver disease, an infection,

or sheer blood loss, what caused his death, and who is to blame?

To find out, Dr. G must persevere in the autopsy.

And her next stop is the chest cavity.

MAN (SINGING) Now this guilty pleasure has taken its toll.

But still my conscience is not sold.

I'm your weak endeavor to sever its hold.

Half the story goes untold.

It's not that you're right.

It's not that I'm wrong.

It's just that you got me hanging on.

So keep away.

NARRATOR She removes the chest plate

and there detects a possible culprit.

His lungs look terrible right off the bat.

NARRATOR She removes and dissects them.

With every slice, the problem grows more alarming.

Eddie's lungs have no trace of the normal spongy texture.

And they're almost solid.

They're airless, they're so solid.

NARRATOR Dr. G is certain the condition is not

the result of a smoking habit or inadequate treatment

by doctors.

It's a natural disease of the lungs called acute respiratory

distress syndrome.

Or what we call ARDS.

It's something he develops while he's

in the hospital being so sick.

NARRATOR ARDS usually strikes when a patient is

very ill, whether from an infection,

injury, or other condition.

The lungs' tiny air sacs get inflamed

and fill with fluid instead of air,

eventually making it impossible to breathe.

When you see them, you cannot believe anybody could

be alive with these lungs.

NARRATOR For Dr. G, this severe lung disease trumps cirrhosis

as the final death blow.

It's a very, very severe disease.

Clearly, he must have d*ed ultimately from the ARDS

with these airless lungs.

NARRATOR Now she knows exactly how Eddie's life ended.

The discovery would bring most autopsies to a close.

But in this case, finding a mechanism of death

doesn't satisfy Dr. G.

The mechanism of death isn't always the cause of death.

The mechanism is just the end piece.

The cause of death is what started

the chain of events that ultimately caused

him not to be able to aerate.

NARRATOR To rule the cause and manner of death,

she must determine what caused Eddie's ARDS

and triggered his downward spiral.

What got him to those airless lungs?

What got him there?

NARRATOR If the hospital is found to be at fault,

they still could be held responsible.

Or if the inciting incident turns out to be the s*ab wound,

Eddie's girlfriend Julia still could be charged with homicide.

.

NARRATOR But so far, Dr. G only has

sporadic links in the chain between the s*ab wound

and ARDS.

And after dissecting the heart and brain,

she can find nothing to complete the picture.

Where I cut his brain, there's a little edematous,

which we see with someone kind of slowly dying.

But overall, his brain looks normal.

NARRATOR At the end of the autopsy,

she still lacks the evidence to rule

a cause and manner of death.

Yeah, I have a lot of the facts

of what his organs look like.

I have, you know, a wound that's been surgically manipulated.

And I can see that he's been very sick.

I've got a mechanism of death, that he
[ … ]

d*ed from respiratory failure because his lungs were

so damaged.

But I really still need to know how

he got to that from a simple s*ab wound to the arm.

NARRATOR Now there's only one place

where she might still find clues that

wouldn't show up in autopsy--

Eddie's complete files from the hospital.

I may not have all the notes.

So I need to look at those medical records very carefully

and put that with what I found at autopsy.

NARRATOR The truth may exonerate Julia

and the hospital or finally give Eddie's

family a chance at justice.

[ominous music]

How much is it for the unstained?

How much are they charging?

WOMAN Stain slides are $.

NARRATOR Sometimes the most creative part of Dr. G's job

happens outside the autopsy room.

You need a quiet place to read the chart more carefully.

You have to kind of think about what you've found.

And you need the police report, the autopsy findings,

your microscopic slides.

And usually, you do that in your office.

NARRATOR The full medical records of Eddie West

have finally arrived.

And Dr. G puts everything else aside to pore over them.

She's certain that the -year-old

d*ed from a respiratory disease in the hospital--

Pay the bill?

NARRATOR --two weeks after his girlfriend

Julia stabbed him in the arm.

But without knowing why Eddie became so ill,

she can't determine who should be

held responsible-- his doctors, Julia

herself, or nobody at all.

If you're going to punish somebody for something,

you just want to make sure that the T's are crossed

and the I's are dotted.

NARRATOR Now she carefully examines

the hospital report, which describes every aspect

of his medical care.

The details are astounding.

So when I review the chart, I see all of his problems

he had during his hospitalization.

NARRATOR One problem in particular stands out.

She discovers that before and even after the surgery,

he had needed massive blood transfusions for two reasons--

his severed artery and his sick liver.

When the liver doesn't work well,

you bleed much more easily.

So if a patient has liver disease

and they have trauma in addition to that,

their blood loss is amplified, accentuated,

three, four, five times.

NARRATOR But while replenishing the blood supply in patients

like Eddie is paramount to keeping them alive,

it can sometimes trigger unexpected side effects.

We all can be allergic to different proteins,

like a bee sting or, you know, certain foods we eat.

Well, there's proteins in some of the blood products

they give.

So some people can have allergic reactions to proteins.

NARRATOR This type of response is

uncommon and almost impossible for a surgical team

to protect against.

A reaction occurs in about one in patients.

But life-threatening cases like Eddie's are even rarer.

Because of them giving him so many blood products,

he ends up having a transfusion reaction

to some of the products that he was given,

most likely some of the protein or the white cells.

NARRATOR Eddie's allergic-like reaction to blood products

caused fluid to leak into the lungs,

making it difficult for him to breathe on his own.

This could explain why doctors put him on a ventilator.

But Dr. G suspects that, at this point,

he still could have recovered.

Although he has a bad reaction,

if the cards are right and things go well,

yeah, he should have survived it.

NARRATOR But Eddie's cards were stacked against him.

And in the hospital report, she soon

spies another blow to his chances,

something impossible to detect in autopsy.

In the days after his surgery, Eddie

had suffered a severe form of alcohol withdrawal known

as delirium tremens, or DTs.

It really has to do with the brain

receptors no longer being exposed to the alcohol

like they normally are.

And you actually get seizures.

You can also get hypotension.

Even with proper treatment, you can have a % to %

mortality just by going through alcohol withdrawal.

NARRATOR The withdrawal symptoms

would have taxed a number of vital organs,

including his damaged lungs, ultimately

enough for him to develop ARDS.
[ … ]

For Dr. G, these details from the hospital records coupled

with her autopsy results finally complete the chain of events

leading up to Eddie's death.

Besides him already having liver disease, the bleeding,

the transfusion reaction, all of those are insults to his lungs."], index ,…}

He needs more and more oxygen to maintain

him having oxygen in his blood.

And at some point, they can no longer then oxygenate

his lungs, and he dies.

NARRATOR Now Dr. G can explain to Eddie's

family exactly what cut the -year-old's life

so tragically short.

[ominous music]

It's a beautiful Saturday afternoon.

But for Eddie and his girlfriend Julia,

there's trouble in the air.

Can't find anything--

NARRATOR Something sparks a fight.

And soon, their argument spirals completely out of control.

ACTOR AS EDDIE WEST Stupid!

And I just still--

I don't know why he's arguing.

But she stabbed him.

[screams]

NARRATOR The Kn*fe impales his upper arm,

severing the brachial artery.

Oh my God.

They know it's severe, calls .

They go to the hospital.

They immediately take him into surgery.

NARRATOR But Eddie's liver, ravaged by alcohol,

prevents his blood from clotting,

and he continues to bleed.

To combat this new problem, his doctors

ply him with transfusions.

But to their alarm, their efforts backfire.

He has a bad reaction to some of the blood products.

But it was unforeseen.

There is no way you could have tested for it.

NARRATOR To help Eddie breathe, doctors immediately

put him on a ventilator.

But then he takes another devastating hit, this time

from alcohol withdrawal.

Doctors face this all the time.

People come into the hospital not healthy,

or, you know, one bad complication

happens after another.

NARRATOR Eddie's condition quickly spirals downward.

His lungs weaken drastically, further exacerbating

his respiratory distress.

And they just can't maintain any oxygen in him,

'cause his lungs are getting worse and worse.

NARRATOR Finally, despite his doctors' best efforts,

Eddie's oxygen-starved organs begin to shut down one by one.

And two weeks after entering the hospital, he dies.

Based on these findings, Dr. G concludes

that the medical team was not at fault for Eddie's death.

But someone is-- his girlfriend Julia.

Although the mechanism of death

is really complicated with all of these chain of events

happening and the ultimate lung failure, the cause of death

actually is very simple, and it's a simple, single s*ab

wound to the arm.

So ultimately, although some of the problems

were his in that he had liver failure,

and some of the problems were just a bad consequences

reaction to the blood, all those things

were set in motion because of the s*ab wound.

NARRATOR And with the s*ab wound

as the definitive cause of death,

Dr. G must make a disquieting ruling.

The manner of death is homicide.

That's more of a forensic term.

Homicide doesn't imply intent.

It doesn't imply that it's premeditated.

It doesn't imply it's a m*rder.

Homicide means that his death is a direct result

of an act of another on him.

And that's what I call it, and that's

what it gets-- how it gets sent for the judicial system

to decide what they do with it.

[peaceful acoustic music]

NARRATOR The police immediately arrest Julia.

She pleads guilty to aggravated as*ault. Her sentence,

years probation.

For Eddie's family, it provides some measure of justice.

But whether it brings them peace, only time will tell.

They see that quite clearly with the autopsy and the death

certificate that, yes, he did die from the s*ab wound,

and yes, it was his girlfriend that

ultimately put him in there.

In a totally healthy person, would

this have been a fatal injury?

It's possible.

It depends how much blood you lose at the time.

It depends that everything went well with the transfusions.

But sometimes things don't go well.

So one of the reasons we want to be in good shape

is if we ever do have to go to the hospital,

the chances of surviving anything are better.
[ … ]

[energetic music]

NARRATOR Coming up, as Dr. G closes one homicide case,

another finds its way to the District Nine Morgue.

It's always a red flag if you're found just dead outside.

He could have been mugged, assaulted by anyone.

Who knows?

[ominous music]

[relaxed acoustic music]

JAN GARAVAGLIA As the medical examiner,

I might be the one holding the scalpel.

But a morgue runs on teamwork.

MAN IN BLACK That, too.

But I--

I don't think I have the ER sheet.

We'll have to go ahead and try and figure it out.

JAN GARAVAGLIA And when the team isn't

clicking on all cylinders-- - Medical examiners.

Carol.

JAN GARAVAGLIA --it can make this job a whole lot harder.

OK, who's his next of kin?

JAN GARAVAGLIA This was definitely

the case for a recent autopsy of a -year-old man

named Gene Andrews.

[ominous music]

NARRATOR AM.

Dr. G arrives at the morgue, where it's strangely quiet.

Oh, my.

We got problems today.

We got-- you know, Steve's out on vacation.

Two of my investigators call in sick.

We're trying to get one in who worked

pretty much all day, till, like, midnight last night.

He says he'll come in.

It's going to take a little bit.

NARRATOR Meanwhile, there are bodies waiting to be autopsied.

The first file she picks up is that

of a man found lying on a street corner

in nearby St. Cloud, Florida.

According to the report, a local flower shop owner

and his manager were walking to their van

when something caught their eye.

And they see this poor gentleman pretty much

on the curb, not looking good.

NARRATOR At first, they assume it's a homeless man

just drunk or asleep.

But on closer inspection, they're shaken when they

realize he's not breathing.

They immediately call .

NARRATOR Paramedics arrive within minutes.

EMS tries to resuscitate him.

PARAMEDIC One, two, three.

NARRATOR But it's too late.

They can't get a pulse, and he dies

right there on the pavement.

No one recognizes the man.

But fortunately, the paramedics are able to get

a quick lead on his identity.

They found a card--

his driver's license or ID card--

in his pocket.

NARRATOR His name is Gene Andrews, his age, .

Now, while the police look for Gene's family,

his body is immediately transferred

to the District Nine Morgue and into Dr. G's hands.

So we're going to have to figure out what went on.

NARRATOR Already, she has a major concern

about his cause and manner of death

because of where they found him.

It's always for us a red flag if you're

found just dead outside.

The location kind of gives us a hint of how you're dying.

Usually, on the toilet, we're thinking,

you know, hypertensive or a rhythmic type death.

Just dead in your sleep, you know,

that tells us more of a heart.

In this case, he's found on the side of the curb.

NARRATOR Nobody actually saw Gene fall

to the ground, which means that an att*ck of some sort

is a likely possibility.

No wallet was found.

He could have been mugged, assaulted by anyone.

Who knows?

[g*nsh*t]

NARRATOR At worst, he could have been sh*t.

A small-caliber b*llet can lead to heavy internal bleeding

that's hard to detect externally.

The blood stays in his chest.

You know, we oftentimes can see that.

NARRATOR If Dr. G finds any evidence of trauma,

police will need to launch an immediate manhunt

for the offender before the trail grows cold.

Given Gene's age, however, death from natural causes

is also a prime candidate.

Unfortunately, she's got no medical records to work with.

And I have nobody in my office to, like,

check all the local hospitals to see

if he had any medical history, any admissions.

But I don't think this is going to get done.

NARRATOR The longer she waits for information,

the harder it will be for police if they need to start
[ … ]

tracking down m*rder suspects.

So I have to proceed.

We've got to put extra care and really

prove that no traumas occurred.

NARRATOR Dr. G begins the external examination

with a search of Gene's clothing.

His clean appearance suggests he's not homeless.

But the contents of his pockets could be even more telling.

All righty.

Let's see.

When you go through the decedent's pockets,

you never know what you're going to find.

A lot of it will build the picture of who they are.

Some guys are really neat, you know?

They have their money in the clip.

A lot of guys, though, uh-uh.

They just got things wadded up in here, old gum wrappers,

you know, just all sorts of little odds and ends.

NARRATOR A good clue can be priceless.

Sometimes you find lots of money,

you know, thousands upon thousands of dollars.

But sometimes you can find syringes,

sometimes the photographs.

We had one where he was in an automobile accident,

and I had his cell phone.

And you could see the pictures on his cell phone

were at a party, and he was obviously drunk.

So it's very helpful to help you build the picture.

MAN Puts on three, four pounds--

NARRATOR Gene's belongings look trivial at first.

And he's got, you know, the typical lighter.

I don't find any cigarettes.

Ooh, let's see.

NARRATOR But then she spies something extremely valuable.

Lo and behold in there, I did get a hint.

And what I got was a slip--

a prescription for him to get a CAT scan.

NARRATOR A CAT scan, or computed axial tomography,

is used to diagnose a multitude of problems,

from cancers to blood clots.

Given that the prescription was still in Gene's pocket,

Dr. G suspects he never used it.

But the clinic where the CAT scan was prescribed

may have vital information about his health,

and in turn, his death.

Normally, she could follow a clue like this

without leaving the room.

I'll give it to my investigator,

and I'll, you know, have him call

while I'm doing the autopsy.

In this case, I didn't have any investigators.

NARRATOR But the clock is ticking.

I'm, like, really wondering what's

going on with the fellow.

So I thought, well, I'll try calling the doctor myself.

[ominous music]

NARRATOR Dr. G steps out of the morgue for a moment,

leaving Gene Andrews' body on the gurney.

I just postponed the autopsy for a few minutes

to see if I could get some more information on him.

NARRATOR With a skeleton staff, it's the only way

to find out why the -year-old had a prescription

for a CAT scan in his pocket.

Hi, this is Dr. Garavaglia at the medical examiner's office.

Now you just can't call a doctor's office, usually,

and get information about anyone.

But, you know, they know the medical examiner's office.

In this state, we can get their medical information

to help us with the cause and manner of death.

NARRATOR At first, it takes a moment

for the clinic's administrative nurse

to track down the records.

That little piece of paper actually

was written about three months earlier.

NARRATOR But the effort pays off.

She's telling me that he was in there.

He had some history of previous strokes and

recent right-sided weakness.

NARRATOR Concerned that Gene's weakness

was the classic sign of a stroke, the doctor prescribed

a diagnostic CAT scan.

Gene took the prescription, but apparently

never went for the test and never returned to the clinic.

He never finished his workup for this right-sided weakness.

Now I find it interesting.

After three months, he still has the prescription in his pocket."], index ,…}

Maybe he's just a typical man.

He's going to get to it.

Maybe the right-sided weakness went away,

and he figured he didn't have to do anything about it.

NARRATOR Yet Dr. G can't ignore Gene's history.

Strokes are the number three cause of death

among Americans his age.

If he truly has a history of stroke,

you know, maybe he's had another huge stroke.

[ominous music]

NARRATOR Dr. G delves into the external exam,

first focusing on the possibility

that Gene was the victim of a mugger's att*ck.

Now I'm still having to worry about trauma.
[ … ]

I look for a skin, for any evidence of bruising, even,

you know, grabbing his wrist, certainly looking for,

in the abdominal area, anything abnormal, any abnormal--

even, you know, a g*nsh*t wound with very little blood.

NARRATOR But she finds no indications

of an as*ault or even illness.

He looks maybe even a little better than .

And I really don't see anything on him.

NARRATOR In fact, for someone with a possible history

of strokes, he shows none of the muscular degeneration

often seen in stroke victims.

They said he had a history of a previous stroke.

They said he had this new onset of right-sided weakness.

But when you look at the guy, he doesn't

show any signs of stroke.

I mean, his muscles look, you know, bilateral.

They look symmetrical.

He's obviously walking down the street.

NARRATOR But about % of patients

make a full recovery with no loss of mobility.

Either Gene was one of those lucky few,

or what he thought were strokes were something else.

Yet based on the known circumstances,

Dr. G still wonders if Gene's sudden death

was from stroke or head trauma.

And there's only one way to find out.

[ominous music]

Slicing from ear to ear, Dr. G peels back the scalp

and at first spots no injuries.

I look at the skull, the calvarium,

and I certainly don't see any fractures.

[drill whirring]

NARRATOR But then, as soon as she extracts the brain,

she sees trouble.

There is a portion of his right cerebral hemisphere,

there's almost and / centimeters by about

two centimeters that is dead.

NARRATOR This is clearly not trauma from an att*ck.

Instead, she recognizes the condition as an infarction,

or the aftermath of a stroke.

When I see a brain, it's usually got the consistency

of a nice, kind of a firm Jell-O. And in this case,

you have the normal kind of gray soft brain, and then you

have a place that's indented.

That part of the brain, almost a wedge shape,

has lost blood supply, and it d*ed,

and it doesn't get replaced.

And that's clearly an ischemic stroke.

NARRATOR Ischemic strokes are those

caused by clots or other obstructions

in a blood vessel in the brain.

If untreated, the victim can incur serious brain

damage and even death.

But oddly, for Gene, that's not the case.

If it was fresh stroke, you know, the tissue

would still be there.

But it'd be soft, and it would show

that it was starting to die.

Now this-- the body's already kind of repaired it.

It almost looks kind of shriveled up,

and it's clearly an old stroke.

I know that's not what caused his death.

NARRATOR As she continues the dissection of the brain,

she's surprised to discover that it's

actually riddled with strokes, and all of them

are old except one.

I do find a little blood clot in one of the vessels.

NARRATOR The finding suggests that all of his strokes

are ischemic, caused by blood clots.

And this little one is the newest.

So eventually, these blood clots get reabsorbed.

And you don't necessarily see them in the vessels.

I'm actually surprised I could actually find even

this tiny one, this fresh one.

NARRATOR But Dr. G is confident that the clot is too small

to have cause Gene's death.

Though there's no doubt he was prone to strokes

for some reason, she finds nothing that

indicates he d*ed from one.

And if a stroke didn't k*ll him, it's more likely than ever

that he suffered a deadly as*ault.

I'm still having to worry about trauma.

MAN Can you get this side off for me?

JAN GARAVAGLIA Yeah, feel free.

NARRATOR Dr. G makes the standard Y incision

on Gene Andrews from the shoulders to the sternum

and down the abdomen.

If he d*ed from a fatal injury, she

would expect to find internal hemorrhaging

from a damaged organ or vessel.

Well, don't have blood there.

My first answer is, he doesn't have any free blood

in the abdominal cavity.

And then I also look to make sure there's

no rib fractures, any evidence of blood,

evidence of blows to the chest.

And there is none.

So I've ruled out trauma in the head,

I've ruled out trauma in the abdomen,

and I've ruled out trauma in his chest.
[ … ]

Trauma is ruled out.

NARRATOR Now she can alert authorities that Gene's

death is not a homicide.

But if neither trauma nor a stroke k*lled him, what did?

We're ready, then?

NARRATOR To find out, she turns up the heat,

checking every organ for any signs of an acute illness.

So I open the chest cavity.

I cut up the anterior ribs on both sides,

take that chest plate off.

NARRATOR But then, as she removes

Gene's abdominal organs, she uncovers

something far more alarming--

kidney damage.

Nice, healthy kidney has, you know, just as you heard,

the typical kidney-shaped bean.

They call them kidney-shaped beans for a reason.

They look like just what the real kidneys look like.

They have a nice, smooth surface.

Now his kidneys, you can see immediately

there's something wrong.

You have nice, normal tissue.

And then you lose tissue.

You know, it kind of bumps down, and then some normal tissue,

and then it bumps down.

And these are-- there's old infarcts in his kidney,

multiple small infarcts, giving these kidneys this kind

of lumpy, bumpy pattern.

The right kidney is going to be .

NARRATOR Much like in the brain, the infarctions

in Gene's kidneys indicate areas where tissue lost blood supply

and d*ed because of the clots.

Yet amazingly, Dr. G believes Gene

may not have even felt the damage, much less d*ed from it.

The beauty is, you have two kidneys.

And you really have to harm a lot of kidney tissue

before it starts truly affecting you.

Just the outer--

NARRATOR Still, she's troubled by the condition

of Gene's kidneys.

Why is he having infarcts in his brain and his kidneys?

That is not something I see every day.

Even more baffling, she can't figure

out how they could possibly relate to his death, if at all.

And she has only one major organ left to examine.

OK, let's see.

I've still got the major cause of death

that comes through my office, and that's heart.

And I still need to look at that heart.

[ominous music]

NARRATOR Dr. G extracts -year-old Gene Andrew's

heart, and it looks quite bizarre.

Just like his kidneys were lumpy-bumpy, his heart

wasn't normal-shaped either.

My, my, my.

I can clearly see part of the heart had d*ed.

NARRATOR Dr. G immediately recognizes

this as a classic sign of a heart att*ck.

To find out what caused it, she begins slicing into the organ.

JAN GARAVAGLIA Let's see.

NARRATOR And there, in the coronary arteries,

she finds the culprit.

He's got bad atherosclerosis, the buildup of fatty plaque.

NARRATOR She believes the plaque impeded blood flow

in Gene's heart, causing his heart att*ck

and k*lling part of the heart wall.

So classic old heart att*ck that I see.

The wall is dead already.

It's been replaced by fibrous tissue.

This is not something acute.

This has been there for months.

NARRATOR But then, attached to the inside of the heart wall,

she finds something that intrigues her even more--

a large, old blood clot.

These blood clots on the inner aspect

of the walls with major heart att*cks are very common.

And in this case, it's, you know,

a pretty big blood clot in there, and it's pretty thick.

And it's well-attached.

You can tell it's been there a long time.

But it's somewhat friable.

It easily breaks apart, and the edges are a little bit loose.

NARRATOR Suddenly, she realizes this finding in the heart

could actually solve the mystery of Gene's

strokes and kidney damage.

I think I have it all figured out.

What happens is that he has a heart att*ck that

kills off the front part of the heart

muscle in the left ventricle.

That's replaced by scar tissue, and a clot had formed.

And occasionally, a big enough piece

breaks off that it kills part of the tissue where it lodges.

And it's obviously lodged a lot in the kidneys,

and it's lodged in the brain.

NARRATOR Now Dr. G has a perfect explanation

for Gene's numerous infarcts.

In the wake of a heart att*ck, a massive clot

in the left ventricle was simply depositing bits and pieces

of itself throughout his body.

And this may even point to a cause of death,
[ … ]

because after a heart att*ck, the resulting scar tissue

leaves the heart vulnerable to dangerous interruptions

to the heartbeat.

With that major of heart att*ck,

it sets up an arrhythmia.

And so he is at high risk for sudden death.

[g*nsh*t]

NARRATOR But as she wraps up the autopsy,

she's not convinced she has all the answers.

She wonders why, after surviving for months

with a damaged heart, brain, and kidneys,

Gene collapsed on that particular day.

He was going along fine with it.

Why does it k*ll him today?

I do have this nagging worry of what else is going on with him.

Ah, I can't figure it out.

NARRATOR Dr. G's last hope for resolving Gene's

puzzling death is toxicology.

Perhaps a secret remains hidden deep within his blood.

JAN GARAVAGLIA Okey-dokey.

NARRATOR Dr. G sends Gene Andrews' fluid samples

to the toxicology lab.

But what comes back is nothing short of shocking.

It is amazing what you find in toxicology.

Surprisingly, even at the age of , even with previous strokes,"], index ,…}

even with this previous heart att*ck,

this guy is using cocaine.

[chime music]

NARRATOR Specifically, the chemicals

found in his blood show that he had used cocaine within an hour

or two of his death.

I mean, it is just unbelievable that

a -year-old man is still doing cr*ck

cocaine out on the street.

NARRATOR But in retrospect, it fits perfectly with all

the clues from the autopsy.

He's got a lighter in his pocket,

but he didn't have any cigarettes.

Even his lungs-- very gray, a lot of anthracotic pigment.

So I suspect he has been smoking cr*ck cocaine for a long time.

NARRATOR This also explains her unexpected findings

in the heart.

Cocaine is known to cause heart disease.

His heart att*ck, his atherosclerosis

can all be associated with cocaine.

NARRATOR But most importantly, cocaine

is also associated with arrhythmias, a disruption

to the heartbeat that can be fatal.

With all the evidence in hand, Dr. G

is now certain that Gene was ultimately

k*lled by a cocaine-induced arrhythmia.

His body is set up to have a cardiac arrhythmia.

He has been cheating death for a long time.

[ominous music]

[dogs barking]

NARRATOR At , Gene Andrews has

a habit he just can't break.

And today is no exception.

He's smoking cr*ck cocaine.

He's out on the street doing what he wants.

NARRATOR He probably doesn't realize what a dangerous chain

reaction cocaine had triggered in his body,

starting with heart disease, then leading to a heart

att*ck and a large clot, which then

slowly chipped away, causing his strokes and kidney damage.

But amazingly, Gene survived all of this.

There are many things that could have

caused his death along the way.

And I think he's lucky to have lived as long as he did.

NARRATOR But finally, his luck is beginning to run out.

As he smokes his usual dose of cocaine,

Gene's heart struggles to pump.

It's a stimulant.

It causes increased heart rate, increased blood pressure.

NARRATOR The drug also acts as an irritant,

causing his heart vessels to spasm.

And this heart then starts to quiver.

NARRATOR He makes his way to the street,

perhaps to call for help.

But it's too late.

Gene is having a cardiac arrhythmia.

His heart can no longer keep b*ating.

And he dies on the curb, not from natural disease

or an as*ault, but as a victim of his own vice.

MAN Hello?

Sir?

[peaceful music]

Do you have a pen I could borrow, though?

NARRATOR Dr. G rules the death an accident,

because although Gene may have soon d*ed from another heart

att*ck or stroke, he d*ed on this particular day

from the unpredictable effects of cocaine.

It's Russian roulette.

You never know when it's going to affect you and can k*ll you.

NARRATOR But for Dr. G, the most unpredictable part

of the case is human behavior.

He's .

I really didn't suspect it.

And you know, it just goes to show, you just never know.

Oh, we got three today.
[ … ]

[futuristic music]

ANNOUNCER Atlas.