05x12 - Crossing the Line

[bunniefuu]

[music playing]

NARRATOR A man takes a nap and never wakes up.

DR. JAN GARAVAGLIA We have three really

deadly things going on here.

This sounds like a bad combination.

NARRATOR But when the clues don't add up,

Dr. G finds herself in uncharted waters.

DR. JAN GARAVAGLIA Sometimes when things don't fit,

you gotta go with your sixth sense.

NARRATOR And then a woman is stricken with

an intense but mysterious pain.

DR. JAN GARAVAGLIA Her son said she

complained just out of the blue, this stabbing eye pain.

And then it went away.

NARRATOR But when she dies the very next day,

her son fears that he may have ignored a lethal warning.

The son is absolutely flabbergasted that she's dead.

It just really came as a shock to him.

[music playing]

NARRATOR Altered lives.

Baffling medical mysteries.

Shocking revelations.

These are the everyday cases of Dr. G, Medical Examiner.

[music playing]

NARRATOR As chief medical examiner of the District Nine

Morgue in Orlando, Florida, one of Dr. Jan Garavaglia's

primary responsibilities is to keep

track of public health trends.

Homicides, motor vehicle fatalities,

and natural disease, such as obesity.

DR. JAN GARAVAGLIA Do you know that there is a million

obese or overweight people in the United States?

And some days I think they're all coming into my morgue.

NARRATOR It's a condition Dr. G understands

both clinically and personally.

You know, I was a fat child, a really fat child.

Oh, yes.

I was, you know, I was the type you made fun of on the bus.

SANDY What?

Oh my god, yes.

[music playing]

DR. JAN GARAVAGLIA You should see pictures of me.

I was a really fat child.

I lost, like, pounds, I believe, between eighth grade

and ninth grade.

And then I gained a lot of weight

after my first child was born.

I had to lose pounds.

SANDY Wow. - Yeah.

And then-- Yeah.

And then I gained a lot of weight

after Eric was born, too.

I'm not good with kids, I guess

NARRATOR Today, Dr. G's first case also

involves a patient who has struggled with their weight,

a -year-old man named Jeremy Weinberg.

[music playing]

NARRATOR The body of Jeremy Weinberg,

a beloved teacher at a nearby Orlando high school,

is wheeled from the refrigeration unit

into the exam room.

DR. JAN GARAVAGLIA According to his family,

according to his principal where he teaches,

this guy is a wonderful guy.

He's one of those big kind of bear--

the loving kind of guy.

NARRATOR Jeremy's unexpected death

has left his family and friends in a state

of shock and disbelief.

It all started the previous evening while Jeremy was

eating dinner with his parents.

At first, nothing seems out of the ordinary.

Then, shortly after the meal Jeremy asks if he can borrow

a bedroom for a quick nap.

But when his parents check on him later that evening,

they can see right away something is very wrong.

DR. JAN GARAVAGLIA His lips were blue.

He didn't look good.

They tried to see if they could arouse him.

They couldn't.

Now, he's a very big fellow.

And they actually try to do CPR with their knee,

because he's got such a big chest.

NARRATOR Jeremy's parents immediately call --,

and paramedics rushed him to the nearest hospital.

They work on him for about to minutes,

but they couldn't revive him.

Jeremy's sudden death has left his mother and father

completely bewildered.

They have no idea what could have k*lled their only son

in the prime of his life.

DR. JAN GARAVAGLIA I mean, to the family he's just still,

I mean.

To the mom and dad, he's still a baby.

He's only , so they're not expecting him to die.

And of course, they're devastated with his death.

[music playing]

NARRATOR Seeing someone pass away mysteriously at such a

young age is unusual, even for Dr. G.

But one glance at Jeremy's body is all it takes
[ … ]

to start lining up suspects.

He is morbidly obese, takes very bad care of himself.

He's pounds.

NARRATOR Jeremy's morbid obesity alone puts him

at risk of dying prematurely from a laundry

list of different ailments.

DR. JAN GARAVAGLIA You know, this

is a fellow that is prime for a lot of natural disease.

Why is that?

Well, people who are that heavy have accelerated

atherosclerosis-- plaque.

They have increased incidence of high blood pressure.

We have an increased problem with blood clots

in the leg, which break off and can cause pulmonary emboli.

So obesity can come at your body in many ways.

NARRATOR In fact, Jeremy had already

developed several conditions related to his obesity.

He's only , but he has severe osteoarthritis

wear and tear on his knees.

He is already on chronic pain meds for that.

[music playing]

DR. JAN GARAVAGLIA He also--

and this is very disturbing--

he has a history of high blood pressure,

and he stops taking his high blood pressure medicine.

And he's got sleep apnea.

Sleep apnea is basically where you stop breathing

while you're sleeping.

And about % of really obese people will have sleep apnea.

NARRATOR The disclosures are troubling.

Sleep apnea, high blood pressure, and morbid obesity

are all risk factors for one fatal condition, heart disease.

We have three really deadly things going on here.

Any three of which could be possibly lethal.

I mean, this sounds like a bad combination.

pounds, not taking medication.

It's just a sure ticket to be coming in here at a young age.

NARRATOR But as Dr. G continues through Jeremy's

medical records, she discovers yet another health concern.

DR. JAN GARAVAGLIA He also interesting enough has a family

history of atrial fibrillation.

That's where the top part of the heart

quivers and doesn't b*at well, although the bottom part

of the heart continues to b*at.

Now, that actually has an increased mortality

in and of itself if he has it.

So, you know, for a -year-old man,

I'd characterize his overall health as pretty bad.

NARRATOR But there's only one way for Dr. G

to know if Jeremy Weinberg's heart led to his early death.

[music playing]

DR. JAN GARAVAGLIA So I do the external examination.

The first thing you look at is just his sheer size.

It's just a huge mountain of a man.

And looking at him, he doesn't look well.

I can't imagine walking around at pounds,

and that it would be comfortable.

NARRATOR From the start, Dr. G notes that Jeremy's body shows

signs of oxygen deprivation, particularly his nails,

which are blue in color.

DR. JAN GARAVAGLIA His nail beds were very cyanotic.

Believe it or not, not everybody who dies

has cyanotic nail beds.

But his were very cyanotic, as if he wasn't getting

enough oxygen. But keep in mind, there's

about a half hour period, minutes of being resuscitated.

NARRATOR Next, Dr. G turns to examine Jeremy's legs.

Obesity can cause blood to pool in the lower body,

leading to the formation of life-threatening clots.

DR. JAN GARAVAGLIA Because of its sheer size,

we have an increased problem with thrombosis,

blood clots in the leg, which break off

and can cause pulmonary emboli.

So that is a possibility.

Could you lift the leg up for me when I measure?

Thanks.

OK.

That all right?

NARRATOR Sometimes, Dr. G can detect signs of a clot

by identifying swelling in the calves,

but Jeremy's size makes the analysis troublesome.

OK, he's kind of heavy.

DR. JAN GARAVAGLIA It's just difficult

sometimes to do physicals on people who are that big,

because it sometimes masks some of the physical findings.

So a subtle change we wouldn't be able to pick up.

OK.

NARRATOR By the end of the external exam,

Dr. G still has no concrete findings.

But one thing is clear Jeremy's obesity has taken

a costly toll on his body.

Perhaps more than either he or his family realized.

This is a fellow that is primed

for a lot of natural disease.

There is a number of complications

that could have got him.

[music playing]

DR. JAN GARAVAGLIA OK.

So I'll tell you what we'll do, is I'll open him--

SANDY All right--
[ … ]

NARRATOR Dr. G is ready to open the body of -year-old Jeremy

Weinberg, who d*ed without warning at his parent's home

less than hours ago.

They knew he didn't take care of themselves,

but they certainly didn't expect him to die.

And of course they're devastated with his death.

[music playing]

DR. JAN GARAVAGLIA So in this fellow, to start the internal,

I have to do the Y incision.

It actually is a little more involved.

We have to-- he's so big, we really

have to get a little stool.

Sandy gave me a little stool, and then she's going

to take it over in a minute.

He's got in some areas over six inches of fat between his skin

and his muscle.

It really is more dangerous for us,

because it really is greasy and fatty.

It's difficult on our backs to get-- because they sit

so much higher on those tables.

And then just trying to get in there and get the organs out

and everything is very greasy.

And it's just more dangerous.

[music playing]

NARRATOR Once the body is opened,

Dr. G gets her first look at Jeremy's internal organs.

DR. JAN GARAVAGLIA You know, everything's

in the right place, but it's all surrounded

by a tremendous amount of abdominal,

or what we call visceral, fat.

NARRATOR In fact, the fat is so extensive,

it's actually pressing into Jeremy's chest cavity.

DR. JAN GARAVAGLIA All that fat in the abdomen it's just pushed

up against his diaphragm.

He's got this tiny little chest cavity.

I don't know how he can breathe that way.

NARRATOR Dr. G also discovers that he

has several broken ribs.

I noticed the broken ribs, both right and left side.

These ribs have very little hemorrhage,

and it's associated with trying to do CPR on him.

NARRATOR Next, Dr. G cuts through the ribs

to get a better look at his heart.

And it isn't long before she notices something troubling.

Whoa.

Something here.

We've got a big heart.

I can see right off that his heart is enlarged.

It's at least grams.

The right side is dilated.

The left side's a little dilated.

And it's thickened.

NARRATOR This finding is exactly what Dr. G feared.

Though only years old, Jeremy had already developed

severe cardiovascular disease.

DR. JAN GARAVAGLIA It's probably a combination

of the high blood pressure, which

he didn't want to treat for some reason, and just

the sheer obesity.

The muscle was normal and could be

a setup for a sudden cardiac arrhythmia.

At this point, I wouldn't have any problem saying

that his heart k*lled him.

But if you're going to pin your cause of death on arrhythmia,

you still have to rule everything else out.

NARRATOR To rule out any other complications in Jeremy's

death, Dr. G turns next to examine

the inside of the atria, the top two chambers of his heart.

According to his medical records,

Jeremy had a family history of atrial fibrillation, a heart

rhythm disorder in which the atria momentarily

flutter instead of b*at.

This can cause deadly blood clots to form in the chambers.

People who have atrial fibrillation

are at increased risk for having strokes and thombotic events,

because the blood just kind of sits there and forms a clot,

which then can break loose.

Where's my fancy Kn*fe?

Eh, it's all right.

We'll do this.

NARRATOR Dr. G cuts open the atria,

but she sees nothing abnormal.

DR. JAN GARAVAGLIA He doesn't have that,

and I suspect that he probably didn't have

atrial fibrillation, even though he's

got a family history of it.

NARRATOR As a next step, Dr. G cuts Jeremy's lungs out

of the cramped chest cavity.

OK.

NARRATOR She's searching for any blood clots

in the pulmonary artery, the large vessel

that carries blood out of the heart and into the lungs.

Now, obesity could have, you know--

they're more prone to pulmonary emboli.

But he doesn't have any.

NARRATOR And yet, Jeremy's lungs are not at all normal.

His lungs are remarkable for being very edematous.

NARRATOR The organs are heavy with edema,

or fluid, which is often an indication

that a person d*ed slowly.
[ … ]

However, this contradicts her theory that Jeremy may have

d*ed from a sudden arrhythmia.

Now, this puts up a little flag in my brain,

that he just didn't maybe die suddenly.

NARRATOR Next, she draws toxicology samples

from Jeremy's body.

Oh, nice full bladder.

NARRATOR And here she discovers another clue that Jeremy's

death was not sudden.

DR. JAN GARAVAGLIA His bladder is very distended,

which can be due to him being in a coma for a period of time.

You know, we're thinking about the heart

and thinking a sudden death, but with his bladder being

distended and his lungs full of fluid,

I kind of suspect maybe more of a slower death.

And now I'm worried maybe he's got something going on

in his brain, like a bleed, brought on by his high blood

pressure that caused his death.

So we've got to go to the head.

[music playing]

NARRATOR Morgue technician Tommy Hemphill

opens Jeremy's skull with a bone saw,

and Dr. G immediately begins searching

for any abnormalities, such as bleeding in the brain.

But the findings are not what she was expecting.

DR. JAN GARAVAGLIA There's no evidence of anything

abnormal in that brain.

Right off the bat, I can tell.

And I slice the brain, there's no evidence of hemorrhage

anywhere in that brain.

No evidence of any kind of stroke in that brain,

which that brain looked normal.

I don't know if surprised is the right word,

and I'm actually a little disappointed that I don't find

the bleed in his brain, because I thought that would

tie things up nice and neatly.

So I'm a little disappointed that he doesn't

have that bleed in the brain.

NARRATOR At this point, only one thing is certain

Jeremy had a severely enlarged heart that could

have been a ticking time b*mb.

DR. JAN GARAVAGLIA You know, I'm done with the autopsy

and I could assign this out right

then and there his heart.

But something tells me differently.

I don't like the fact that he's got so much pulmonary edema

and that distended bladder.

It just doesn't really fit that sudden cardiac arrhythmia.

And, you know, sometimes when things don't fit,

you've gotta go with your sixth sense.

I don't think there's any harm in appending this.

NARRATOR Dr. G pends Jeremy's case

until toxicology and microscopic results are complete.

In the meantime, she makes a difficult call to his family.

I talk to the family.

They understood that I wanted to wait.

I needed to look at the tissues under the microscope.

And I wanted to look at the toxicology,

because I still have that uneasy feeling in my mind

that something else is going on.

[music playing]

NARRATOR Several weeks after the autopsy

of -year-old Jeremy Weinberg, Dr. G still

doesn't know what k*lled him.

But today she's hoping that microscopic slides of his heart

and toxicology results will provide

some clarity both for her and Jeremy's grieving parents.

DR. JAN GARAVAGLIA It's always a trying time for the families,

waiting for the answers.

We always get a lot of anxious phone calls.

Is it done yet?

Is it done yet?

But we have to wait for the lab to finish their tests.

NARRATOR Dr. G begins by examining

the slides of Jeremy's heart.

Sometimes you do get surprised looking under the microscope

at something you don't suspect.

But in this case, there was really no surprises.

We still have the effects of obesity and high blood

pressure.

And that could be a setup for a cardiac arrhythmia,

which certainly could be the cause of death.

But I still have that same problem--

the pulmonary edema, the distended bladder.

NARRATOR To make sense of Jeremy's sudden death,

Dr. G needs an explanation that can reconcile

these conflicting findings.

[music playing]

But then she gets her first look at the toxicology report,

and staring her right in the face

is a problem she never anticipated.

DR. JAN GARAVAGLIA At this point, this is out of the blue.

NARRATOR First, Jeremy had high levels of oxycodone

in his blood.

The medication he was prescribed for his arthritic knee.

DR. JAN GARAVAGLIA He had levels way above therapeutic.

He was clearly taking too much.

NARRATOR The level of oxycodone alone isn't high enough

to k*ll Jeremy, but it's what Dr. G

discovers next that reveals the truth
[ … ]

behind his untimely death.

DR. JAN GARAVAGLIA Toxicology results

didn't let me down on this.

I think they added a very important piece of this puzzle

of what's going on.

[music playing]

NARRATOR It's a Sunday afternoon in Orlando,

and -year-old Jeremy Weinberg is on his way

to his parent's house for dinner.

But his knee is acting up, so he takes

the edge off what some of his prescribed pain medication,

oxycodone.

Unfortunately, this isn't the only drug Jeremy

has been using for pain relief.

DR. JAN GARAVAGLIA Tox finding just came out

of the blue for me, in that he had both oxycodone

and methadone on board.

NARRATOR Methadone is a narcotics often used

to treat heroin addiction, but it's also a potent pain

medicine, and one that Jeremy had been taking

without medical supervision.

DR. JAN GARAVAGLIA He does not have a prescription

for the methadone.

The methadone he was getting somewhere

else, which is still a mystery.

NARRATOR But what Jeremy doesn't realize,

is that methadone lingers in the body

much longer than most dr*gs.

DR. JAN GARAVAGLIA It's got such a long half life,

that it stays in your system for a long time

and can cause an accumulative effect.

And then you take more on top of that,

and the levels just keep building.

NARRATOR Unbeknownst to Jeremy or his parents,

the tragic misuse of two powerful pain medications

is about to come to a head.

DR. JAN GARAVAGLIA Now, this is a bad combination.

The way these dr*gs-- both of which are narcotics,

very potent narcotics--

will affect you, Is that their central nervous system

depressants.

And they can decrease your respiration.

NARRATOR By the time dinner is over,

Jeremy is beginning to feel the full effect

of the oxycodone-methadone cocktail.

He's overwhelmed with drowsiness and lays down for a nap.

But it isn't long before Jeremy's

body, already ravaged by morbid obesity,

is pushed over the edge.

Now, this is a morbidly obese man that already has problems

with a small chest cavity not being able to expand

his lungs, sleep apnea causing him to obstruct his airway

to not get enough oxygen. And now

we're throwing on top of that, let's

throw in a little central nervous system depressant

so I don't breathe well enough.

So what is all that combination do?

That combination is going to decrease your oxygenation.

Well, let's say he's already got a big heart that's

sensitive to decreased oxygenation,

and that's just a setup for death.

NARRATOR While he's sleeping, Jeremy's lungs

start to fill with fluid.

And it isn't long before he slips into a coma.

Eventually, his heart gives out, and in the guest bedroom

of his parent's home, he dies.

In medicine, sometimes it's not just one thing.

It's piled up.

Many things piled up on top of each other.

And that's probably why this man d*ed, with the coup

de gras being the dr*gs.

Without the dr*gs, at that moment

he probably wouldn't have d*ed.

NARRATOR With the cause of Jeremy's death

finally revealed, Dr. G once again calls his mother

and father to explain the complex chain of events

that took their son's life.

His parents were totally surprised that he had

that kind of narcotics in him.

Right.

OK.

They knew he didn't take care of himself.

They really were surprised, though,

that he was taking narcotics.

You know, I find cases like this really, really frustrating.

He leaves in his wake people who are devastated by his death.

The kids in his classroom are devastated

that their teacher dies.

All his co-workers loved him.

They're devastated that he d*ed.

His family is devastated.

His mom and dad.

These are frustrating cases that come through here that didn't

have to come through here.

NARRATOR Sadly, many of Dr. G's cases

have one lesson in common--

unhealthy choices often lead to premature deaths.

DR. JAN GARAVAGLIA I think a lot of people

don't appreciate what bad habits can do to your body.

And I don't think they see sometimes
[ … ]

the connection between the habit and the disease.

That's something I see every day in the morgue.

NARRATOR And on first glance, her next case

appears to be no exception.

[music playing]

NARRATOR Today, Dr. G and some of her staff

are checking on the construction of their future workplace.

[drilling noises]

(SHOUTS) Welcome to your new home.

(SHOUTS) Thank you very much!

This is the office.

My desk is right here, I think.

MAN Yep, right there.

It's really going to look really pretty.

It's unbelievable to see this go up like this.

MAN That's the outside wall.

This is the length of a cooler right here.

This is also where the skeletons will be, so anything

that's decomposed or skeleton--

This is where you bring the stinky ones.

DR. JAN GARAVAGLIA You got it. (CHUCKLES)

You like doing this part better than decomp? (CHUCKLES)

DR. JAN GARAVAGLIA This has been a lot of fun, Sandy.

It is much better than doing a decomp.

[laughter]

[music playing]

NARRATOR But Dr. G's work can't wait for the new morgue

to be complete.

Back at the old building, she has a full caseload.

And the next one on her list looks

to be anything but clear-cut.

Well, today we have a -year-old

African-American female who really has

very little medical history.

[music playing]

NARRATOR Fresh out of college, Justin Bailey

lives in his own apartment in Orlando, Florida.

But he still leans on his mother, Cora,

for support and guidance.

So early one morning when a new job offer comes his way,

he wastes no time calling his mom for advice.

The son tries to call her, she doesn't answer.

He can't get a hold of her.

NARRATOR Justin continues calling throughout the day,

but all he gets is his mother's voicemail.

Growing more concerned by the moment,

he leaves work and drives directly to her house.

He comes over and knocks on the door.

She doesn't answer.

He walks in and finds her sitting on the couch.

[music playing]

He sees that she's unresponsive.

NARRATOR Frantic, Justin calls , but it's too late.

[music playing]

DR. JAN GARAVAGLIA She's clearly dead.

This is a sudden, unexpected death.

The son had no idea what could have k*lled her.

It just really came as a shock to him.

Because she's only , and you shouldn't normally die at .

NARRATOR But the initial shock soon gives way to guilt,

as Justin wonders if he could have saved his mother had

he only acted sooner.

The one person who can answer that question now is Dr. G.

Cora's medical report begins with the mention

of a common health concern.

DR. JAN GARAVAGLIA She's clearly

being treated for high blood pressure, which doesn't

seem to be too bad, actually.

NARRATOR But while the high blood pressure appears

to have been under control, that was just the beginning

of Cora's problems.

DR. JAN GARAVAGLIA She smokes.

Number one bad thing you can do to decrease your longevity.

She's obese.

That's the number two thing that you

can do to yourself that's going to decrease your longevity.

And she drinks.

She drinks a lot of beer and a lot of liquor.

NARRATOR All these factors can contribute to heart

disease, stroke, even diabetes.

But Dr. G is equally concerned about a strange symptom

that emerged the day before Cora d*ed.

Her son said she complained just

out of the blue of this stabbing eye pain,

and then it went away.

NARRATOR At the time, Justin and his mother

simply brushed it off as a harmless event,

but now Dr. G wonders if this stabbing pain

could have been a harbinger of something far more serious.

DR. JAN GARAVAGLIA You know, I wonder

is that perhaps kind of, you know,

pre-stroke kind of symptomatology?

NARRATOR Only the autopsy can see for sure.

This case could really be anything.

[music playing]

NARRATOR Dr. G begins the external exam with Cora's face,

and here she gets her first real clue.

She's got frothy fluid coming out of her mouth,

and she's got frothy fluid coming out of her nose.

That's worrisome.
[ … ]

NARRATOR This is typically an indication of pulmonary edema,

an accumulation of fluid in the lungs that can flood

the respiratory passageways.

Dr. G sees it often in cases of drug overdose or heart failure,

but given Cora's symptoms, there's another possibility

that seems to make more sense.

DR. JAN GARAVAGLIA We see that when something happens

in your brain, like a stroke--

mind, she'd had some type of pain behind the eye just,

you know, a day earlier that she clearly was complaining about.

NARRATOR But as Dr. G shifts focus

to Cora's torso and lower body, a frightening new possibility

arises, trauma.

She's got a few bruises on her, about four bruises on her leg.

A couple on her arm.

Even one on her abdomen.

That's not normal.

So it'll be interesting to do this autopsy.

These are the kind I like.

[music playing]

NARRATOR -year-old Cora Bailey

was found dead by her son, Justin, yesterday afternoon.

She had suffered a mysterious pain

only a day before her death, and now he

feels he may be to blame.

You know, the son is wracked with guilt

because he didn't check on his mom sooner.

NARRATOR The pain may have been an early warning

sign of a stroke, but the external exam

has brought another disturbing possibility to the forefront.

DR. JAN GARAVAGLIA We do see multiple bruises on her body.

I'm worried that she may have fell and hit her head.

We see those bruises a lot in our alcoholics

that come through here.

Sometimes it's because their liver isn't

making enough clotting factor.

They tend to bleed a little more readily.

They tend to fall more easily when they're intoxicated.

She's probably stumbling around when she's intoxicated,

and certainly falling and hitting her head

is another possibility.

Oftentimes the alcoholics already

have somewhat of a shrunken brain,

and there's a little more room in there

for the subdural to develop.

NARRATOR And possible cranial trauma

points her in one direction.

I think we'll go to the head first.

[music playing]

All right, now.

NARRATOR Dr. G begins by palpating Cora's

skull for any abnormalities.

DR. JAN GARAVAGLIA I'll feel that head for evidence

of a contusion before I open it, but I

don't feel anything on her.

But she has a nice head of hair, and I may be missing it.

So I will go ahead and reflect the scalp off

of the calvarium-- off the bone, off the skull,

and look for bruising.

Good, good, good.

And I really don't see anything.

NARRATOR Then, Dr. G's morgue tech, Sandy Ludwig,

uses an oscillating saw to open Cora's skull.

We start to cut the calvarium off,

and my tech is having a hard time getting through the skull.

[saw buzzing]

NARRATOR Finally, the skull cap is removed.

But before she can examine the brain for trauma,

something about Cora's skull itself catches her attention.

DR. JAN GARAVAGLIA Normally, you know,

the skull is very smooth on the inside,

but on this the inside was very thick and lumpy, bumpy.

Very irregular bone.

NARRATOR Dr. G immediately recognizes

this as a telltale sign of a bone disorder

called Paget's disease.

DR. JAN GARAVAGLIA Paget's disease

is an abnormality in the bone.

It is caused by an imbalance of the renewing of our bones.

Our bones are living things.

They are constantly cells dying and cells replacing them.

What happens is the cells start to die in an accelerated rate,

but the replacement bone tends to get over exuberant

and try to build up new bone very quickly.

And then that starts taking over.

And you get a lot of irregular bony buildup.

NARRATOR The disease can develop

in any bone in the body, and usually causes

aches similar to arthritis.

A lot of times we get a Paget's in the spine, which

can be painful.

And in this case, the exuberant bone growth

was occurring in her skull.

Now, this is a bad place for Paget's.

In the skull it causes a lot of problems,

because we have a lot of nerves coming up.

And if you've got exuberant bone growth,

they can impinge on some of these nerves.

That bone that was pressing against

the cerebral hemisphere, you could
[ … ]

kind of see that indentation.

NARRATOR This leads Dr. G to her first conclusion.

DR. JAN GARAVAGLIA So Paget's disease

could probably explain why she was having some eye pain,

possibly.

NARRATOR But while it might account for Cora's pain,

Paget's is rarely life threatening.

And from looking at the surface of Cora's brain,

Dr. G believes the condition caused no fatal damage.

DR. JAN GARAVAGLIA So at this point,

it doesn't really explain her death.

NARRATOR In fact, there doesn't seem

to be any damage at all, which leads

Dr. G to her next conclusion.

We've ruled out trauma to her head.

NARRATOR She then dissects the brain, looking

for evidence of a stroke.

There's really nothing here.

Her brain itself looked OK.

I don't see evidence of anything that

would have caused her death.

Everything looks good.

We've ruled out a stroke.

NARRATOR What's more, with no brain trauma and no stroke,

Dr. G can't yet make sense of an earlier finding.

So after I do the cranial exam, we

can rule out the brain was not the cause

of her pulmonary edema.

[music playing]

Suddenly, Dr. G finds herself back at square one.

Hopefully the answers are going to be

found in the internal exam.

[music playing]

DR. JAN GARAVAGLIA Well, during my Y incision,

I don't see anything out of place.

From here, I will go ahead and take off the chest plate,

and I'll turn my attention to the heart and lungs.

NARRATOR She first removes the lungs

by slicing through the vascular and bronchial connections.

Yeah, there's certainly a lot of fat everywhere.

NARRATOR Right away, she can tell

something is terribly wrong.

You can squeeze the lungs and get

that frothy fluid coming out.

Definitely pulmonary edema.

All right.

NARRATOR While there are many causes of pulmonary edema,

one suspect immediately comes to mind.

DR. JAN GARAVAGLIA We see that with congestive heart failure.

When the heart can't b*at strong enough and the fluid

starts backing up into the lungs.

NARRATOR She slices open the pericardial sac

and gets her first look at the heart.

It's a big heart.

It's enlarged, not just by weight.

It weighs a little bit heavier than we normally have.

But what's really remarkable about this heart,

is that it's very dilated.

So it's almost like filling up a balloon out.

A big (BREATHES IN) and we've blown it up.

NARRATOR This is a condition known

as dilated cardiomyopathy, a type of heart disease

in which the organ expands, weakening its ability to pump.

It's the third most common cause of heart failure

in the United States, with ,

new cases diagnosed each year.

As soon as I see her heart in conjunction

with that pulmonary edema, I know this is why she d*ed.

She's dying of some type of congestive heart failure.

NARRATOR But this autopsy isn't over.

For Dr. G, key piece of the puzzle is still missing.

Well, you know, I could just say she's got a cardiomyopathy

and leave it at that.

That's good enough for the death certificate--

she d*ed of congestive heart failure and dilated heart,

but why?

We know her mechanism of death, but we still

need to put it all together with the reason why.

NARRATOR And it's not just Dr. G who needs to know.

If Cora's suffered from a fatal genetic condition,

Justin could also be at risk.

DR. JAN GARAVAGLIA Many a time that I'll do an autopsy

and something unexpectedly genetic is found out

that will have ramifications to future generations.

[music playing]

NARRATOR Dr. G is on the hunt for what

could have caused a cardiomyopathy that

k*lled -year-old Cora Bailey.

This condition can be hereditary,

and if that's in fact the case here,

her son Justin may suffer from it as well.

Some of these things are genetic.

I see myself as their love one's last physician,

and it's part of my responsibility to explain

why they d*ed to them.

Giving them a knowledge of why they d*ed

helps them understand why their loved one d*ed,

and it may have some implications for the family

if it's congenital.

So it really is our due diligence
[ … ]

to look for the underlying cause of death.

NARRATOR Dr. G will have to examine the heart tissue

under the microscope for any abnormality that

might explain what caused Cora's cardiomyopathy.

She takes tissue samples to be sent to the lab,

but it will take weeks for slides to come back.

But before she finishes examining the heart,

she looks for one more possible cause of the cardiomyopathy--

coronary artery disease.

She looks at the vessels by dissecting Cora's heart.

DR. JAN GARAVAGLIA We have to look at the coronary arteries,

and I'm fully suspecting this is probably

why she has this dilated heart, her coronary arteries.

And this ought to give some people who smoke

and who are obese at least some hope,

her coronary arteries were clean.

And there wasn't a bit of atherosclerosis in them.

NARRATOR But there's still another very rare

condition Dr. G must consider.

Paget's-- a really widespread Paget's disease

could be a possibility.

NARRATOR Paget's could have caused

Cora's dilated cardiomyopathy, because the heart must work

harder to send blood through the blood

vessels in the abnormal bone.

But this only happens in cases where the disease is severe.

To find out if the disease is widespread,

she digs deeper to examine the spine, pelvis, and collarbone,

and arrives at a disappointing conclusion.

It doesn't appear she's got Paget's disease,

though, bad enough to have caused

her congestive heart failure.

So our last hope for a definitive answer

would be the microscopics.

[music playing]

NARRATOR It's late on a Friday, and Dr. G finally

receives the microscopic slides of Cora Bailey's heart tissue.

Let's see here.

NARRATOR Immediately, she examines the samples

for anything that might provide a clue about what caused Cora's

heart failure, but finds none.

It's a frustrating turn in the investigation.

DR. JAN GARAVAGLIA I've ruled out the things we can rule out,

and we're left with an I don't know

cardiomyopathy that's caused her heart muscle to dilate.

NARRATOR But as Dr. G begins her draft

of the autopsy report, she revisits the details

of the case one by one, and it isn't long before the findings

reveal a distinct pattern.

With this last piece of the puzzle in place,

Dr. G can finally confirm exactly

how and why Cora Bailey d*ed at the relatively young age of .

DR. JAN GARAVAGLIA Well, this is something that

just didn't occur that night.

[music playing]

NARRATOR It's a balmy Sunday evening in Florida,

and Cora Bailey is at home enjoying

the final hours of the weekend.

Little does she know, they're also

the final hours of her life.

Unbeknownst to anyone, Cora is dying from heart failure,

and Dr. G now knows why.

DR. JAN GARAVAGLIA I suspect that ultimately she

d*ed at not because of her inheriting something wrong,

but what she did to her body and not taking care of herself.

She's got a lot of bad habits.

She smokes.

She has high blood pressure.

She is obese, which in and of itself

is a strain on the heart.

And she certainly has chronic alcohol

abuse, which is injurious to the heart muscle itself.

NARRATOR All of these things together take

a catastrophic toll on Cora's heart.

Her heart is under a lot of pressure,

and over time there is enough damage

that it will start to dilate.

NARRATOR The heart gradually experiences

more and more difficulty pumping out

enough blood with every b*at.

And the buildup of blood stretches and weakens the walls

of the muscle even further.

The heart can't maintain its shape anymore,

and then that sets up a whole cascade, because if you're not

pumping enough blood, the pressure start building up,

and the fluid part of the blood started going into the lungs.

NARRATOR As the night wears on, Cora

has a hard time breathing lying down flat in her bed,

so she moves to the couch.

The fact that we find her sitting is probably very

important, because oftentimes when

the fluid starts to build up in the lungs,

people cannot lay down.

It makes them feel like they're asphyxiating.

They can't catch their breath because of that fluid,

so they need to sit up to sleep.

And that appears what she was doing.

NARRATOR But sitting up is of little help.

Filled with fluid, Cora's lungs can no longer

deliver fresh oxygen to the rest of her body.
[ … ]

DR. JAN GARAVAGLIA And eventually

the heart probably goes into an arrhythmia, and then she dies

[music playing]

NARRATOR Cora's son, Justin, is stunned to learn

that his mother's premature death was a direct result

of her lifestyle, but he's also relieved to know that there was

nothing he could have done that day

to stop the domino effect brought

on by a lifetime of bad habits.

It was clearly a preventable death,

but the only one who could have stopped it was Cora herself.

When I talk to them and explain

that some of her choices in life,

like her obesity or hypertension,

her chronic alcoholism, they connect the dots then

and see that she wasn't as well on the inside

as they thought she was.

I think a lot of people don't appreciate what bad habits can

do to your body, and I don't think

they see sometimes the connection between the habit

and the disease.

That's something I see every day in the morgue.

[MUSIC - ABE QUIGLEY, "SOLOMON'S MINE"]

(SINGING) I found a home here in Soloman's mine.