05x13 - Whispered Warnings

[bunniefuu]

[ominous hum]

[dramatic music]

NARRATOR When a healthy young man unexpectedly drops dead,

Dr. G is baffled.

Healthy guys don't die suddenly.

Something's going on.

NARRATOR But a trail of strange clues only deepens the mystery.

This body's whispering something to me,

but I'm just not sure what it's saying.

NARRATOR Then, a woman is found dead on her bathroom floor.

DR. G There's water on the floor.

We don't know if she slipped and fell and hit her head.

Accidents happen.

NARRATOR But something about this case

raises troubling doubts.

I've got years of experience saying,

this isn't adding up.

[theme music]

NARRATOR Altered lives.

Baffling medical mysteries.

Shocking revelations.

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

[light music]

This morning at the District morgue in Florida, Dr. Jan

Garavaglia has some news to share with her technicians

Brian and Kelly.

DR. G Well, you know, I got the pers-- did I tell

you what I got for Christmas?

Yes.

I'm not looking forward to it.

I don't know.

I haven't met with her yet.

I want to see what kind of Attila the Hun she is.

Did you want to lose weight more so, or tone up?

Uh, both.

I need to lose pounds, I've decided.

No, forget that.

You think I'd tell you?

Even if we weren't on camera, you think I'd tell you?

I have my-- this is like a top secret.

You think that the missiles are top secret.

My weight's top secret.

[chuckling]

NARRATOR Dr. G knows all too well

that exercise and proper nutrition

can go a long way to keeping you out of the morgue.

But unfortunately, healthy habits aren't always enough.

And such seems to be the case with her next decedent, Jeffrey

Woods.

So he's a -year-old male.

No known medical problem.

He eats right.

He doesn't use dr*gs.

He doesn't drink.

He doesn't smoke.

But clearly, something's wrong.

[light music]

NARRATOR It's mid-afternoon on a sunny Saturday,

and Jeffrey Woods is just finishing up

his day shift at a restaurant in downtown Orlando.

He's been waiting tables here for over three years,

and is a favorite with the regulars.

But today, something's not right.

He told one of his co-workers he wasn't feeling well.

In fact, he didn't even feel well enough to drive home.

So he kind of sat it out for about an hour and decided,

maybe he should call his girlfriend.

He spends probably another hour or so

waiting to get a hold of her.

Takes her another minutes to get there.

[car honking]

NARRATOR Finally, Jeffrey spots Grace

pulling into the parking lot.

He exits the restaurant and walks toward her car.

But after a few labored steps, his knees buckle.

Jeffrey!

NARRATOR Grace rushes to his side, but he's unresponsive.

She calls .

Emergency crews get there.

He's got irregular heart rhythm.

NARRATOR But as Jeffrey is rushed to the hospital,

his condition rapidly worsens.

DR. G Eventually, his heart stops.

They try to work on him, but he dies in the emergency room.

They finally pronounce him.

NARRATOR Grace is crushed, and she can't imagine

what could have k*lled her boyfriend so suddenly

and unexpectedly.

According to Grace, Jeff was the picture of health.

He's a karate instructor.

He's very into his health and what he eats.

And she says he doesn't smoke.

He doesn't drink.

He takes very good care of himself.

Now, she says he doesn't have any medical history,

that he's in great shape.

As far as she knows, he doesn't go to the doctor.

[somber music]

NARRATOR But Dr. G knows Jeffrey can't possibly have

been as healthy as he seemed.
[ … ]

Healthy guys don't necessarily die suddenly.

Something's going on.

NARRATOR And she has a strong hunch

what that something could be.

-year-old African-American male dies suddenly.

It certainly can be a heart att*ck,

and that's what I'm thinking it's probably going to be.

NARRATOR Still, it's too early to rule

out other possibilities.

DR. G The girlfriend also says he doesn't use dr*gs.

You know, I've heard that before.

You know, maybe he is using cocaine.

That's certainly associated with sudden collapse.

NARRATOR Now the pressure's on for Dr. G

to find answers and explain Jeffrey's sudden death to those

he left behind.

[dramatic music]

DR. G So when I do the external examination, the first thing

I do is go through his clothing, look at his personal effects.

NARRATOR And here, Dr. G discovers

what could be her first clue.

A roll of small bills that amount to $.

DR. G Now, that's a lot of money

just to be carrying around.

Now, he's a waiter.

That's pretty good day's work.

Or is he doing something else at work?

Is he selling dr*gs at work?

I often see large amounts of money

with small bills on drug dealers.

Only time will tell on that one.

NARRATOR Dr. G next turns her attention to Jeffrey's body.

Immediately, she can see that Grace was not exaggerating.

Jeffrey is in peak physical form.

DR. G Very lean, muscular kind of guy.

Looks the stated age of .

Maybe even a little younger.

NARRATOR As a first step, she carefully scans him

for any signs of abnormality.

DR. G I look in the arms to look for any vascular scars.

They say he didn't use dr*gs, but is there any sign of it?

And there isn't.

NARRATOR Dr. G's next stop is Jeffrey's head.

And there, she does find something odd.

The moist tissue lining his eyelids and mouth,

called the mucous membranes, appear pale.

DR. G But that could be from many things.

Really doesn't alert me to anything at this point.

All righty, so I got that, I got that.

So when I and my external examination,

I really don't know any more than when I started.

He may look good on the outside, but he may

not look good on the inside.

[ominous music]

All righty.

So I do my normal Y incision.

Huh.

Nothing abnormal in the abdominal cavity

when I first open it up.

Organs all appear to be in the right location,

and there's no free blood or fluid there.

NARRATOR Next she removes the chest plate.

DR. G I'm going to be looking for anything I find that's out

of the ordinary and that would fit

with his symptoms, which would be feeling ill

and then a sudden collapse.

NARRATOR Taking into account the circumstances

of Jeffrey's death, Dr. G goes straight to the prime suspect--

the heart.

And with one glance, she can see that something

is terribly wrong.

He's got something right off the bat that

could have caused his death.

[ominous hum]

[light music]

NARRATOR Dr. G is examining the heart

of -year-old Jeffrey Woods.

His girlfriend Grace insists he was the picture of health.

But Dr. G has just discovered something

that indicates otherwise.

DR. G Immediately, we see something wrong.

The heart's enlarged.

Typical weight for a guy this size would be .

His is .

gram heart in a small guy is huge.

NARRATOR And that's not all.

When she dissects the organ, she discovers

another serious condition in his arteries.

DR. G He's got at least an % narrowing

of one of his coronary arteries by atheroscleratic plaque.

So he's got the double whammy.

The narrow blood vessels and the enlarged heart.

Typically, we would see that with somebody

with longstanding high blood pressure.

DR. MARIO MADRUGA High blood pressure

is the force that's exerted on the walls of the blood

vessels of your body--

namely, the arteries.

NARRATOR This added strain on the arteries

causes the heart muscle to thicken.
[ … ]

And as it expands, the muscle has

difficulty getting oxygen, making

it vulnerable to an arrhythmia.

Now, could that have caused his death?

It could have.

He could have been a sudden cardiac arrhythmia.

NARRATOR A fatal arrhythmia is an irregular

heartbeat that short circuits the entire organ.

But it leaves behind no evidence.

So in order to determine if it's the cause of death,

Dr. G must first rule out everything else.

DR. G We've got to put all the pieces together, because it

could be from his heart, but I would like to see

what the rest of him shows.

Al right.

Then we look at his lungs.

Now, this is the guy that's supposedly

the picture of health, and his lungs don't look good either.

NARRATOR The first abnormality she sees

is in the pleura, the soft membrane

that encases the lungs.

DR. G He's got some adhesions.

Little fibrous connections.

Normally, your lungs should be able to move very

freely in that space in your chest as you breathe out

and breathe in.

And there's usually a thin amount

of fluid, a little fluid that helps lubricate it in there.

And sometimes, because of an infection, or inflammation,

those adhesions, little scar tissue

forms between the surface of the lung and the cavity

where they sit.

NARRATOR Such adhesions can be insignificant--

simply the result of previous infections

or other minor lung problems.

But then she dissects Jeffrey's lungs

and finds something definitely alarming.

DR. G The lungs clearly have scar tissue in them.

Fibrosis throughout the lungs, and they also

had a lot of fluid in them.

NARRATOR Both of these symptoms-- fluid

and scar tissue in the lungs--

point towards a dark possibility.

One of the possibilities with that kind of fibrosis

could be, you know, dr*gs.

NARRATOR Many illicit dr*gs, including heroin and cocaine,

contain impurities such as talc.

Dr. G wonders if Jeffrey had been injecting such dr*gs,

allowing the impurities to travel through his bloodstream

and into his lungs.

Over time, the particle buildup would

have caused the kind of fibrosis or scar tissue

she's now seeing.

But she won't know for sure until she

gets a look at the lungs under the microscope.

DR. G His girlfriend is saying he's not using dr*gs,

but we don't know until we test him.

So I need to get toxicology, because toxicology

clearly is a player here.

NARRATOR Dr. G takes samples of Jeffrey's blood and eye fluid

to submit for testing.

But it will take at least three weeks for the results

to come back from the lab.

[doorbell ringing]

DR. G Anybody I know?

BRIAN [inaudible]

DR. G Yeah.

NARRATOR For now, she continues to scour

Jeffrey's body for clues.

And as she removes the liver, she can see right away

that something isn't adding up.

Normally, when we have somebody die suddenly

and unexpectedly, it's a very congested, kind of brown liver.

This liver looked more pale.

NARRATOR Dr. G now wonders if this finding could

be connected to the clues she found

earlier in his eyes and mouth.

It kind of matched the pale appearance

of those mucous membranes.

NARRATOR This indicates that none of these body parts

were receiving enough oxygen-rich blood.

But at this point, she's uncertain what it means.

DR. G Things aren't looking right.

This body's whispering something to me,

but I'm just not sure what it's saying to me.

And when she examined Jeffrey's kidneys,

she finds another confounding clue.

The organs are not only pale--

they're also spotted with areas of extreme discoloration.

They had kind of a mottled appearance.

They're definitely something wrong with those kidneys.

NARRATOR But her naked eye isn't giving her any answers.

It's clear she'll need to take a much

closer look at the evidence.

DR. G I don't know until I look under the microscope,

so I'm definitely going to have to start taking

some microscopic slides here.

NARRATOR She takes tissue samples of the kidneys

and other organs, hoping a magnified view will shed light

on their strange appearance.
[ … ]

Well, at the end of the internal, something's going on.

There's some subtle findings.

There was a not-so-subtle big heart.

You know, if I wasn't curious, that would've been the answer.

But something else is going on here.

This body's telling me something,

and I need to listen to it.

NARRATOR And there's one body part left that could tell

her what she wants to hear.

[ominous music]

Dr. G's morgue technician, Brian Machulski,

saws through the skull so that she can access the brain.

DR. G Now, the head might scream the answer

to us if we have a big bleed.

Because we already know he has some essential hypertension.

His heart's enlarged.

Maybe he had a bleed in his brain,

and that could explain everything.

NARRATOR If that's how Jeffrey d*ed,

she may find an area of congealed blood

within the brain tissue.

She removes the organ and sections it with her blade.

There's no evidence of a bleed inside the brain.

NARRATOR Still, she can see that something isn't right.

The brain looks kind of pale too.

So the brain may be whispering something to me too,

but I really can't put my finger on it,

and it doesn't really give me an answer.

NARRATOR The physical examination is complete,

but Dr. G has yet to decipher what Jeffrey's

body is trying to tell her.

DR. G I'm going to have to wait for the toxicology,

and I definitely want to look at the microscopic examination.

Hopefully, one of those two may give me the answer.

[ominous music]

[light music]

NARRATOR anxious days pass before Dr. G receives

Jeffrey's toxicology report.

The first thing she checks for is

the one that would be most devastating to Jeffrey's

girlfriend, Grace--

evidence of illicit dr*gs like heroin and cocaine.

He didn't have any dr*gs at all in the system.

NARRATOR But there's more to the report.

And as she reads on, Dr. G pays particular attention

to the body chemistries revealed in Jeffrey's eye fluid

analysis.

That's very valuable to us, because that's the only fluid

I can check for electrolytes.

Your sodium, your potassium, your chloride,

but also your creatinine.

Those give us indications of dehydration

and sometimes kidney function.

When I looked at what that vitreous fluid told me,

it was quite remarkable.

NARRATOR Jeffrey has extremely high levels of creatinine

in his system, a natural byproduct

released by the body's muscles when converting food to energy.

Normally, the kidneys filter creatinine from the blood

into the urine.

But when your kidneys start to fail,

this creatinine will start going up because your kidney's not

getting rid of it.

NARRATOR Healthy kidneys keep the creatinine level

between . and . milligrams per deciliter of blood.

But Jeffrey's level had far surpassed the danger zone.

His is .

He doesn't have any kidney function left.

NARRATOR Looking at this figure,

Dr. G now knows exactly how Jeffrey d*ed.

His kidneys literally shut down.

DR. G It's clear he's in renal failure

and this is what's k*lled him.

But why?

Why did he go into renal failure?

Renal failure isn't the answer for me.

Now I've got to figure out, what's going on with him?

[ominous hum]

[dramatic music]

NARRATOR Dr. G is now certain that -year-old Jeffrey

Woods d*ed from kidney failure.

But she's still missing a key piece of the puzzle,

and the last place to look is the micros.

The microscopics better give me the answer.

[upbeat music]

The first thing I look at's his heart.

His heart really doesn't give me the answer.

It just confirms what I saw with my eye.

NARRATOR Next, she examines the lung tissue

but finds nothing more than what was apparent at autopsy--

fluid buildup and scar tissue, or fibrosis.

I put two polarizing filters to see if there's

any objects like talc or something

that would have caused that fibrosis.

He doesn't have any.

So it could be just idiopathic, meaning we don't

know why he's got fibrosis.

A lot of the time, you never find a cause.

NARRATOR So far, she's found nothing

to suggest why Jeffrey's kidneys shut down so abruptly.
[ … ]

But there's a critical slide left to check.

And I immediately go to the kidney,

because I know he's in renal failure.

And his kidneys look terrible.

NARRATOR Dr. G twists the dial to sharpen the image,

and what comes into focus is astonishing.

DR. G The tissue is dying.

The blood vessels are very damaged.

NARRATOR And this particular type of damage

can only mean one thing.

DR. G When I did the autopsy, there was something subtly

wrong with those organs, and it was whispering the answer

to me, but I couldn't hear it.

But when I looked at the tissues under the microscope,

the answer shouted out at me.

[ominous music]

[light music]

NARRATOR To everyone around him,

Jeffrey woods is the picture of health.

But looks can be deceiving.

Although he supposedly takes good care of himself,

and exercises and eats right, something terrible

is going on inside of him.

NARRATOR Jeffrey's heart is severely

damaged by high blood pressure, or chronic hypertension.

DR. G You know, it's not that unusual to get a history

that somebody's in great shape.

Then I open them up and find heart disease.

Particularly high blood pressure.

Chronic hypertension is a silent k*ller.

It goes along for years, affecting your blood

vessels slowly over time.

NARRATOR But Jeffrey's kidneys showed evidence

of an unusual illness that's much

more aggressive-- malignant or accelerated hypertension.

Malignant hypertension is a much higher blood pressure

where it just goes way out of control really fast and really

high, causing havoc and damage very

acutely to the blood vessels.

DR. MARIO MADRUGA The degree of pressure

can be so high that that inner lining of the blood vessel

is damaged.

NARRATOR In turn, the damaged lining tears apart

the red blood cells that are trying to deliver

oxygen. The condition is called microangiopathic hemolytic

anemia, and it explains why Jeffrey's eyes, mouth, and some

of his organs appeared pale.

DR. G You'll see these very pale organs,

because although he's not bleeding out,

his blood's breaking up on the inside

and not able to get through there.

NARRATOR But worst of all is how

the effects of malignant hypertension

devastate his kidneys.

DR. G The blood can't get to the kidney.

The kidney starts to die.

That's causing the waste products

no longer to be filtered out.

His blood chemistries are completely out of whack.

He's feeling tired.

He's probably getting nauseous.

NARRATOR Based on his creatinine levels,

Dr. G suspects these symptoms began long before his collapse.

DR. G If he had a normal creatinine, to get to a

would take at least or days.

He's going about his daily business

trying to probably brush off some of these feelings.

He's probably getting a little fluid

buildup, shortness of breath.

But he's working through it.

He's not listening to his body.

NARRATOR Jeffrey doesn't share his symptoms with a soul--

not even his girlfriend.

And as he begins his afternoon shift,

his condition rapidly deteriorates.

And by the time he called his girlfriend,

his kidneys were totally sh*t.

NARRATOR And as the waste products build up in his blood,

it places an unbearable strain on his heart.

Most likely, the final straw is a cardiac arrhythmia.

DR. MARIO MADRUGA And if you have arrhythmias of your heart,

you can suffer cardiac arrest.

NARRATOR At this point, there's simply no stopping

the disastrous chain reaction, and Jeffrey collapses

with no hope of resuscitation.

DR. G His body, it's just got too much wrong with it.

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

Once we have the cause of death, I

called the girlfriend to try to explain it to her,

and she was so surprised.

She thought he was just in such good shape,

and he looked so healthy.

NARRATOR But Dr. G tells her there

might be a reason why Jeffrey developed

malignant hypertension.

DR. G Malignant or accelerated hypertension is really rare.

Less than % of people who have chronic high blood pressure

ever get anything like this.

But there's something that he possibly

has that's even rarer than just the malignant hypertension.
[ … ]

Maybe he has scleroderma, a very rare connective tissue disease."], index ,…}

NARRATOR Jeffrey didn't have any clear external signs

of scleroderma, such as scarred or discolored skin.

But internally, the disease can also

cause scarring in the lungs, and it's known to trigger

malignant hypertension.

DR. G So it could explain his kidneys and his lungs,

and it would unify the whole thing.

It's a hunch.

It's a theory.

But I think it's a pretty good one.

NARRATOR Still, all the theories in the world

can't account for the tragic nature of Jeffrey's death.

This guy could've done a lot to save himself.

He should have listened to his body,

because there are good treatments now,

and chances are that they would have been able to treat this.

So I think what people should take away from this is that,

listen to your body.

If it's trying to whisper to you, listen.

[ominous music]

NARRATOR Understanding the chain of events

that precede a sudden death can be

the key to closing any autopsy.

But when a woman is found in a pool of blood

on her bathroom floor, Dr. G is left with precious little

to go on.

We've got a woman who on the floor face-down.

What happened to her?

How did she end up on the floor in her house?

[ominous hum]

[light music]

NARRATOR It's early in the morning in Orlando, Florida,

and Dr. G is on her way to the District more.

DR. G [yawns]

Let's see what we got going on today.

Think the news is coming.

NARRATOR It's a demanding job, but after more than

years as a medical examiner, Dr. G

still finds her work exciting.

Every day, it's a new mystery.

It's a new challenge.

NARRATOR And her next case is no exception.

[light guitar music]

-year-old Florida resident Melinda Lopez never

had children of her own, but she loves her niece Bree

as if she were a daughter.

They talk almost daily, even though Bree

goes to graduate school more than , miles

away in San Diego, California.

Until one morning in October, when Melinda suddenly

stops answering her cell phone.

Her niece tried to get a hold of her over a couple days,

and she didn't answer the phone, and she

became very worried about her.

She called her neighbor, hoping that the neighbor

would go over there.

NARRATOR Using a spare key, the neighbor lets herself in.

NEIGHBOR Melinda?

NARRATOR At first, it seems as if no one's home.

NEIGHBOR Melinda?

NARRATOR But as she turns a corner

at the end of the hallway, she makes a gruesome discovery.

Melinda face-down on the bathroom floor

in a pool of water and blood.

She calls , but she's clearly

been dead there for a while.

[somber music]

NARRATOR When Bree learns the news,

she's devastated and overwhelmed with questions.

She's in another city, and she's very upset.

And she really is wanting to know why she d*ed.

NARRATOR Dr. G begins by reading

through Melinda's case file.

And based on the circumstances at the scene,

one theory immediately jumps to mind.

DR. G Is it one of our thousands of home accidents

that we see come through medical examiners' offices

around the country?

She's on the floor face-down.

There's water on the floor.

There's a bucket there that she appears to have

been filling the toilet with.

Maybe she slipped and fell on the water and hit her head.

You know, accidents happen.

Falls are one of the number one ways,

in the house, that you can die.

And there's a lot of hard things in the bathroom.

The edge of the tub, the edge of the toilet.

So a fall in the bathroom can be quite deadly.

NARRATOR But then, in Bree's statement to investigators,

Dr. G discovers a clue that could

suggest a more tragic scenario.

DR. G We talked to the niece.

They say she's been depressed for a while.

She thought she was taking antidepressants.

So overdose is a possibility.

Could this be maybe a su1c1de?

Families are always upset when you

call something an overdose, a su1c1de,
[ … ]

especially when it's out of the blue.

NARRATOR Bree is now terrified that she may have missed

important clues, and that her aunt could be alive today

if she'd only been a better listener.

But like so many deaths in the morgue,

it's also possible that Melinda simply d*ed of natural causes.

Her heart is a possibility.

Maybe a heart att*ck, and she just goes down.

NARRATOR A key detail in the report heightens her suspicion.

She smokes about a pack and a half of cigarettes a day

and has been doing that for a long time.

Smoking really does nothing good for you.

It certainly increases the chance

of having atherosclerosis.

Smoking adds just a whole 'nother dimension

to the way you can die.

We're really not going to know why

she d*ed until we do the autopsy,

so we'll just have to see.

[dramatic beats]

I should've got a cup of coffee before I started this.

The first thing we do is, really, we

sit back and get an overview.

In the overview, really, she didn't look that good.

She looks older than her stated age of .

Clearly has a lot of wrinkles.

She's got dirt on her feet, dirt under her nails, thin arms,

and not a lot of muscle on her.

She is a woman who looks like she's neglected herself.

NARRATOR The question is, could this state of neglect

reflect a worsening state of depression?

It's possible, but it's not something Dr. G can determine

from an external autopsy.

What she can investigate is whether or not

Melinda sustained some type of fatal injury.

DR. G I'm looking for evidence of trauma, any trauma.

Because even a subtle bruise could maybe give

us a clue to what happened.

NARRATOR And it's not long before she

spots what appears to be a large suspicious bruise.

DR. G There's some green discoloration going

from the lower abdomen onto her thigh and a little bit

onto the lower chest.

NARRATOR But on closer inspection,

she can see that the discoloration

is not a result of trauma.

DR. G I think it was more a combination of congestion,

where the blood is settling, and that also is the area

that was starting to decompose.

She's face-down, so that's very common.

NARRATOR Moving on, Dr. G checks Melinda's head

for injuries and right away takes note

of the blood around her mouth.

DR. G I think that's post-mortem, when

the little blood vessels break inside the mucous membranes

after death.

Let's get a towel.

We'll clean it up, and let's take another picture this way.

She doesn't have a lot of trauma to the face that I could see.

I palpated her scalp.

I don't really feel anything.

NARRATOR But more than years' experience

tells Dr. G that negative findings on the outside

do not necessarily indicate an absence

of injuries on the inside.

You may not always see the trauma

because of a full head of hair on particularly a woman.

One of my hypothesis is that she hit her head

on the side of the toilet.

And so we'll go ahead and just see

if that's where the money is.

[ominous hum]

NARRATOR Dr. G slides her blade across the scalp of -year-old"], index ,…}

Melinda Lopez, who was found dead on the bathroom floor

in a pool of blood and water.

Her grieving niece Bree is terrified at the prospect

that Melinda may have k*lled herself,

and is hoping Dr. G will find another explanation.

DR. G A loved one dies in another city,

and they're looking for me for answers.

NARRATOR And although the clues are scarce,

Dr. G has her own hunch.

She's in the bathroom face-down.

Maybe she slipped and fell on the water and hit her head.

[ominous music]

All righty, now.

So we peel the scalp off.

That's a good place to look for bruising.

And she didn't have any.

NARRATOR But Dr. G can't be certain

until she removes Melinda's skull cap

and looks inside for any internal bleeding.

And then I will take the calvarium

off and look at the brain.

But her brain didn't have any swelling, and when I slice it,

it showed no evidence of hemorrhage.

You name it, that brain didn't have it.

NARRATOR It's definitive.

Melinda did not die of a head injury.

But it's still possible that a fall in the bathroom
[ … ]

caused fatal trauma elsewhere.

DR. G We've got the whole rest of the body

to look at to hopefully come up with the cause of death.

OK.

NARRATOR Dr. G makes her standard Y-shaped incision,

then peels back Melinda's skin and continues her search

for signs of internal injury.

DR. G It could be broken ribs and a punctured lung.

We want to look for rib fractures.

We want to look for bruising.

NARRATOR She closely examines the organs in situ

and is surprised by her findings.

DR. G There's really nothing like bleeding

or bruising on the inside to say that that

had any role in her death.

I think we've safely ruled out trauma.

NARRATOR With the prime suspect now ruled out,

it's looking even more possible that Melinda may have succumbed

to a long battle with depression and took her own life

with a drug overdose.

But the only way to find out for sure

is to run a series of toxicology tests.

So I remove blood to check for dr*gs.

That should be enough.

We'll look to see if there are any substances

that could have caused death.

And we'll take eye fluid, the vitreous fluid.

We'll look at her eye chemistry, because-- like a doctor

can go and check your blood.

I can't do that because your cells have already

started to break up, and all those things

are messed up in your blood.

But your eye fluid is still a little

protected, because there's no free cells,

like red blood cells that are breaking up in there.

And so that will stay a little more pristine

for a longer period of time.

So the vitreous fluid is very important in somebody who's

d*ed, because they will allow me to check

some things which I normally wouldn't be able to check

for after you die.

NARRATOR But the toxicology results

won't be in for several weeks.

For now, she pushes on with the autopsy,

looking for anything that could help

explain Melinda's sudden death.

DR. G So I have to take each organ out one by one

and examine it.

NARRATOR She begins with the lungs,

and right away, she spots trouble.

DR. G They don't look that great.

They've got a lot of black pigment from smoking.

They've already got some breakdown--

what we'd call emphysema from smoking.

Doesn't look like it's bad enough to k*ll her.

NARRATOR Still, Dr. G suspects that Melinda's

heavy smoking may have caused her death

by inducing heart disease.

And that's where she goes next.

Scalpel in hand, Dr. G carefully slices through the membrane

that envelops the heart.

DR. G I open up the pericardial sac.

There's no excess fluid.

And of course, there's no free blood.

NARRATOR She then removes the heart from the chest cavity

and dissects the arteries, where she immediately

finds her first concrete clue.

DR. G She does have atherosclerosis,

or narrowing to the coronary arteries, one of which

is getting severe.

Her right coronary artery was filled up %, %

from plaque buildup.

That's when it starts to get really critical,

and you easily have problems with that.

We often see it as a result of years of smoking.

NARRATOR Smoking contributes to heart

disease and at least two ways--

by constricting the arteries and by causing

bad cholesterol to accumulate in the same narrowed vessels.

In Melinda, Dr. G even finds damage

in the aorta, the largest artery stemming from the heart.

DR. G Well, her aorta is typical of a long-term smoker.

It's actually-- the cholesterol is built up in the wall,

and it's broken through the lining,

and so it's just-- you see this gooey

necrotic stuff just coming out of the wall of your aorta.

It is not a pretty sight.

NARRATOR Although Dr. G now has evidence that Melinda's smoking"], index ,…}

definitely took a toll on her heart,

she doesn't see any sign of an acute heart att*ck,

such as pale, dead tissue.

The heart's a possibility, but it's

right there on the borderline of causing her problems.

It's not a slam dunk.

And we'll have to see what the rest of the autopsy shows.

NARRATOR Her next stop is the abdominal cavity--

the stomach, spleen, and pancreas,

where she's looking for any sign of natural disease.

Let's see what we have here.

Nothing's giving me any clear-cut indication
[ … ]

of what went on.

NARRATOR But when she gets to Melinda's liver,

she spots another clue.

This is a lot of fat on here.

It has kind of a pale yellowish appearance.

It's enlarged.

The anterior edge, the front of it is rounded.

Usually, you have a nice sharp edge.

It really appears to have some--

what we call fatty metamorphosis,

or fat within the cells.

I'm seeing really a severe fatty liver.

NARRATOR Though severe, Dr. G doesn't believe it's fatal.

But it is puzzling, because a fatty liver is most often

caused by obesity or alcoholism, and Melinda

has neither in her profile.

She's clearly not obese, and I don't

have a history of drinking.

But the number one reason for fatty liver

is alcohol consumption.

NARRATOR Now, Dr. G wonders if Melinda

could have been hiding an alcohol

problem from her niece Bree.

Decedents give up their secrets to me in the morgue.

Sometimes things that they don't tell their family,

especially dr*gs, alcohol.

NARRATOR While the liver may reveal secrets

about Melinda's life, it doesn't shed

any new light on how she d*ed.

With the autopsy complete, Dr. G has just one chance

left to uncover the truth behind this mysterious death.

But a haunting scenario weighs heavily on her mind.

There's a possibility that it could be some type of overdose.

So I'm hoping toxicology's going to give me the answer.

And we're just going to have to wait and see.

What happened to her?

How did she end up on the floor in her house?

[ominous hum]

NARRATOR Three weeks after Melinda Lopez is found dead

on her bathroom floor, her toxicology

report lands on Dr. G's desk.

Melinda's niece Bree fears the worst--

that her aunt tragically took her own life.

Dr. G is hoping the report will tell a different story.

DR. G The first thing I look at is to see if there's

any dr*gs or alcohol.

She's negative on dr*gs and alcohol.

It's clearly not an accidental overdose.

It's clearly not a su1c1de.

NARRATOR It is an enormous relief to Bree.

But the results pose another problem.

Dr. G still has no idea what could

have k*lled Melinda Lopez.

Sometimes, at the end of the autopsy,

you don't know why they d*ed.

I was hoping for the answer, because these are a lot of work

when you can't figure it out, and you

got to start at square one, and start rethinking it out.

NARRATOR Line by line, she scours

the rest of the toxicology report,

looking for anything that could shed light on Melinda's death.

And it isn't long before she comes

across something unexpected in the vitreous levels.

DR. G When I look at that eye fluid,

she has a high glucose level, which we typically see

in somebody who is diabetic.

NARRATOR Diabetes.

This would explain Melinda's fatty liver,

because it's known to increase the risk

of developing liver disease.

But Melinda has no history of diabetes,

and it rarely leads to an unexpected death.

DR. G But it's uncommon to see somebody

dying at home from diabetes.

So what's going on?

NARRATOR Then, Dr. G makes another discovery

in Melinda's lab results, and she

can hardly believe her eyes.

DR. G Something that I really didn't expect was there.

It really all points to one thing.

I know why she d*ed.

[dramatic beats]

NARRATOR It's a sunny fall day in Florida,

but Melinda Lopez is having trouble enjoying it.

She's stuck inside, feeling ill.

But she has no idea how sick she really is.

DR. G Even though she probably didn't know,

and no one in her family obviously knew,

she had diabetes.

NARRATOR Toxicology results confirm that Melinda was

suffering from diabetes, a condition that causes glucose

levels to rise because the body is

unable to produce enough insulin or is resistant to it.

Insulin is the hormone that is made by the pancreas that takes

your blood sugar, your glucose, and brings it into your cells

so your body can use that for energy.

What happens is, without the insulin,

the glucose levels just keep getting

higher and higher in the blood, but your cells are starving.

Your cells don't have any energy.
[ … ]

NARRATOR Melinda does her best to manage her mounting fatigue,

but her body is growing increasingly

starved of glucose.

DR. G When your body can't use glucose for fuel,

it has to break down other things.

And one of the things it breaks down is fat.

NARRATOR But burning fat for fuel

causes a highly acidic byproduct, acetone,

to build up in the blood.

In the tox report, Dr. G saw that Melinda's acetone level

was extremely elevated, and this is

what gave her the final clue.

DR. G That acetone then starts making you feel horrible.

As your blood becomes more and more acidic, your muscles ache.

You feel like you have the flu.

You're nauseated.

You're vomiting.

You have abdominal pain.

She probably was having symptoms for extended period of time.

NARRATOR And with no medical intervention,

her condition eventually erupts into a full-blown crisis

known as diabetic ketoacidosis.

DR. G Because of the increased acid in your blood,

your organs don't work well.

When you feel horrible, you go to the bathroom.

So I don't think it's a coincidence

that she dies in the bathroom.

There gets to be a point when you just don't have enough fuel

to the brain, and your brain stops functioning,

and she passes out.

And she's slipping further and further into a coma

until she dies.

[light music]

DR. G She d*ed from diabetes.

But this is % treatable.

The root cause of why she d*ed is

that she ignored her symptoms and she

didn't take care of herself.

Why is it that she would ignore these symptoms?

Maybe the bottom line is the depression that

kept her from seeking help.

NARRATOR For Bree, the confirmation

that Melinda didn't take her own life

provides some measure of peace.

But the revelation that her aunt disregarded

so many warning signs comes as a sobering lesson.

DR. G You don't want to run to the doctor

all the time, that's fine.

But there are few things you're just

going to have to get checked out occasionally,

and that's going to be your blood sugar, cholesterol

level, and blood pressure.

Because those are silent K*llers, and you

may not have any symptoms.

You just occasionally need to go to the doctor.

If nothing else, get those three things checked.