06x10 - Deadly Descent

[bunniefuu]

[music playing]

NARRATOR When a routine flight turns deadly,

Dr. G is faced with a gruesome challenge.

It's not pretty when you hit the ground

at a high rate of speed.

NARRATOR And as the autopsy unfolds,

she begins to wonder if the pilot could

have made a deadly mistake.

I was a little surprised.

That's probably two things that pilots shouldn't be doing.

NARRATOR Then, a woman is found dead in her home

down in a pool of blood.

This could be foul play.

NARRATOR And it looks like the person closest to the victim

could be the chief suspect.

The detectives suspect this is a domestic, violent homicide.

[music playing]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

These are the everyday cases of Dr. G, medical examiner.

[music playing]

Throughout her year career, Chief Medical Examiner Dr. Jan

Garavaglia has seen her fair share of unusual accidents,

from car wrecks and boating deaths,

to train fatalities and even the occasional plane crash.

It's probably about every other year, every couple

of years, that a plane crash death

will come through your morgue.

NARRATOR And while each accidental death presents

its own unique set of challenges,

plane crashes can prove to be especially difficult.

I have had some devastating plane crash, where

a plane goes into the side of the mountain

at a high rate of speed.

The people are in pieces, and your skin is inside out.

I mean, they can be devastating.

NARRATOR One such case occurred in August ,

while Dr. G was working at the Bexar County

morgue in San Antonio, Texas.

We have a -year-old Hispanic male from rural West Texas.

And he was flying an airplane, and nobody knows what happened.

It crashed and b*rned, and that's about as far as we know.

[music playing]

NARRATOR It's just before PM on Thursday afternoon

when someone reports a grass fire to the Upton

County Fire Department.

[sirens]

So the volunteer fire department goes out there,

and lo and behold, it's not a grass fire.

It's a plane crash.

NARRATOR Firefighters scramble to extinguish

the burning wreckage.

And inside, they find the pilot's severely charred body.

They quickly ID him as -year-old Richard Garcia,

and immediately begin searching the area for clues.

Nobody witnessed this plane go down.

NARRATOR Following standard operating procedure,

the fire department turns the investigation

over to the NTSB, or the National

Transportation Safety Board.

Investigator Hector Casanova is assigned to the case

and his first order of business is to gather more information

about this recreational pilot.

The pilot was very experienced.

I think he had ,, , hours of total flight time.

So he was extremely familiar.

But for some unknown reason, he hits the ground.

NARRATOR Now, it's up to the NTSB

to find out exactly why the plane went down.

They're looking, is it something

to do with the person?

Is it something to do with machine?

Meaning your airplane, or is it something

to do with the environment, the weather?

NARRATOR And is the NTSB prepares

to conduct a full inspection of the aircraft,

Richard's body is transferred to the Bexar

County morgue, where Dr. G will perform a complete autopsy.

My job is the pilot, that person

aspect of the investigation.

The NTSB, they want us to give them information

about the pilot that may help them piece together

what happened in that cockpit prior to hitting the ground.

Maybe something human has something

to do with the accident.

But isn't that the way with everything?

How often is it the car that malfunctions,

causing the accident?

It's usually the person.

OK.

So.

NARRATOR As a first step, Dr. g combs through the investigators

report, looking for anything that could shed

light on Richard's accident.

We know he's married.

We know he's years old, Hispanic fellow.

But we don't have direct contact with the family.

So we don't know anything about his medical history,

his social history.

We don't know anything about him.
[ … ]

NARRATOR Yet despite the lack of background information,

there is one thing that Dr. G does know.

By law, all pilots must undergo routine physical exams.

He can be a private pilot.

You can be a commercial pilot.

Each of them have different medical requirements.

If you are a private pilot, you can be good for one year.

NARRATOR This means that Richard

was given a clean bill of health sometime within the past year.

That said, Dr. G still can't rule out the possibility

of a natural death.

Just because pilots have to have physicals

doesn't mean there's not some silent k*ller

going on in your body.

When we see that, every day in this morgue.

They've gone to the doctor.

They've given a clean bill of health.

And then they die.

NARRATOR With this in mind, Dr. G

will be on the lookout for any signs of natural disease.

I'm worried about a stroke, or maybe a heart att*ck.

He didn't necessarily have the die of a heart att*ck.

Maybe he's distracted by the severe chest pain.

And that's caused him to lose control of the plane.

NARRATOR Dr. G must also take into consideration

the possibility that Richard's judgment was somehow impaired.

We need to know if he's under the influence

of dr*gs or alcohol.

And if that could have affected his decision making.

NARRATOR With a number of theories in hand, and the NTSB

eagerly awaiting the results of the autopsy,

Dr. G knows only one thing for sure,

she has her work cut out for her.

Many die from blunt impact.

Did he have any natural disease that could have contributed?

Was he impaired in some way with dr*gs or alcohol?

So all of those will be that person component.

[music playing]

OK.

Let's see.

Yeah, let's go for it.

Our general appearance is he is intact.

That's the good news.

The problem is he is partially charred.

He was clearly in a fire.

NARRATOR The burns and extensive trauma

covering Richard's body make him completely unrecognizable.

Because of the condition of the body,

we're clearly not going to be able to do a visual ID.

So we're going to try to fingerprint him.

Although some of his portions of the hands are b*rned,

his finger ridges in some of his fingers are still intact.

NARRATOR Dr. G's morgue technician

pulls prints from his undamaged fingers,

and sends them off to be analyzed.

And it doesn't take long to confirm

that this is indeed the body of -year-old Richard Garcia.

Dr. G begins with the overwhelming task of

documenting Richard's injuries.

He's clearly got trauma.

You can see broken extremities that aren't

quite in the right place.

His legs and arms aren't going in the right direction.

Oh, gosh.

These are broken.

His upper arms are fractured.

His forearms are fractured.

He's got upper leg fractures.

The femurs, lower leg fractures.

Fractures by the knees, fractured by the ankles.

His face he's got trauma, a lot of lacerations.

His nose is actually kind of torn off.

So a lot of fractures, and dislocation to the bones

of the extremities.

All right.

NARRATOR It's a sobering laundry list of injuries,

and one that suggests even more extensive trauma on the inside.

If you have broken every single long bone in your body,

chances are there's something wrong

with your internal organs, too.

NARRATOR But despite the myriad of burns and fractures,

it's still anyone's guess what actually

k*lled a -year-old pilot.

And more importantly, why his plane

went down in the first place.

So we'll see.

You know, we don't know until we open him up.

This is going to be a mess.

[music playing]

NARRATOR The remains of -year-old Richard Garcia

have just been pulled from the burning wreckage

of a small engine plane.

Now, Dr. G is faced with the daunting task

of looking inside the charred and battered body.

It's not pretty when you hit the ground

at a high rate of speed.

So I don't know exactly what I'm going to find.

[music playing]

Well you know, even though in some areas,

the skin is almost completely burnt off,
[ … ]

you'll still do your y incision.

I then start looking for trauma, and he had a lot of trauma.

All of his ribs were fractured in the front.

All of them were fractured on the side, and all of them

were fractured in the back.

NARRATOR As a first step, Dr. G carefully

clears the pieces of broken ribs from Richard's chest cavity.

Then, she surveys the organs in situ.

His lungs you have so many lacerations from the edges

of the ribs sticking into him, his pericardial sac

is torn open.

His heart is multiply lacerated.

Big tears the muscle of the heart.

NARRATOR But while Richard's heart is severely damaged,

Dr. G is still able to collect vital blood

for toxicology tests.

I certainly will take blood for toxicology.

NARRATOR She sends the samples off

to the lab for a rush analysis.

Then turns her attention to Richard's abdominal cavity.

His diaphragm has large tears.

See, that's his diaphragm.

And his internal organs were just in disarray.

That's not good.

NARRATOR The diaphragm is a thin sheet of muscle

that stretches across the bottom of the rib cage,

and separates the organs in the chest cavity

from those in the abdominal cavity.

But Richard's torn diaphragm acts as an open door,

allowing his abdominal organs to enter his chest cavity.

His spleen is no longer in his abdomen,

because it went through the tear in his left pleural cavity.

And that's in multiple pieces.

That's a lot of trauma.

Part of his bowels are in his left pleural cavity,

where his lung should sit.

His abdomen has multiply torn liver.

His aorta is torn.

His back is in two pieces, and one's on top of the other.

That's not good.

His pelvis, believe it or not, doesn't have any fractures.

That was intact.

His bowels are contused.

NARRATOR But despite this damage,

Dr. G is still able to spot a subtle clue.

He's got some problems here.

He had a lot of blood in the soft tissue,

a lot of hemorrhage associated with those fractures.

A lot of hemorrhage in the bowels.

What it tells me is his heart was b*ating,

and he was alive when he hit the ground.

NARRATOR This is a critical finding.

It confirms that Richard's death stemmed from injuries sustained

in the crash itself, but it still

doesn't explain why the seasoned pilot

drove his plane into the ground at over miles per hour.

We've got some answers from the autopsy,

but we don't have all the answers.

He clearly d*ed from his injuries.

But I don't know if he's incapacitated

or using dr*gs and alcohol.

And we're worried about natural disease.

NARRATOR With that in mind, Dr. G

turns her attention to an organ high on her list of suspects.

Using an isolated saw, Dr. G's morgue technician

cuts through the skull to expose the brain.

When we do the head exam, we find

he's clearly got some devastating trauma

which would have been enough to k*ll him in and of itself.

But not as much trauma, honestly,

as the rest of the body.

NARRATOR She removes the organ and carefully

dissects the brain tissue, searching

for any abnormalities.

See what we have here.

NARRATOR But she comes up empty handed.

No natural disease in his brain, either.

No strokes, no infarcts.

Nothing that I could find that would have incapacitated him.

NARRATOR With the brain ruled out,

Dr. G's next stop is Richard's badly damaged heart.

Although it's multiply torn, we

can still look at his heart for natural disease.

NARRATOR Carefully, she dissects the organ,

slicing through the tissue and into the coronary arteries.

The heart muscle looked good.

It wasn't enlarged.

Coronary arteries were fine.

Everything looked normal.

So he clearly didn't have a heart att*ck.

NARRATOR But this search for natural disease

is far from over.

Dr. G's next stop is Richard's lungs.

When I open his windpipe, his trachea, his bronchi,

there is no evidence of soot.

He was not breathing in any smoke.

So he's burnt on the outside, but that happened

after he hit the ground.

There was no evidence that he was exposed to smoke or soot

prior to the crash.
[ … ]

The fire clearly was post-crash.

NARRATOR She slices through the lung tissue,

and it isn't long before something catches

her attention.

Although I couldn't put my finger on it,

the lungs didn't look quite right to me.

They are very dry.

Parts of the lungs looked a little over inflated.

NARRATOR Not exactly sure what this could mean,

Dr. G takes samples of the tissue

so she can get a closer look.

I needed to look under the microscope.

NARRATOR Then, just as she's wrapping up

the internal autopsy, Dr. G receives

crucial new information from the NTSB's investigator.

There appeared to be nothing wrong with the plane,

and they really don't have an explanation for the accident

yet.

So at that point, they're ruling out mechanical failure.

They're ruling out weather.

What's left is the person aspect of this equation.

So at the end of the autopsy, we know he d*ed from blunt trauma."], index ,…}

He had no natural disease.

And at this point, I don't see any incapacitating

problems he could have had.

NARRATOR Now the investigation is hinging on one thing,

Dr. G's lab results.

I still have my toxicology to go,

and I still want to look at that lung tissue

under the microscope.

At this point, the only thing they have left

is anything I can find.

[music playing]

It's been three long weeks since the autopsy

of -year-old Richard Garcia, who d*ed

in a small engine plane crash.

So far, the NTSB investigation has

ruled out whether in mechanical failure

as the cause of the accident.

And Dr. G's autopsy has yet to uncover

why Richard's plane would have taken a sudden nosedive

into an open field.

I found nothing that would have incapacitated

him prior to the accident.

Did dr*gs or alcohol incapacitate him?

I don't know, but the tox may answer those questions for us.

[music playing]

When we get the toxicology report,

I was a little surprised.

He has a little bit of alcohol, at about a six

grams per deciliter.

So he clearly probably had a beer at lunch.

I don't know if you can drive a plane with a .,

but I don't think I'd want my pilot with any alcohol.

NARRATOR But Richard's alcohol level

isn't high enough to convince Dr. G that it's

to blame for the crash.

And as she continues to scan the report,

she spots something else that raises a red flag.

He had a little bit of diphenhydramine on board.

That's the kind of antihistamine that kind of puts people

to sleep.

It would take a boatload of diphenhydramine

to incapacitate you, but it can make you

sleepy at high enough levels.

But his level really wasn't that high.

I don't know why he took it, but maybe he

was having seasonal allergies.

Maybe he was having some type of allergic feeling.

NARRATOR Although the level is low,

it's possible that this, along with the alcohol

made for a deadly combination.

He had a beer, and he was taking

some diphenhydramine, probably two things

that pilots shouldn't be doing.

NARRATOR But for Dr. G, the pieces of this puzzle

aren't quite fitting together.

And there's only one tool left in her arsenal,

the microscopics.

We still need to look at that lung tissue.

[music playing]

NARRATOR Dr. G places the slide of Richard's lungs

under the microscope.

And adjusts the dial to bring the image into focus.

When I look at the lung tissue under the microscope,

I was really surprised.

I'll get that again.

It really all points to one thing.

NARRATOR And in an instant, Dr. G

knows exactly what caused the plane crash

that k*lled Richard Garcia.

That microscope doesn't lie.

[music playing]

NARRATOR It's Thursday afternoon,

and pilot Richard Garcia is about to indulge

in his favorite pastime.

But before he takes to the skies, he grabs a quick lunch.

I think he probably had a beer at lunch.

After eating lunch, I don't know if he was having

problems with a dry cough, or what he thought
[ … ]

were seasonal allergies.

But he takes a diphenhydramine, an antihistamine.

NARRATOR Richard then boards his small engine plane

and prepares for takeoff.

He gets in that plane, probably

with some mild symptomatology of a dry cough.

Maybe somebody thought was seasonal allergies.

While he's flying at feet, he probably starts

to get shortness of breath.

NARRATOR But Richard isn't only suffering

from seasonal allergies, instead microscopic results

confirm he's in the midst of an asthma att*ck.

He was clearly having acute asthma

at the time of the incident.

The airways in his lungs were clogged

with mucus, the characteristic that we see with asthma.

Asthma is a reactive airway disease of the small vessels

that contracts the airways.

And mucus starts coming out of the lining of the airway,

and it blocks those airways.

As those airways start contracting

he's having difficulty breathing.

He can't get oxygen to his blood,

and he's feeling like he's short of breath.

NARRATOR As Richard gasps for air,

he focuses all of his attention on his next breath.

And it isn't long before his plane begins

to careen toward the ground.

He hits that ground so hard that it breaks

every long bone in his body.

It tears his diaphragm.

It tears his heart, fractures all his ribs.

A fire ensues, and he gets partially b*rned before they

can put out the fire.

NARRATOR With this, Dr. G closes the case on Richard

Garcia, and report your findings to the National

Transportation Safety Board.

I don't think he d*ed from asthma.

But if you get distracted with shortness of breath

from an asthma att*ck, it's not a stretch of the imagination

that that was a contributing factor, if not

the cause for that accident.

So the blunt trauma is the cause of death,

but really the initiating problem was the asthma.

NARRATOR This information allows

the NTSB to complete their investigation

and rule the pilot at fault.

The cause of the accident was the pilot's failure to maintain

clearance with terrain.

NARRATOR Then Dr. G, reaches out to local authorities

to deliver the information to the family.

I give the information to the justice of the peace,

and they relay that to the family.

I would think that the reaction would

be surprised, considering that most likely

nobody knew he had asthma.

But maybe it helps them at least understand

it wasn't a failure in decision, or failure in something

he necessarily did.

I just don't think he knew he had it,

and clearly this may have been one of his worst att*cks.

A lot of people think that asthma is just for children,

but a lot of adults get asthma.

And a lot of them don't have it diagnosed,

because they must take their symptomatology of asthma

for something else.

It just goes to show that oftentimes, the autopsy may

not show anything important.

Sometimes it plays a small piece of the puzzle.

But sometimes it's key.

NARRATOR And in Dr. G's next case,

the autopsy proves to be the missing link

in a homicide investigation.

The detective was very worried that this woman was m*rder*d.

Now, it's my responsibility of truly prove why she d*ed.

[music playing]

NARRATOR Sunny skies and world class attractions.

Together, they draw more than million visitors a year

toward Orlando, Florida.

But inside the District morgue,

Dr. G is witness to the darker side of this lively city.

Even though it's a wonderful city,

there's a lot more v*olence in Orlando than you would think.

There's stabbings, and sh**t, and things going

on that I see on a daily basis.

Overall, about % of our cases are homicides.

But actually, everybody that comes through our office

is a potential homicide until proven otherwise.

Just don't throw anything away yet until we

figure out what that is.

[music playing]

NARRATOR It's a muggy Sunday evening in Orlando

and [inaudible] has just returned home after a weekend

away with friends.

He gets home about o'clock in the evening,

he finds that the kitchen door is unlocked.

Rosie?

DR. JAN GARAVAGLIA And as soon as

he walks in he sees a struggle.

BEN Rosie!
[ … ]

NARRATOR Ben's girlfriend, Rosie [inaudible]

is lying face down and emotionless on the floor.

He's obviously startled.

He calls the police, who come and pronounce her dead.

NARRATOR And as police examine the scene,

a gruesome scenario begins to emerge.

There's some blood pooled around her face.

And she's got kind of a black eye.

This could be foul play.

NARRATOR Although Ben seems genuinely shaken,

police can't help but wonder if he may have

played a role in Rosie's death.

The detective is very worried that this woman was m*rder*d.

Keep in mind, % of women that are m*rder*d

are m*rder*d by an intimate partner, by their boyfriend,

by their husbands, by their ex-husband.

The boyfriend is clearly upset, but is it an act, or is it not?

Did he have something to do with her, or did he not?

The police are very suspicious of him.

NARRATOR But there's one problem,

without physical evidence linking Ben to Rosie's death,

police have their hands tied.

They left a law enforcement officer at the scene

to guard the crime scene until my determination at autopsy.

So I do want to make sure that I get this case done

as quick as I can.

So I can either tell them it is a homicide,

or tell them it isn't a homicide.

[music playing]

NARRATOR Rosie's body arrives at the District morgue,

and as a first step Dr. G reached

through the investigators report.

We have a -year-old African-American

woman that the police are suspicious might be a homicide.

NARRATOR But Dr. G knows better than to jump to conclusions.

Just because the police thinks it's homicide,

doesn't mean I have to think it's a homicide.

There's another possibilities.

It could be an accident.

She could have collapsed from natural disease.

We don't know.

NARRATOR And right away, she spots

a few details in Rosie's medical records that raise a red flag.

She's not just overweight, she's obese.

And there's a lot of problems with obesity.

You certainly have more heart disease.

It's certainly going to predispose

you to high blood pressure.

She smokes.

There's no good reason in the world to smoke,

and it's going to affect your heart.

It's going to affect your lungs.

And she drinks heavily.

She could have been drinking and fell very suddenly

and hit her head.

NARRATOR She also wonders if Rosie may have indulged

in another dangerous habit, one often

associated with sudden death.

She already smokes, she drinks.

Her boyfriend's out partying and drinking.

Who knows what else she's doing?

It could even be dr*gs.

It could be a homicide.

It could be an accident.

It could be natural.

I'm keeping all of my options open.

[music playing]

Did you see that nice shiner she's getting?

So when I start my external, the detective is there with me,

giving me more information, and just waiting for me

to tell him what I found.

It's really actually very important

that when I'm doing a suspicious death,

that the detective who's investigating,

or one of his partners is there at the autopsy.

But you guys have to give me information.

Oh, that too.

NARRATOR Dr. G's first order of business

is to try to piece together the chain of events

leading up to Rosie's death.

She's already starting to get some very early

days, compositional changes.

She's been there over hours.

So we at least know whatever happened was

closer to the Saturday morning.

The boyfriend leaves Saturday morning,

comes back Sunday night.

NARRATOR Given the timeline, it's

possible that Ben k*lled Rosie before he left on his trip.

So we certainly haven't ruled out the boyfriend.

NARRATOR Next, Dr. G inspects Rosie's skin inch by inch,

searching for forensic evidence.

I look very carefully for any kind of trace on her body

itself.

Hairs, fibers, anything strange.

But I didn't find any trace evidence.

NARRATOR She also checks for needle marks

on the arms and legs that could tell her

if dr*gs somehow played a role.

We don't see any evidence of drug use.
[ … ]

But I may not see that, if she does it orally,

or she sniffs it, or she smokes it.

So I can't rule out dr*gs.

NARRATOR Then Dr. G turns her full attention

to Rosie's bloody head.

Oh, gosh.

She's a mess.

Her face is still matted in blood.

So I can't really see what's going on.

NARRATOR Morgue technician Brian

Machulski is assigned the gruesome task

of cleaning her head.

Slowly, the veil of blood over Rosie's face falls away.

And what lies underneath takes Dr. G by surprise.

There is no laceration, or tearing of the skin.

I don't see where this blood is coming from.

NARRATOR But while Dr. G can't pinpoint

the source of the blood, she does spark another clue.

She's got a lot of ecchymosis.

That's blood which is gone into the delicate tissues

of the upper and lower eyelid.

Maybe she fell.

Maybe it's a blow to the eye, or maybe it's due to the fact

that she's just face down, and she's starting to decompose.

At this point, I can't really tell you why she d*ed.

It could very well be a homicide.

[music playing]

NARRATOR Dr. G is investigating the mysterious death

of -year-old Rosie [inaudible] who

was found lifeless in a pool of blood just a few hours earlier.

This is a case at right off the bat came in as suspicious.

NARRATOR And police can't help but wonder

if the victim's live in boyfriend, Ben [inaudible]

may have been involved.

He's worried that this is a domestic, violent homicide.

NARRATOR So far, the external exam has raised many questions

but yielded few answers.

And with no proof of m*rder, the police investigation

remains at square one.

The hunt for the culprit must now

continue inside Rosie's body.

We have to see what the internal findings are.

[music playing]

NARRATOR Dr. G slides her scalpel across Rosie's

torso in a Y-shaped incision.

People always think the Y incision is at the beginning

of the autopsy.

The beginning of the autopsy starts

when I first look at the body.

So by the time I finally get to the y incision,

the body is cleaned, I've documented

everything I could find.

At least an hour and a half has gone by.

I'm looking specifically for any trauma underneath the skin.

I'm looking for bruising.

I'm looking for rib fractures.

I'm looking for maybe blood in her abdomen.

She doesn't have any.

So we don't see any other trauma.

There's no free blood in the belly.

Yeah.

NARRATOR Next, she takes blood and urine samples to send out

for toxicology tests.

The tox is important with her because she d*ed suddenly

and unexpectedly.

When anybody has a sudden death, we will check toxicology

to see if dr*gs played a role.

Good.

NARRATOR Moving deeper into the chest cavity,

she cracks open the rib cage and removes the lungs.

Her lungs are not in that bad a condition,

considering her habits of smoking.

At , she still had a long way to go before those cigarettes

would get to her.

NARRATOR Then, Dr. G turns her attention to the heart,

and immediately she spots an alarming clue.

Oh, something here.

We have a big heart.

The first thing I noticed, it's enlarged,

and it's much heavier than it should be.

.

That's a big heart.

What is it that's causing her heart to be like that?

NARRATOR To find out, Dr. G begins a careful dissection

of the organ.

And it isn't long before she gets her answer.

Oh, what's this?

But when I cut the heart muscle, her heart muscle was thickened."], index ,…}

And in her case, that indicated high blood pressure.

NARRATOR High blood pressure forces

the heart muscle to work harder, causing

it to grow abnormally thick.

The heart muscle passed a pump against that elevated pressure.

And over time, the muscle thickens.

Well, suddenly the large heart is severe enough

to have given her a sudden cardiac arrhythmia,

but did that k*ll her?

I don't know.

NARRATOR An arrhythmia leaves no physical evidence

in the body.
[ … ]

So the only way to know if Rosie's heart is to blame

is to first rule out every other possible cause of death.

When you do an autopsy, it's a process for elimination.

I would have to rule out everything else

before I could make that determination.

All righty.

But unless I find something else to Tr*mp that,

that very well may be her cause of death.

NARRATOR Now Dr. G must finish your examination

of Rosie's abdominal organs.

And given the -year-old's history of alcohol abuse,

she begins with the liver.

Her liver is slightly enlarged.

It appears to be a fatty.

This could be partly due to her drinking,

and it could be partly due to her obesity.

But it doesn't look bad enough that it would have k*lled her.

NARRATOR She then examines another organ that's

often destroyed by alcohol.

DR. JAN GARAVAGLIA We look at her pancreas.

A pancreas is that organ that helps regulate your glucose.

It also provides a lot of digestive juices

into your small intestine.

That will be affected in some people

with chronic alcohol use.

But again, her pancreas looked pretty good.

NARRATOR Dr. G's next stop, the kidneys.

Look at that.

NARRATOR And there, she spots something odd.

I notice that her kidneys have a lot of a granularity

to its surface.

That indicated years of high blood pressure.

NARRATOR And there's more.

Just above the kidneys or the adrenal glands,

tiny organs that produce hormones

crucial to the regulation of bodily functions.

In Rosie, these glands are strangely misshapen,

and with Dr. G cuts them open, she can see why.

She has adrenal adenomas.

So what an adenoma is, it's a small tumor.

And that tumor could be cancer, or could be benign.

NARRATOR Dr. G doesn't believe the tumors directly caused

Rosie's death, but it is possible they contributed

to her high blood pressure.

And in some circumstances, those adenomas can be a cause

for high blood pressure.

But most of these little tumors are just incidental findings.

They don't mean anything.

All right.

So let me think what I still need to do.

OK.

NARRATOR As the abdominal exam comes to an end,

the spectre of foul play still looms large.

Why does she have the blood around her?

I still can't rule out foul play.

At this point, they're not holding the boyfriend.

They're not interrogating him until they

know it's a homicide, and I can give

them some specific information.

NARRATOR And she has one last place

to look for the final piece of the puzzle.

At this point in the game, I'm hoping the answer

is going to be in the head.

[music playing]

NARRATOR Dr. G and her team are preparing for the cranial exam

of -year-old Rosie [inaudible] who

d*ed under mysterious and highly suspicious circumstances.

On the one side, I have a possible cause of death.

Her big heart could have caused her

to go down suddenly and unexpectedly

with an arrhythmia.

On the other side, I still have to contend with this blood

around her head.

I still can't rule out foul play.

I'm hoping but the final piece of this puzzle

is going to be in her brain.

[drilling sound]

[music playing]

So when I go to the head, I'm looking

for any kind of bruising.

She didn't have that, and I don't see any skull fracture

to the calvarium, the skullcap.

NARRATOR But in some cases, fatal trauma is only

evident on the brain itself.

Morgue Technician Brian Machulski

ski saws open Rosie's skull.

Then Dr. G steps in for a closer look.

Let's see.

NARRATOR And just beneath the dura,

the outer covering of the brain, she spots an alarming clue.

I see a little bit of blood.

Something's going on here.

NARRATOR Carefully, Dr. G extracts the organ

and dissects it.

And deep within the tissue, she finds her answer.

She has bleeding into the deep structures of the brain.

And of course, swelling of the brain.

The questions are over.

This trumps anything else I found.

[music playing]
[ … ]

NARRATOR It's Saturday morning and Rosie's boyfriend,

Ben has just gone off on a trip with friends,

leaving Rosie to enjoy a quiet weekend at home.

So what we thought was a homicide,

and what we thought was his bogus alibi,

turns out to be really what happened.

And Meanwhile, this poor woman is enjoying

the weekend by herself.

Probably starts getting a headache.

NARRATOR Little does she know that inside her head,

a ticking time b*mb is about to go off.

In this case, everything pointed to high blood pressure.

NARRATOR Over the years, Rosie's

untreated high blood pressure has wreaked havoc on her body.

b*at by b*at, the increased pressure strains the heart,

causing it to enlarge.

You get a thickened heart from it having to pump so hard

against that high pressure.

NARRATOR But the fallout from this chronic condition

is not confined to Rosie's heart.

It also affects her entire vascular system.

High blood pressure has effects on your brain.

It has effects on your heart.

It damages the kidneys.

It affects all your blood vessels.

NARRATOR And on this fateful Saturday morning,

the pressure becomes too great inside a blood vessel

deep within Rosie's brain.

She probably had a horrible headache.

NARRATOR Then suddenly, the vessel burst.

DR. JAN GARAVAGLIA That causes bleeding inside her brain

causing it to swell.

NARRATOR The swelling puts unbearable pressure

on the organ depriving it of vital oxygen.

Soon, her brain can no longer function, and she collapses.

Tragically, almost two days pass before Rosie's boyfriend

returns from his trip and finds her body

decaying in a pool of blood.

That blood around her face is caused by her being face down,

starting to decompose.

And then, the delicate blood vessels of the nose

are breaking down, and the blood is just oozing out.

NARRATOR Finally, with all the pieces in place,

Dr. G's ready to share her findings with the police.

I know this isn't a homicide.

So the boyfriend's off the hook.

We've got the k*ller, and the k*ller was high blood pressure.

Anyway, well you already knew some.

The detective is like all smiles.

You mean, because that made his day.

He is not spending the rest of his day

interviewing the boyfriend.

He's not spending the rest of the day looking

for a perpetrator, because her perpetrator

was their high blood pressure.

NARRATOR It's possible that the tumors Dr. G found

on Rosie's adrenal glands could have caused

her elevated blood pressure.

The adrenal glands may or may not have been the cause

of their high blood pressure.

NARRATOR Special tests do exist that could have

identified the adenomas as the source

of Rosie's high blood pressure.

But unfortunately, she never sought medical attention.

It would be interesting to find out,

but now there's nothing I can do about it.

If she was alive, that would be wonderful.

If you're alive with high blood pressure,

and they find the cause for high blood pressure, and something

like taking out that tumor to get rid

of your high blood pressure, that would by all means,

be worth it.

But she's already dead.

When we run a medical examiner's office,

we have to kind of allocate our resources

on what's important to find out, and what's not.

And unfortunately, that's the reality of the situation.

And those are the kind of calls I have to make.

NARRATOR And although Dr. G takes comfort in the fact

that Rosie wasn't m*rder*d, this case

is yet another example of an unfortunate and premature

death.

She could have prevented her death by stopping

smoking, and losing weight.

NARRATOR There are also effective medical treatments

for high blood pressure.

We have good medications to control high blood pressure.

And if one doesn't work, they try another.

Some cases are just sadder than others.

High blood pressure can be a silent k*ller.

That is why knowing your blood pressure

is one of those essential numbers you need to know,

if you want to live to old age.

Anyway, so not a bad today.

Just tragedy.

There is no excuse for you to have high blood pressure,

and not treat that aggressively, unless you don't want to live.

[music playing]