Transcripts - Forever Dreaming

[music playing]

NARRATOR A young man dies in a freak car accident.

There's no real reason why he would run off into this fence.

NARRATOR Now it's up to Dr. G to get

to the bottom of this tragic and mysterious death.

JAN GARAVAGLIA The family wants to know.

People have questions, and we're here to find

the cause and manner of death.

I can't just put a car accident.

NARRATOR Then, the naked, decomposing body

of a middle-aged man is found at the foot of his staircase.

Oh god.

Was he drunk and fell?

Did he have some natural disease that caused him to fall,

or did he collapse right there?

NARRATOR But can Dr. G uncover the truth

behind this bizarre scene?

[music playing]

Altered lives, baffling medical mysteries,

shocking revelations.

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

[music playing]

It's a typical Tuesday morning, and like over million

other Americans, Dr. Jan Garavaglia

will get behind the wheel of her car

today to take her kids to school and go to work.

But unlike most drivers, Dr. G views the road

with a medical examiner's eye.

She views every mile, every curve as a potential pitfall.

is just terrible.

You take your chances.

Any of us could die at any minute.

NARRATOR And in fact, . million people die worldwide

in car accidents each year.

Of course, the exact mechanism of death

often reveals itself only through an autopsy.

And sometimes, as in Dr. G's next case,

the truth can be quite surprising.

Today, Dr. G will spend her time trying to unravel the mystery

behind the vehicular death of Manny

Alvarez, an ambitious young warehouse manager and father.

JAN GARAVAGLIA We have an interesting case.

He's a relatively young man, only years

old, that just drives his car off of a parking lot

into a fence.

NARRATOR According to the investigator's report,

paramedics responded yesterday afternoon to a call

from a warehouse just outside Orlando.

There they discover a peculiar scene,

a car at the edge of the lot with its hood

punched through the fence.

The driver, Manny, is slumped and

unrestrained in the front seat.

JAN GARAVAGLIA It doesn't look like a very high speed crash,

but there is some trauma to the car, they say.

NARRATOR At first, Manny appears uninjured,

but the medics quickly realize something's wrong.

He's very combative.

NARRATOR After a minor struggle,

they manage to move him to a stretcher.

JAN GARAVAGLIA (VOICEOVER) He's fighting them off.

He's saying crazy things.

NARRATOR But then to their shock.

JAN GARAVAGLIA He codes, meaning

they lose his heartbeat.

NARRATOR The paramedics work desperately

to resuscitate Manny.

Initially, the defibrillator works,

and they rush him to the ER, but the triumph is short lived.

JAN GARAVAGLIA And then he codes again,

doesn't have a heart rate, doesn't have

blood pressure at that point.

NARRATOR This time, despite repeated efforts,

they're unable to revive him.

Just a short time after mysteriously crashing into

a fence, Manny Alvarez is dead.

The news devastates Manny's wife,

who's left alone to raise their young son

and come to terms with his bizarre and unexplained

tragedy.

JAN GARAVAGLIA The family wants to know.

People have questions.

NARRATOR With no witnesses to the actual event, finding

the answers will be tough.

But based on her experience with vehicle related deaths,

Dr. G has a strong suspicion.

Trauma.

In Manny's case, Dr. G is particularly concerned

about a head injury and for good reason.

The fact that he's combative, often people with head trauma

can be very combative.

NARRATOR On the other hand, Dr. G must consider other scenarios

that don't involve trauma.

JAN GARAVAGLIA It can be natural disease.

Maybe he had a heart attack and just

died and ran into the fence.

NARRATOR But this type of accident is very rare.

Roughly % to % of all traffic homicides

occur because of natural causes.

NARRATOR But after reading the report,
[ … ]

Dr. G's first priority is to figure out the cause of death,

not the cause of the crash.

And it boils down to one question.

Do we have just trauma, or do we

have just pure natural disease going on here?

My job is to figure it out.

NARRATOR As soon as the external exam begins,

Dr. G realizes Manny's injuries, if any, won't be easy to find.

JAN GARAVAGLIA We don't have any blood on him.

We don't really see any trauma.

No anterior wrist scars.

There is no wrist scars, like he's trying to--

committed su1c1de or attempted su1c1de before.

OK, so--

NARRATOR Even a small cut or bruise could

belie a fatal internal injury.

JAN GARAVAGLIA Oftentimes, it's very subtle,

like maybe contusions to the chest or contusions

to the abdomen.

NARRATOR She also pays special attention

to the head, where the hair can hide inconspicuous wounds.

Yes, sir.

I, of course, look at his head very carefully,

and I'm feeling for any bruises or contusions, swelling.

NARRATOR But her search comes to a surprising end

with no sign of visible trauma whatsoever.

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Still, Dr. G remains suspicious of what

she might find inside his body, especially his head.

You can't always tell what the trauma is from the outside,

so I'm really going to have to wait for the internal

to figure out what's going on here.

[music playing]

NARRATOR To see if Manny had suffered a fatal brain injury,

Dr. G begins the internal exam by opening up his skull.

JAN GARAVAGLIA I've seen many people with almost completely

trauma free externally and still have severe trauma internally.

NARRATOR She must also consider another possibility--

that Manny's brain will reveal a natural disease

that k*lled him.

JAN GARAVAGLIA A bleed in his brain or a stroke

or a ruptured aneurysm at the base of the skull

could have been a reason for him to become unconscious and go

off the side of the road.

NARRATOR First, she reflects the scalp,

Then removes the cranium and extracts the brain.

JAN GARAVAGLIA Let's hope he didn't hit his head.

NARRATOR She closely inspects it for broken vessels

and unusual pockets of blood.

Until finally, she arrives at her verdict.

JAN GARAVAGLIA There is no trauma to the brain whatsoever.

There's no trauma, no natural disease.

NARRATOR Dr. G has now ruled out two

of the most promising explanations

for Manny's death--

head trauma and natural disease in the brain.

Will the rest of the internal exam

lead to answers or more dead ends?

So far, I don't really see much.

[music playing]

NARRATOR Coming up next, an alarming discovery stuns Dr. G.

It's a twist.

But where's it coming from?

What's causing it?

I don't know.

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

Continuing her search for trauma,

Dr. G makes the standard Y incision along the torso

of -year-old Manny Alvarez.

Yesterday afternoon, the young father

had what appeared to be a minor car accident,

but after struggling with paramedics,

he suddenly collapsed and died.

JAN GARAVAGLIA You know, it's so out of the blue.

It's so lightning strike.

It's hard to believe.

NARRATOR So far, she's found no trace

of trauma or natural disease.

If the cause remains elusive, Manny's family

may never be able to come to terms with his untimely death.

Dr. G proceeds to open the abdominal cavity, ready

to inspect his internal organs.

But there, she makes a startling discovery.

Oh my gosh.

He's got a tremendous amount of blood in his abdominal cavity.

NARRATOR Dr. G immediately measures out

the fluid to find out if this internal bleeding caused

his death.

And after removing all the excess blood

from Manny's abdominal cavity, it measures

in at a devastating . liters.

JAN GARAVAGLIA So he's lost a tremendous amount

of blood, for him a little less than half of his blood volume.

That's clearly his cause of death.

NARRATOR Dr. G has now determined what k*lled Manny--

this massive loss of blood.

But the autopsy is far from over.

To complete Manny's story, she must

now determine why he lost so much blood in the first place.
[ … ]

JAN GARAVAGLIA Where's it coming from?

What's causing it?

I don't know at this point.

Yeah, it could have.

NARRATOR Typically, a car accident

leads to internal bleeding in one of two ways.

The first is when the vehicle suddenly stops,

but the heart continues its forward motion

in the body cavity, ripping surrounding

vessels such as the aorta.

JAN GARAVAGLIA Part of the aorta is free,

and part of the aorta is anchored to your back.

And so what happens when you have a deceleration injury,

it tears right there, right at the point where it's anchored.

NARRATOR But a torn aorta located above the heart

would not have bled into the abdomen.

That blood would be in the chest cavity.

NARRATOR Instead, Dr. G suspects

Manny died from the second major source of internal bleeding

in a crash--

injured organs.

JAN GARAVAGLIA I'm thinking, he's got to have

torn his spleen or his liver.

NARRATOR Now, Dr. G examines Manny's

organs in situ, while they're still

inside the abdominal cavity.

If he had ripped open his spleen or liver,

she'll be able to see the gash or feel it with her hands.

But shockingly, she can't find any wounds anywhere.

JAN GARAVAGLIA The liver was clearly not damaged,

and the spleen, it was intact also.

It didn't have any tears to it.

NARRATOR This lack of trauma baffles Dr. G.

So at this point, I don't know why

he has this blood in his belly.

NARRATOR The entire case hinges on

whether she can find the mysterious source of bleeding.

As a next step, she preserves some of the collected blood

for a toxicology screen.

JAN GARAVAGLIA I have to remove blood,

because did alcohol play a role?

Why did he go off the side of the road?

NARRATOR Then, she extracts the organs for further examination.

She first removes his lungs and heart.

JAN GARAVAGLIA And then I'll do my routine dissection.

NARRATOR But these organs reveal no new clues.

Whatever is wrong with him is in his abdominal cavity.

That's where he's lost the blood.

NARRATOR With her options dwindling,

Dr. G begins to remove and dissect the spleen,

but then something next to the spleen grabs her attention.

I notice that there is something wrong.

NARRATOR It's not an injury, but an unusual patch

of fat on the splenic artery, a major blood

vessel that supplies oxygenated blood to the spleen.

The splenic artery, the artery that's going to the spleen

runs right across the top of the pancreas.

And there's a little bit of fat, mesenteric fat,

adhered to in the area of the tail of the pancreas.

NARRATOR Now, Dr. G must determine

what this strange finding means, and could it

somehow be linked to Manny's massive internal bleeding?

Coming up next, Dr. G discovers a shocking time

b*mb in Manny Alvarez's body.

It happened very suddenly, and it's just

one of those freaky things.

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

Dr. G carefully inspects a little piece

of fat, oddly attached to Manny Alvarez's splenic artery.

She is determined that the -year-old father died

from massive internal bleeding after running

his car into a fence.

But so far, she's found no trauma to any organ.

JAN GARAVAGLIA So it really wasn't making a lot of sense

where this blood was coming from.

NARRATOR Could this little piece of fat hold the key

to Manny's untimely death?

[music playing]

Dr. G gingerly removes this bit of fat.

And right underneath it on the splenic artery

itself, she finds the answer she's been looking for.

JAN GARAVAGLIA And lo and behold,

I see that there is an aneurysm.

He's got an abnormality.

Instead of just having the nice tube of a vessel with blood

going through it, we have a tube of a vessel

with like a little balloon attached to it, almost

an inch by an inch in size.

It's fairly big.

NARRATOR An aneurysm is an abnormal ballooning

of the artery, caused by the weakening of the artery wall.

Aneurysms most often occur in the brain or the aorta,

a major artery that carries blood from the heart

to the rest of the body.

Each year, they afflict over two million Americans often

with little or no symptoms.

But if they go untreated, aneurysms

can silently grow, thinning out the wall of the vessel.

Eventually the vessel wall can become so thin
[ … ]

that it can no longer hold in the circulating blood,

and it tears open.

People die rather suddenly when those burst.

NARRATOR Immediately, Dr. G can tell that's exactly

what happened to Manny Alvarez.

The aneurysm in his artery wall leading to the spleen

became stretched beyond capacity and burst open.

JAN GARAVAGLIA It looks like it had a big pop or a big opening.

That's worrisome.

Which caused all that blood to rush out into his abdomen.

NARRATOR It's clear right away that this

is not a result of trauma sustained in the accident.

JAN GARAVAGLIA Trauma doesn't cause your vessel to balloon.

NARRATOR In fact, the little patch of fat

proves that the aneurysm had been slowly leaking

blood for at least a week.

JAN GARAVAGLIA I can tell because the body's

trying to stop it.

The fat kind of goes there and tries to block

off that kind of oozing.

It's sticking like glue to it.

It was just too much for the body to fix.

NARRATOR For Dr. G, there's no question now

that this burst aneurysm is at the root of Manny's

massive internal bleeding.

But splenic aneurysms are an extremely rare cause of death,

especially among men.

In fact, they are four times more common in women.

Pregnant women are at the greatest risk.

JAN GARAVAGLIA With gestation, they

think there are some changes to the walls of the vessels that

maybe make them more relaxed, and it

makes it more vulnerable to out pocketing and a ballooning out.

NARRATOR Though the cause of splitting artery aneurysms

is not fully understood, they can

be the result of a congenital defect in the artery wall.

And Dr. G believes that this is likely

what caused his aneurysm.

JAN GARAVAGLIA You know, what's happened

is he was born with a weakening of the wall

of that blood vessel, and it's just

one of those freaky things.

NARRATOR With this unusual finding in hand,

she can finally tell Manny's wife,

and family exactly what happened on the day of his fatal crash.

[music playing]

Up until his death, Manny Alvarez

seems to be living a perfectly healthy life.

But over the years, a virtual time b*mb has been ticking

away deep inside his body--

an aneurysm on his splenic artery,

most likely the result of a defect in the blood vessel

that had been there since birth.

JAN GARAVAGLIA For whatever reason,

that weakened area of the blood vessel starts to balloon.

He doesn't have any symptoms from that.

NARRATOR A week or two before his death, the aneurysm

reaches a critical point.

It begins to bleed just slightly.

Maybe it drops, just oozing a little bit.

His body fights to contain the blood.

JAN GARAVAGLIA The fat kind of adheres to it from the abdomen,

but it's not enough.

NARRATOR Then one day, as Manny is

driving out of the parking lot at his warehouse,

the b*mb goes off.

JAN GARAVAGLIA He's probably feeling great as he gets

into his car, until it burst.

NARRATOR Blood gushes from the hole, pouring into the abdomen.

Overcome by hemorrhagic shock, he loses control of the car.

Runs off the road into the fence.

NARRATOR He suffers no trauma, but the paramedics

find him in critical condition.

JAN GARAVAGLIA When they get to him,

his blood pressure is getting low.

He's combative.

That's because his brain isn't getting enough blood.

NARRATOR Eventually, his heart also begins to shut down.

The paramedics try to resuscitate

him, but to no avail.

JAN GARAVAGLIA And he codes.

He cannot maintain his blood pressure anymore,

because the blood is all going into his abdomen.

The blood is just pouring out of that tear too fast.

NARRATOR Then, drained of more than two liters

of the life-sustaining fluid, Manny

dies from internal bleeding.

[music playing]

Dr. G rules the manner of death as natural, not accidental.

JAN GARAVAGLIA Now, in this case,

it's the pure natural disease.

He clearly just died from a ruptured splenic aneurysm

that was developing over a long period of time.

There was no trauma associated with that car accident.

NARRATOR Instead, it was a rare case

in which natural disease caused both

the accident and the death.

His wife and family are relieved to have an answer,

but are still stunned by the findings.

JAN GARAVAGLIA When I tell them they
[ … ]

has a weakness of splenic artery aneurysm,

and that's why he died, I think they're shocked.

They're like, what?

It's hard for them.

It's hard for them to grasp.

NARRATOR Dr. G knows all too well death

can take anyone by surprise.

JAN GARAVAGLIA You may have an aneurysm that's getting

ready to blow any minute.

[music playing]

Maybe you ought to go hug your loved one.

NARRATOR The only thing to do is make the most of every day.

Life is a crapshoot.

You never know when it's going to end.

Think about that and maybe change the way you live.

You know, you may not have forever.

[music playing]

NARRATOR Coming up next, a landlady

discovers the contorted decomposing

body of a man in his home.

Did he accidentally fall, or is something

more sinister to blame?

Anything's a possibility.

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

JAN GARAVAGLIA It's a busy day.

We've got about eight autopsies, a couple

homicides, a decomp coming in, about four car accidents.

There's a lot of things that come into my office that

are uncommon.

Let me go get my--

We don't always see the common.

we often see those things that are a little bit

odd, a little bit different.

NARRATOR And that's exactly the case with Dr.

G's next autopsy of the day.

[music playing]

As a first step, Dr. G reads over her investigator's report,

which describes the circumstances

behind -year-old Sam Gray's unusual death.

So it looks like we have a fellow

that's naked at the bottom of the stairs.

NARRATOR The decedent is a retired salesman

who had moved into a small two-story apartment in Orlando

after his wife's death.

He basically lives alone.

We don't know anybody that really has contact with him.

NARRATOR Shy by nature, Sam leads a reclusive life

and seldom interacts with his neighbors.

But after hearing complaints of a strange odor in the building,

his landlady stopped by to investigate.

They haven't seen him around.

There's starting to be a little bit of an odor

coming from the apartment.

Something wrong over there, be it,

you know, a gas leak or a dead animal or a dead person.

Obviously, they're all hoping that it's not a dead person.

Sam?

NARRATOR When Sam doesn't answer the door--

The landlady used a passkey to get in.

NARRATOR Moments later, she comes face to face

with a gut-wrenching sight--

Sam, naked, dead, and decomposing.

Police immediately notified the medical examiner's office.

JAN GARAVAGLIA My investigator went out there, took pictures,

and investigated.

It looked as though he had fallen from somewhere up

on the stairwell.

His lower legs and feet were still on the stairs.

The body--

NARRATOR After evaluating the scene,

police find no reason to suspect foul play.

It was a secured apartment, OK?

And they had to use a key to get in,

and there were no signs of forced entry.

I mean, that certainly wasn't a break in.

NARRATOR The real question is, did this man simply

die of trauma from the fall, or did

natural disease play a role?

It's either going to be that the fall k*lled him--

maybe he broke his neck, maybe he hit his head--

or that he died of maybe a heart attack

or a stroke, something that would have caused

him to go down immediately.

NARRATOR Despite the fact that Sam Gray was an older man who

lived alone, Dr. G is determined to figure

out exactly how he died.

As a medical examiner, it is her responsibility

to investigate any unwitnessed or unusual death.

Unfortunately, one big piece of the puzzle is missing--

Sam's medical history.

JAN GARAVAGLIA We don't know what he's got a history of.

NARRATOR In hopes of gathering information

about Sam's medical history, investigators

attempt to track down any surviving family members.

They're only able to locate his daughter,

and she reacts with both shock and guilt.

She hadn't spoken to her father in years,

and she knows nothing of his health.

But now, she is desperate to know exactly what caused
[ … ]

her father's untimely death, and might it have been prevented

had help been closer by?

With little information about his medical history,

Dr. G must work from a blank slate.

JAN GARAVAGLIA It's really not the best

way to practice forensics.

When it's not there, you deal with it,

and you see what you can find.

[music playing]

NARRATOR Dr. G begins the external exam,

searching for any hints about Sam's life

that could help explain his death.

Immediately, a few clues speak to her loud and clear.

Overall, he looked kind of thin.

He's got muscle wasting of his arms and legs,

but yet, he has some protuberance to his belly.

NARRATOR Next, she physically examines the belly.

If Sam had suffered an internal injury from the fall,

the bulge may be a result of massive bleeding.

JAN GARAVAGLIA I palpated and check

to see if there's maybe ascites or fluid collection,

but it feels like fat.

NARRATOR Apparently, Sam is simply overweight,

albeit primarily around his stomach.

But this trait could indicate a pre-existing medical problem,

such as alcoholism.

JAN GARAVAGLIA It's something we see with people

who maybe drink a lot.

NARRATOR If Sam was an alcoholic,

it's possible that the fall and death were the result

of a drunken accident.

He could have maybe been drunk at the top of the stairs

and fallen down, broken his neck.

NARRATOR Then she makes another discovery, a distinct wound

pattern on his head.

JAN GARAVAGLIA He's got two abrasions

on his forehead just above kind of the medial or middle portion

of his eyebrow on the left.

So when you put together the picture of where he is found,

it's probably where he hit the side of the wall with his head.

NARRATOR An impact like that could

cause bleeding in the brain, a likely cause of death.

We'll see how significant those

are when we look internally.

[music playing]

NARRATOR Coming up next, Sam's body

unleashes a Pandora's box of problems,

but the cause of death remains elusive.

There's nothing that says that this is what k*lled him.

NARRATOR When "Dr. G, Medical Examiner" continues.

[music playing]

Dr. G's morgue technician, Arden Monroe,

reflects the scalp of -year-old Sam Gray.

I'm going to look for a bruise where he hits

his head against the stairs.

NARRATOR Yesterday, Sam's landlady

found his body, naked and decomposing

at the bottom of a staircase.

That's the worst nightmare for an older person who

lives alone, that something could happen to them and nobody

notice, and nobody find them.

NARRATOR Now, Dr. G follows a clue from the external exam--

one that may unravel the case or drive

her deeper into the mystery.

[music playing]

She painstakingly examines Sam's reflected

scalp and the exposed cranium, and surprisingly,

finds no injuries.

His skull looks intact.

I don't see any skull fractures.

I don't see any bruises.

NARRATOR Still, she's not ready to rule out head trauma

as a cause of death just yet.

I really need to look at his brain.

NARRATOR If his brain sustained a fatal injury,

Dr. G would expect to find excess blood

in and around the organ itself.

I open up his skull, take the calvarium off.

NARRATOR And upon extracting the brain,

she immediately has her answer.

JAN GARAVAGLIA And I see that his brain

has no evidence of trauma.

NARRATOR Whatever k*lled Sam, it's not

a head injury from the fall.

Now Dr. G must look for clues to Sam's mysterious death

in the internal exam.

[music playing]

Dr. G makes the standard Y incision,

exposing the abdominal cavity.

First, she checks for any blood or fluids that

could indicate internal trauma.

JAN GARAVAGLIA Open them up, oftentimes we'll

see rib fractures when you fall down the stairs.

I don't find any rib fractures.

All his organs look in place.

There's no free fluid.

I don't see any trauma yet in any of the body cavities.

NARRATOR Now, the only place left

to look for trauma is his neck.

JAN GARAVAGLIA I need to see his vertebrae where
[ … ]

his spinal cord goes through, and I

need to see his neck to make sure he didn't break his neck.

NARRATOR Broken vertebrae are a common cause of death

in accidents such as this.

Falls or other trauma to the upper body

can damage the spinal cord, shutting down critical nerve

signals to vital organs.

But upon dissecting the area, she finds no damage whatsoever

to the bones or the cord.

And

I don't see any signs of trauma.

I really don't think that trauma is going

to play a role in his death.

NARRATOR At this point, she can safely

rule out a fatal injury from the fall as a cause of death.

But if an accident didn't k*ll Sam, what did?

JAN GARAVAGLIA I don't know yet.

I'll have to look at each organ individually to see.

We're going to have to look for evidence of natural disease.

[music playing]

NARRATOR Now, Dr. G begins inspecting

the organs one by one.

[music playing]

And it doesn't take long before suspicious clues emerge.

JAN GARAVAGLIA One of the first things I notice is his liver

is abnormal, and the liver should be

brown with a nice sharp edge.

His liver has a rounded edge, kind of large,

and has kind of a yellow appearance

as if there's fat in the liver that we

see often with alcoholism.

NARRATOR Then Dr. G discovers another ailing organ that

also hints at alcohol abuse.

JAN GARAVAGLIA And his pancreas shows some disease.

Some of the tissue has turned waxy and died,

and there's little calcifications in it.

NARRATOR She recognizes the illness as pancreatitis,

or inflammation of the pancreas.

I see evidence of chronic pancreatitis,

which the vast majority is usually

due to chronic alcoholism.

NARRATOR As she makes her way to the lungs,

it becomes obvious that alcohol isn't Sam's only vice.

JAN GARAVAGLIA The lungs are-- there's

anthracotic pigment, that blackening

that we often see with smoking.

I don't know anything for sure, but his insides look

like a smoker and a drinker.

NARRATOR A fatty liver, a diseased pancreas,

and black lungs.

Dr. G no longer has a blank slate,

but a myriad of health problems.

Still, none of these spell out a cause of death.

JAN GARAVAGLIA They wouldn't have caused him to die

suddenly that I can find.

Let's do this heart--

NARRATOR Now, Dr. G turns to one of the last major organs

she's yet to examine--

the heart.

When I get to the heart, I realize

that his heart's enlarged.

It's heavy.

It weighs more than it should.

This is what we would see in high blood pressure.

The heart is definitely abnormal.

NARRATOR And as Dr. G cuts into Sam's heart,

she makes another critical discovery in his main arteries.

It has coronary artery disease,

narrowing to the blood vessels that supply

blood and oxygen in the heart.

NARRATOR The condition is severe.

Sam's main arteries are up to % blocked.

I really hardly ever see it that bad.

He certainly has enough heart disease to cause his death.

And that disease would have k*lled

him, possibly in bed, while he's walking down the stairs.

He could have died very quickly from that.

NARRATOR The blocked arteries fit with the earlier signs

of smoking, a habit known to increase

the risk of heart disease.

With this highly restricted blood flow,

Sam was in constant danger of collapse.

JAN GARAVAGLIA Basically, what he has is

he's probably walking down the stairs,

and he has a sudden arrhythmia, an

irregular electrical heartbeat.

NARRATOR But an arrhythmia does not

leave behind any concrete evidence

within the heart itself.

JAN GARAVAGLIA There's nothing that says

that this is what k*lled him.

I have to rule everything else out.

NARRATOR To eliminate any other possible causes of death,

her morgue tech collects blood and fluid samples

to send to the toxicology lab.

JAN GARAVAGLIA I'm going test him for glucose.

I'm going to test him for any kind of dr*gs.

Certainly going to test him for alcohol.

We're going to look to see if anything

else could've k*lled him.
[ … ]

NARRATOR Dr. G's final ruling now hinges

on the toxicology report.

She hopes those results will provide

her with some definitive answers to Sam Gray's mysterious death."], index ,…}

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Coming up next, a number turns the case upside down.

I am actually quite astonished.

NARRATOR When "Dr. G, Medical Examiner" continues.

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Dr. G sends Sam Gray's blood and eye fluid samples to the lab

for a full toxicology screen.

The -year-old widower had died alone,

his body later discovered at the bottom of his staircase.

Based on the severe heart disease

she found in the internal exam, Dr. G believes Sam suffered

a sudden heart arrhythmia.

I've ruled out trauma.

I've ruled out other diseases.

The heart may be the smoking g*n.

The heart may be where it's at.

You know, it was all consistent with the way he's found.

I think that's all she wrote for now.

We have to stay tuned until I get more info.

NARRATOR But she cannot make her final ruling until

the tox report comes back.

That's another pending.

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NARRATOR Six weeks later, Dr. G receives

the tax report for Sam Gray.

And the results are nothing short of shocking.

JAN GARAVAGLIA What was astonishing

is he's got very little alcohol in him.

NARRATOR Instead, he has a conspicuous amount of blood

sugar, also known as glucose.

JAN GARAVAGLIA Glucose is a sugar that fuels your body.

It's your fuel.

NARRATOR But in some people, the body cannot use this fuel

because they don't have enough insulin,

the hormone that normally carries sugar into cells.

As a result, glucose accumulates in the blood.

This is the illness known as diabetes.

JAN GARAVAGLIA He's got a very high glucose.

That's telling me he's diabetic, which

was really a surprise to me, because we

had no idea he was diabetic.

NARRATOR But what astounds Dr. G even more is just

how high his glucose level is.

JAN GARAVAGLIA Most of my cases,

when I check the glucose, it's almost a zero,

because glucose goes down rather quickly after death.

His glucose is over , which means that when he was alive,

it was probably well over ,.

NARRATOR That's almost times the norm--

an extraordinary number that tells her Sam's diabetes

was out of control and very deadly.

JAN GARAVAGLIA He doesn't have the insulin to get

the glucose into the cells.

And what the cells are feeling is, I have no fuel.

I have nothing.

I'm starving here.

NARRATOR To compensate, Sam's body

needs to break down fats and proteins

to use as emergency fuel.

This produces ketones, a byproduct that

turns blood dangerously acidic.

JAN GARAVAGLIA That's bad for your body.

Your body can't get energy.

The cells can't get energy.

You cannot function.

You also get extremely dehydrated.

You just can't maintain your blood pressure,

and you collapse, and you die.

NARRATOR This fatal condition is

called diabetic ketoacidosis.

JAN GARAVAGLIA It's a deadly complication if not treated.

Now, once you get to the hospital,

I mean, the mortality is very low.

It's maybe only %.

But no treatment, it's about % fatal.

NARRATOR Weighing all the evidence

under a different light, Dr. G considers

a new cause of death--

one that could not only explain his collapse, but almost

every other finding in the autopsy.

JAN GARAVAGLIA I originally kind of put the pieces together

that he's an alcoholic, disheveled guy that walks

around naked, but certainly, diabetes, and his diabetes

being out of control, could have also been the answer

to a lot of what I found.

NARRATOR His wasting muscles.

JAN GARAVAGLIA His diabetes has probably been out of control

for a long time.

It's probably why he's losing weight.

NARRATOR The recurrent pancreatitis.

JAN GARAVAGLIA It could destroy the cells

that produce the insulin.

NARRATOR The fatty liver.

JAN GARAVAGLIA With a diabetic liver,

you can see a very fatty liver, and it may

not be due to alcohol at all.
[ … ]

Well, looking back, putting it all together, that really fits.

NARRATOR Dr. G also considers the fact

that Sam lived alone, was on no medication,

and seemed to pay little attention to his health.

JAN GARAVAGLIA I really don't think he knew he was diabetic,

and that is not unusual that the first presentation of diabetes

is diabetic ketoacidosis.

NARRATOR Ultimately, Dr. G has no doubt

as to what k*lled Sam Gray.

JAN GARAVAGLIA There is very few things that I would think

would trump the heart in this case,

but I think a glucose with ketones will trump it.

I believe he died from diabetic ketoacidosis.

NARRATOR Now, she can finally replay

the entire story behind Sam Gray's unusual death.

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Widowed for years and his only daughter estranged

and far away, Sam Gray pays little mind to his health.

JAN GARAVAGLIA I doubt that he's gone to a doctor recently.

I doubt that he's taken good care of himself.

NARRATOR And he's got not one, but two serious illnesses--

heart disease and diabetes.

In his heart, plaque has built up, blocking off up to %

of his main arteries.

JAN GARAVAGLIA He would have died from his heart disease

probably in the near future.

NARRATOR But surprisingly, his heart

is not the first to give way.

Instead, the diabetes chips away relentlessly at his life.

JAN GARAVAGLIA And his diabetes is getting worse and worse.

He's probably starting to lose weight.

NARRATOR Then, in the last few weeks,

his glucose reaches a dangerously high level.

JAN GARAVAGLIA He's getting more and more thirsty.

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Getting headaches, not feeling well, feeling weak.

NARRATOR A few symptoms may even

drive him to shed his clothes.

JAN GARAVAGLIA He's probably vomiting.

He's probably urinating a lot, because his body's trying

to get rid of all that sugar.

Probably got terrible diarrhea, and he

just figures, to heck with it, it's easier to be naked.

NARRATOR Unfortunately, the little comfort he gains

does nothing to curb the effects of sugar

and acid rising in his blood.

JAN GARAVAGLIA His blood sugar is going higher and higher.

The cells are starting to starve because he

doesn't have any insulin.

NARRATOR To compensate, his body begins to break

down fat and protein for fuel.

But this unleashes the deadly byproduct ketones,

which disrupt the body's control of fluid levels

and nerve functions.

Now, on the day of his death, the condition

spirals out of control.

And while trying to make his way down the stairs,

he slips into a coma.

JAN GARAVAGLIA He just collapsed.

That just happened to be where he was.

NARRATOR With no one to call an ambulance,

Sam has no chance of survival.

JAN GARAVAGLIA And dies at the bottom of the stairs.

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NARRATOR For Dr. G, the case highlights a golden rule

of forensic science--

keep an open mind, especially when

starting from a blank slate.

A new piece of information may totally

change the picture of what he was like and how he died.

NARRATOR Thanks to the complete autopsy, Sam's daughter

can now faced the truth and reality of her father's death.

But she may never overcome the guilt of not being there

when he needed her most.

JAN GARAVAGLIA It's sad that people--

you know, here he is, he lives alone.

He's not taking care of himself.

You know, he dies, and nobody really checks

on him for a couple days.

The only reason anybody checks on him

is because he's kind of starting to smell.

It is sad.

It's sad that people are so isolated in this world.

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MALE [whisper] Atlas.