04x11 - Twin Terror

[bunniefuu]

[music playing]

NARRATOR It's a parent's worst nightmare.

A baby girl found dead in her crib.

You know, when we see a baby, it's devastating.

NARRATOR But could it be possible

that the baby d*ed at the hands of her own parents?

Infants, unfortunately, are sometimes subjected to abuse.

We still have to rule out that she wasn't m*rder*d.

NARRATOR And then it seems like just

an unfortunate natural death.

We have a man in his early s who is found dead by his wife

across the bed.

NARRATOR But is there a dark secret

that his wife's been keeping?

You just never know.

They just don't always tell you the truth.

[music playing]

NARRATOR Altered lives.

Baffling medical mysteries.

Shocking revelations.

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

Up to cases come through the District Nine County Medical

Examiner's Office each week.

And Chief Medical Examiner, Dr. Jan Garavaglia

is ultimately responsible for all of them.

But not everybody ends up under Dr. G's Kn*fe.

In addition to her own caseload, Dr. G

oversees a team of four other medical examiners.

I have to make sure that the doctors

are doing things correctly.

So I, in a way, have a quality assurance

duty over all of the cases.

NARRATOR Her newest hire is Dr. Joshua Stephany.

He's been a forensic pathologist for less than a year,

but Dr. Stephany already has a long history with Dr. G.

I've known Josh for five years.

He was actually a resident over at the training

center at the hospital associated with the morgue.

NARRATOR In fact Dr. G trained Dr.

Stephany during his forensic pathology rotation.

Dr. G is sort of a mentor figure for me.

Knowing that I wanted to go into forensics,

she helped me with a lot of the stuff

that you can't read in books-- a lot

of the things you learn by doing and seeing

more so than reading about.

NARRATOR Although he is now a licensed physician,

Dr. Stephany still relies on Dr. G's expertise

on his most difficult cases.

My work relation with Dr. G, I think, is a pretty good one.

She's always been helpful in guiding me what to do

and, you know, things to look for.

NARRATOR Every morning, Dr. G and her team meet and assess

the cases for the day.

We all review all the cases, we look what came in that day.

White male, obese.

This is the one where he's snoring loudly

and he took his mother's pills.

NARRATOR Among the new intakes is

Melanie Simmons, a baby girl.

Of all their cases, none is more heart wrenching

than the death of a child.

Babies, you know, obviously, are helpless.

Those kind of hit home a little bit more.

NARRATOR But infant fatalities aren't

just tragic, they're often extremely

difficult forensic mysteries.

These cases can be anything from natural to homicide.

And you can't really tell just by sometimes

looking at the baby or even the circumstances.

NARRATOR And today, the youngest decedent

falls to the youngest member of the staff.

Dr. Stephany ended up with the baby that day.

And it was his job to come up with an answer.

[music playing]

NARRATOR The case began hours

earlier in Kissimmee, Florida.

According to the statement Deborah Simmons gave police,

she started getting her identical twin daughters,

Morgan and Melanie, ready for bed at PM.

[music playing]

Here we go.

Why don't you lay down?

[music playing]

NARRATOR After she finishes breastfeeding,

she places the babies in the crib

together and rolls them onto their stomachs to sleep.

They're both face down on the bedding, pillows,

stuffed animals, heavy quilts.

NARRATOR Then at around PM,

Deborah finally goes off to bed herself.

[music playing]

It's not until the next morning

that she hears one of her babies crying.

It's Morgan, who's apparently ready to be fed.

The mother got one twin daughter

and was taking care of it in the morning.

Like her usual ritual.

Put it down and went to look at the other twin.

NARRATOR But when she picks up Melanie,
[ … ]

the baby is cold, unresponsive, and it only

takes a few moments for Deborah to realize

her daughter is not breathing.

Panicked, she immediately calls .

[phone ringing]

[sirens]

[inaudible]

NARRATOR Paramedics arrived minutes later,

but it's clear to them right away Melanie

has been dead for hours.

[screaming]

[radio chatter]

Deborah Simmons is beside herself with shock and grief.

But when investigators are called to the scene,

their first priority is not to comfort her.

When our investigators get there

they don't want anyone suspected of foul play near the baby.

So in this case, the mother was not allowed to see the baby

or touch the baby after the initial was called.

NARRATOR When it comes to the death of an infant,

abuse is often high on the list of suspects.

So it's essential that Dr. G's investigators

leave no stone unturned.

You have to do a very thorough or scene investigation.

Sometimes we even collect the last formula bottle.

Believe it or not, we get babies that are drugged

and they put it in the formula.

NARRATOR In fact, Deborah doesn't even

get a chance to hold her daughter before the tiny body

is transported to the county examiner's office

and onto Dr. Stephany's table.

No medical history of infections or fever.

It appears the baby had pretty much been normal up until she

was found dead this morning.

NARRATOR Dr. Stephany already has his own suspicions

on the cause of death based on photos taken

by investigators at the scene.

Looks like-- from the pictures, it looks like

a pretty big pillow in a crib.

So it's possible suffocation being found face down.

NARRATOR If Dr. Stephany fails to find out

how Melanie d*ed the cause of death

will be determined as SIDS.

SIDS is an acronym that stands for Sudden

Infant Death Syndrome.

Basically, if after the autopsy external examination,

internal examination, histology looking

at all the slide of the internal organs,

toxicology results, cultures, pretty much ruling

everything out that you can possibly think of,

we call it SIDS.

Basically, it means we don't know

what caused the baby's death.

NARRATOR SIDS, or Sudden Infant Death Syndrome

is the most commonly ruled cause of death

for infants between one month and one-year-old.

But for doctors, it's a so-called wastebasket

diagnosis.

A ruling made when the autopsy is inconclusive,

It really, honestly, is a fancy word for undetermined.

It fits the syndrome of being found dead in bed

for no reason.

It's probably a natural disease--

it's probably several natural diseases

that just aren't detected yet.

NARRATOR Dr. Stephany hopes he won't make a SIDS diagnosis.

He's determined to find the cause of death.

And one thing is crystal clear, time is of the essence.

If he finds Melanie d*ed of natural causes

it would immediately absolve her parents of any charges

of abuse or negligence.

But it could also mean that Melanie's

twin sister Morgan is at risk of suffering the same fate.

What you have to worry about is

if you have a genetic or a congenital anomaly

or defect or disease in one twin.

Especially in identical, you really have to let the parents

or let their doctors know about it so they

can monitor the other twin.

[music playing]

NARRATOR Doctor Stephany's first priority

in the external exam is to check Melanie's body

for signs of physical abuse.

They check for contusions, bruises,

abrasions, lacerations, tears, any signs of trauma.

NARRATOR On the outside, Melanie's body

appears to be in good shape.

She has no bruises, cuts, or scarring.

But that doesn't mean she was never abused.

Blows to the abdomen may just not show.

Blows to the head may not show.

You can't always see the bruises.

NARRATOR As Dr. Stephany moves up the body,

he notices lividity or purplish red discoloration of the skin

due to the settling of blood.

Lividity occurs after death as gravity causes blood to settle.

So if the baby is on his back the blood

will pool to the back.

If the baby's on the stomach the blood will pool

to the abdomen or the face.
[ … ]

NARRATOR Lividity is crucial to determining

the body's position at death.

And Melanie's lividity pattern provides Dr. Stephany

with an important clue.

In this case, the blood pulls of the abdomen and the face.

NARRATOR This proves that Melanie was on her stomach

when she d*ed, just like her mother said.

Now, Dr. Stephany is even more convinced

that Melanie most likely suffocated while sleeping

in this position.

Babies have a hard time lifting up their head

and turning their head.

NARRATOR But as he leans over the baby he notices something

else, something that will transform

his thinking about Melanie's last minutes alive

and her premature death.

[music playing]

Doctor G's newest Associate Medical Examiner,

Dr. Josh Stephany thinks he knows what

k*lled baby Melanie Simmons.

The lividity, or purplish red discoloration

on her face and stomach leads him to believe that Melanie's

face down position in the crib prevented

her from getting enough oxygen.

So automatically you think of possible suffocation.

NARRATOR But as he examines the baby's face more closely

he discovers an important clue.

There was an air of whiteness to the side of the face--

NARRATOR Dr. Stephany recognizes

the whiteness as a pressure mark on Melanie's face.

--meaning that that was the portion that was most

in contact with the pillow.

NARRATOR Judging from the pressure mark,

Dr. Stephany now believes that Melanie's cheek was pressed

against a pillow as she slept.

The finding is an important clue in Dr.

Stephany's investigation.

If Melanie suffocated with a pillow pressed firmly

against her nose and mouth, those areas

would be white from the pressure as well.

But upon further inspection, it's

clear that the area of whiteness is limited to Melanie's cheek.

The area around the nose where she's breathing,

had the normal lividity pattern, meaning it was red,

reddish-purple.

So judging by the pattern, it looked

like this baby's nose and mouth was not obstructed by a pillow.

[music playing]

NARRATOR As he concludes his external examination,

now Dr. Stephany believes it's unlikely Melanie

suffocated to death.

I've moved possible suffocation

further down on my list of possible cause of death.

NARRATOR But other possibilities remain.

Some more frightening than others.

Even if the baby looks good externally,

we still have to rule out that they weren't m*rder*d.

NARRATOR The truth behind Melanie Simmon's death

could be hidden deep inside her tiny body.

[music playing]

Before the cranial exam begins, the area at the base

of the skull is sterilized.

This is one of the processes that is different with babies

that with adults is, we're always thinking

about possible infection.

NARRATOR If the cultures and tissue samples

Dr. Stephany is taking become polluted by bacteria

it could ruin the chance of an accurate diagnosis.

Dr. Stephany takes his first culture from the sterilized

area and extracts a sample of Melania's cerebrospinal fluid

to test for meningitis.

Kal, can you give me the scissors, please?

[music playing]

NARRATOR An infant's cranial exam requires different tools

than those used on adults.

An adult skull is hard bone and we

need a saw to cut that open.

A baby skull is soft, it's malleable.

With a baby you can use scissors to open up the skull.

[music playing]

I don't see anything.

NARRATOR On first glance, Melanie's brain looks healthy.

There are no signs of trauma and no discoloration

which would indicate an infection such as meningitis.

Take a closer look after I wash it off.

NARRATOR Next, Dr. Stephany completely removes the brain

and washes it carefully.

If this were an adult, he would cut directly into the brain

with his scalpel.

But with an infant, this is difficult.

Babies' brains are very soft and it's almost the consistency

of jello, maybe even softer.

NARRATOR The brain is then placed in a vat

of fixative known as formalin.

Over the next few weeks, the formalin

will harden the brain matter and also intensify

the color of brain tissues.

This will allow doctors to see abnormalities and evidence

of internal brain trauma more easily,

including trauma that may have been caused by abuse.
[ … ]

Infants, unfortunately, are sometimes subjected to abuse.

And sometimes that abuse doesn't show externally.

NARRATOR As he heads into the internal exam,

Dr. Stephany still has no solid leads on what or possibly

who took Melanie's life.

[music playing]

As with an adult, Dr. Stephany begins the infant's exam

with a y-incision.

Painstakingly, he examines Melanie's chest muscle

and soft rib cage looking for fractures

or any other signs of injury.

It all looks normal until Dr. Stephany removes the rib cage

and gets a look at Melanie's thymus gland.

The thymus gland was a little enlarged.

NARRATOR The thymus plays a major role in the body's

immune system manufacturing the T cells

that fight off infections.

It's a organ that produces inflammatory cells.

So if you have an infection throughout the body,

you're thymus gland can enlarge in response to that infection.

In this case, the thymus gland was a little enlarged,

but I don't think was outside the normal range.

At this point, I'm not really worried about it.

[music playing]

NARRATOR Dr. Stephany next dissects Melanie's heart

looking for signs of congenital defect,

blood clots, or infection.

I'm looking at the ventricle walls.

They look pink, I don't see anything abnormal.

[music playing]

NARRATOR The absence of any clues in Melanie's

head and heart are troubling.

The number of places left to look for a cause of death

are now growing short.

[music playing]

They go into the organs of the abdomen, which include

the liver, kidneys, adrenal glands,

spleen, intestines, stomach.

NARRATOR But again, this is a dead end.

To the naked eye, Melanie's organs look fine.

But lab work on tissue samples and blood

may still reveal whether or not a microscopic source,

like a well hidden infection, might

be to blame for her death.

Well, in a baby, you know, we still worry very much

about infection because they can die

very quickly with an infection.

It can overwhelm them much quicker than an adult.

NARRATOR As Dr. Stephany concludes the autopsy,

he's worried that he may ultimately have to rule

this case as inconclusive.

Didn't find anything.

No tumors, no hemorrhage, no obvious signs

of trauma or anything, any stomach abnormalities.

NARRATOR However, one thing is clear.

So far, it's looking like Melanie's

parents had no involvement in their daughter's death.

Dr. Stephany must now contact Deborah Simmons with an update,

but it's not going to be easy.

I think it's hard for him sometimes to talk to families,

particularly grieving mothers.

And, you know, I made it very clear that in some cases

you really got to talk to them.

NARRATOR And in this case, the call

will be even harder because he still has

no idea what k*lled her baby.

Talking the mother was difficult

because you're dealing with someone who is grieving,

who feels guilty.

NARRATOR But alleviating guilt is not Dr. Stephany's priority.

Melanie's twin, Morgan, could still be in danger.

If he can't identify what k*lled Melanie,

this tragedy could potentially end with the death of not one,

but two innocent lives.

[music playing]

Dr. G has a lot of confidence in her rookie Associate Medical

Examiner, Dr. Josh Stephany.

I think he'll have a great career in forensic pathology.

You know, he's very quiet, but always looking

around, always thinking.

[birds chirping]

NARRATOR Two weeks have passed since Dr.

Stephany's inconclusive autopsy of baby Melanie Simmons.

The autopsy was essentially negative.

We knew we'd just have to wait for all the tests to be done.

NARRATOR For Melanie's mother, the wait is agonizing.

I spoke to her pretty much almost

every day or every other day.

She was concerned, she was guilty.

And she just kept wanting answers.

NARRATOR She's also extremely concerned

that whatever took Melanie's life could strike twice.

It's natural for all parents to wonder--

if they're a twin, whether or not the other one's in danger.

My personal suspicion at this point

is I may have to call it SIDS.

NARRATOR A SIDS, or Sudden Infant Death Syndrome Diagnosis

would leave the real cause of Melania's death a mystery.

And leave her parents uncertain about the health

of her identical twin sister, Morgan.
[ … ]

The toxicology reports and microscope

slides are now their only hope of quelling these fears.

[music playing]

At times magnification, Dr. Stephany

can see every detail of the organ tissue he's examining.

And it doesn't take long for him to find something very wrong.

Looking at the heart, I see some abnormalities

on a cellular levels.

NARRATOR Melanie's heart cells, called myocytes, look enlarged."], index ,…}

Regular myocytes are nice and pink and a little compact.

These cells are a little lighter pink,

they're foamy or granular, and they're more plump.

I didn't know quite what it was, but I knew it was abnormal.

NARRATOR He also knows when it's time to get

an expert second opinion.

You can do other training in the world,

but you get more by experience and Doctor G's been doing this

for a lot longer than I have.

Did you look under in the microscope?

Josh knew that something was unusual so he called me

and he asked me to look at it.

Once I saw it or the microscope, I go, Oh, wow.

I know what this is.

Because I'd had a case like that before in Texas when I

was a much younger pathologist.

NARRATOR Dr. G's case was an infant girl

who had d*ed with no warning.

Like Melanie, the microscope revealed strange foamy cells

in her heart tissue.

I'd read about it in a forensic article

that these little infant girls could die suddenly.

And I was able to find one little mention

in a cardiology pathology textbook

and was able to match up the pictures that, yeah,

that's what that is.

She just took a quick look at it

and said, oh, yeah this is histiocytoid cardiomyopathy.

NARRATOR Histiocytoid cardiomyopathy is an extremely

rare disorder of the heart.

Less than cases have ever been reported

in the literature, but the actual number of cases

is much higher.

And most fit a similar profile.

It can cause sudden death, mostly little infant girls.

NARRATOR And like the deaths it causes,

the root of the disorder is mysterious.

It is a mutation in DNA.

Nobody really knows how it works.

NARRATOR One thing they do know is

that these abnormal cells can prevent the heart

from b*ating properly.

This abnormal cell blocks electrical impulses,

it can send irregular rhythms to the rest of the heart.

It's a devastating disease because these babies can

die suddenly and unexpectedly.

And they may not have any symptoms beforehand.

NARRATOR Now, Dr. Stephany knows

that's exactly how Melanie Simmons d*ed

unexpectedly, without warning.

[music playing]

It's PM and Deborah Simmons puts

her identical twin baby girls, Morgan and Melanie, to bed.

She put them both down in the crib with bedding and a pillow

and some quilt, face down.

NARRATOR On the outside Melanie looks to be peacefully asleep.

But inside her heart is struggling.

The complex system that fuels its b*at

is being thrown off by abnormal cells.

These abnormal cells, they either trigger

the abnormal b*at or causes the heart

to just b*at faster and faster.

They think they go into a very fast rhythm

and then into a fibrillation where they just fibrillate,

and then can't pump.

NARRATOR And then Melanie's heart stops b*ating completely.

It's most likely that the child d*ed in her sleep

and d*ed painlessly.

[music playing]

NARRATOR Dr. Stephany's diagnosis

of what k*lled Melanie Simmons should wrap up the case.

But instead it takes on a whole new urgency.

We had a genetic defect that caused this baby to die,

and there is a twin.

We have to alert the family.

If ever there was a case in forensic pathology

that you have to talk to the family with,

this would be this case.

NARRATOR Dr. Stephany now has to tell Deborah Simmons that

what k*lled one of her babies could

potentially k*ll the other.

Hi.

May I speak speaking Ms. Simmons, please?

I let her know that her other daughter could be

at risk for this same entity.

So I wanted her to get in contact

with a pediatrician and a pediatric cardiologist

as soon as possible.

NARRATOR Moving forward, doctors

will need to regularly monitor Morgan's

heart for arrhythmia, a crucial indicator for the disease.
[ … ]

She could have the mutation but she may still

not show any problems with it.

And she could maybe not have the mutation at all,

believe it or not.

She may have not inherited it.

If it's discovered or diagnosed

that the other twin does have the same disorder

and that she is getting help, it makes us feel that we're doing,"], index ,…}

you know, our job.

I was able to tell the parents that there's

nothing they could have done that would

have prevented the death.

I'm not sure relief is a good word,

but I think closure is a good word for them.

[music playing]

NARRATOR Dr. Stephany is glad that he didn't have

to diagnose Melanie's cause of death

as Sudden Infant Death Syndrome.

The fact that we found a diagnosis--

a concrete diagnosis and didn't sign it as a SIDS,

it's kind of not so much a relief, but as helpful

to have a solid diagnosis for me and for the family.

We know we have a concrete diagnosis,

we can tell the family why the child d*ed.

NARRATOR Dr. Stephany also knows how important Dr. G's

guidance was in getting Melanie's parents

the answers they needed.

She pretty much gave me my diagnosis.

I just saved him a step.

He'd have figured it out.

I have never heard of this disease entity, and it's rare.

It doesn't mean I'm not going to be looking for it again.

And I can guarantee you, I'll never miss it in the future.

I think to be a really great forensic pathologist, the more

experience you have, the better you get.

You know what?

And the beauty of this field is, you never see it all.

There's always going to be something new out there.

[music playing]

NARRATOR But even Dr. G couldn't

have been fully prepared for the truth behind what

k*lled her next dissident.

He looks like a guy in his early s

who could be your grandfather.

I just didn't expect it.

[music playing]

DR G You know, it's hard for most people

to stomach the thought of food after what we do all day.

But for my team and me, grabbing lunch

is always a welcome break.

[laughter]

Yeah.

When I thought--

I ran about miles on--

- Did you? - --Sunday night.

And I went to gym my Friday night.

[interposing voices]

I go every day for about two and a half or three hours.

All I can tell you, don't get married.

Yeah, forget that.

That's going to go by the wayside.

[laughter]

He's thinks he's gone to the gym for two to three hours a day.

Forget it, he'd be divorced within--

[interposing voices] --like two months.

MAN [inaudible]

Well, we're trying to get--

Ashley's getting married.

MAN --to get married.

I will not have a groom.

He will be gone. He will not--

DR G It'd be cheaper to--

We could probably arrange for a hearse to drive him in.

Oh, a hearse?

There you go.

Hop in back.

This was a very short time offer

because once we start bringing bodies in there, forget it.

We can't do it anymore.

Would you do it?

What would you do it if your groom was--

If you got me drunk enough I would.

Really?

[laughter]

DR G Being able to laugh together

can sometimes help us deal with what

we see in the morgue every day.

Because truly our cases are never a laughing matter.

NARRATOR The body Dr. G will autopsy next was transferred

to the morgue yesterday.

A seemingly healthy man named Vincent Morehouse.

We have a man in his early s who is found dead by his wife.

[music playing]

NARRATOR According to the investigators

report, Vincent and his wife, Audrey slept in late yesterday

morning--

a Sunday.

When Audrey wakes up first everything seems fine.

So she decides to let Vincent sleep while she takes

care of some household chores.
[ … ]

She saw him at about o'clock that morning,

and then about four hours-- five hours later, she goes to check

on him and he's unresponsive.

And she calls .

[music playing]

They get there and pronounced him, he's really quite dead.

NARRATOR For Vincent's wife, Audrey,

the death is devastating.

The couple had been married for years

and had recently begun planning his early retirement.

And compounding her sudden loss is

an overwhelming sense of guilt.

She did have some guilt worrying and wondering

if maybe she had gone and really tried to wake him up

and realized something was wrong he would

have had a chance to live.

NARRATOR Dr. G looks over the case file

and considers the circumstances.

By all accounts, Vincent seemed perfectly healthy for his age

and had no recent illnesses.

He'd voiced no complaints a shortness of breath,

no complaints of chest pain, no complaints of dizziness,

vocalize a headaches.

NARRATOR According to his wife, Vincent's only medical issue

was that he had high blood pressure,

but he was taking medication to control it.

He's been feeling good.

He does smoke.

He socially drinks beer, but that's about it.

When we do the autopsy, you know,

anything's fair game here.

I mean, I don't really have a good hypothesis.

And we'll see then what the external tells us.

[music playing]

Why don't we do his face first before we turn him?

NARRATOR Dr. G examines Vincent's body.

Outwardly, he looks healthy.

Just as his wife indicated.

No trauma on him.

He looked in pretty good shape.

NARRATOR But she does notice something

that his wife didn't mention.

A distended belly and a large hernia bulging from his navel.

He's got an umbilical hernia.

Some of his bowels look like they've kind of protrude

into this out pocketing right at the umbilicus or belly button.

It's at least three or four inches in length.

So it's a pretty good sized hernia, quite noticeable.

NARRATOR A hernia occurs when the intestines

push through a weak spot in the abdominal muscles.

In some cases, hernias can cause significant complications

such as incarceration or trapping of the intestines

in the hernia.

When I see the hernia, I mean, other things then start

running through your mind.

You know, could this hernia have anything to do with his death?

I do worry about that the bowel got incarcerated in there.

If the bowel gets incarcerated in there it loses

its blood supply, it dies.

You can-- you can die from that.

I'll be there in a second.

NARRATOR But within moments, she

discovers that a hernia isn't the only cause for concern.

Another is Vincent's legs.

He's got some edema to his lower extremities.

NARRATOR The edema, or swelling due to fluid accumulation,

is in Vincent's lower legs and feet.

This could be a sign of heart trouble.

When the amount of blood that the heart pumps out is low,

the body is fooled into thinking it needs to retain fluid.

A pooling of blood in the veins can

also lead to an accumulation of fluid

in the surrounding tissues.

I'm a little worried, maybe he's had

a little bit of heart failure.

NARRATOR Heart disease, a deadly complication

from a hernia.

Suddenly the external exam of Vincent Morehouse

is suggesting that he wasn't as healthy as his wife described.

Now, Dr. G wonders, what other secrets might

Vincent's body reveal?

You cannot judge a book by its cover.

And that's why we always have to probe.

[music playing]

Yeah.

I think he's--

All right, once I open him, I can tell in a minute

if I'm going to need that blood culture.

NARRATOR Dr. G is ready to open the body of -year-old Vincent"], index ,…}

Morehouse, who d*ed yesterday morning while his wife thought

he was sleeping.

She thinks he's sleeping and she goes about her chores.

And she goes back and checks on him

and, unfortunately, he's dead.

[music playing]

NARRATOR Dr. G opens the body with a y-incision

where she will get her first look

at Vincent's umbilical hernia.

Maybe some of his bowel got stuck in there and then twist

and now it can't get the blood to the bowel.
[ … ]

NARRATOR Carefully, she exposes the abdominal organs.

But after a thorough examination,

it's clear that the bowel is not trapped in the hernia

and that the hernia was not fatal.

It's just there and he never got it repaired.

So it's hard to say what that's telling me at this point.

Where are the clippers?

NARRATOR But then she sees something

else that might be fatal.

I can see that he's got a pretty gnarly liver.

So far his liver's peeking out at us, and it looks terrible.

Normally, it's a nice uniform brown that's very pretty,

but when it really looks gnarly, it's

like lumpy, bumpy kind of yellowish

will all this fibrosis going through it and very hard.

This is chronic alcoholism.

It has this nice micro nodule or small nodules.

And that's how alcohol slowly kills your liver.

NARRATOR Liver disease, including cirrhosis,

is one of the top causes of death in the United States.

This finding reveals something vital and unexpected

about Vincent's health.

Now, I was not told he had cirrhosis of the liver.

His family makes him seem like he's a pretty healthy guy.

And then my first look when I open up to his body

is, he's got pretty bad cirrhosis of the liver.

So now that I see this cirrhosis,

I'm wondering what's going on.

And B, you know, maybe alcohol plays a role here.

[music playing]

NARRATOR But if Vincent's liver was indeed already failing,

Dr. G would expect to see telltale signs.

He does look like he's dying from liver failure

because he's not jaundice, not yellow.

But it does lead me to think maybe he

d*ed from some complication of alcohol,

whether it be acute alcohol intoxication.

Whether it be from falling intoxicated

and hitting his head.

NARRATOR To determine the level of alcohol in Vincent system

at the time of his death, Dr. G's tech,

Arden Monroe draws samples for toxicology.

Well this is good peripheral blood.

I certainly am going to check to see how much alcohol he has.

And I'm certainly going to check all his dr*gs

to see if there's any illicit or even prescription

dr*gs present.

We didn't get quite the truth about the alcohol.

We don't know any-- everything's up for grabs now.

[music playing]

A lot of men in their early s that come through my office

or alcoholics.

So, you know, it's not that surprising.

And a lot of people with alcohol,

they kind of downplay how much they drink.

So it's really not that unusual.

They may not be, you know, trying to lie to us.

It's just that they downplay it.

He may try to hide it from his wife.

He may be somewhat of a closet drinker.

NARRATOR Next, Dr. G begins to remove

and examine the rest of the internal organs one by one.

He's not as healthy as it comes off, either by his family

or his external appearance.

NARRATOR Vincent's spleen is enlarged.

His kidneys are congested.

His lungs are heavy with fluid.

But it's his heart that troubles Dr. G the most.

It looks a little bit big.

I take the heart out, I weigh it.

It is big.

It looks like it's got some effects of high blood pressure.

Normally his heart would be maybe , .

His is up to almost grams.

NARRATOR But Vincent's heart isn't only enlarged,

it's dilated as well.

Blood had clearly begun to back up into the organ causing

it to expand and to weaken.

The heart starting to fail.

NARRATOR Moreover, Dr. G finds evidence of coronary artery

disease as well.

He did have a significant % narrowing

in the coronary artery.

That's a very significant narrowing.

It could have caused him some problems.

NARRATOR But while Vincent's heart is severely diseased,

Dr. G finds nothing acute.

The arteries have no blood clots and there's no visible damage

to the heart muscle.

From the heart, nothing tells me acutely what happened.

Did it cause his death or did it not cause his death?

I'm not sure yet.

NARRATOR With nothing near a smoking g*n,

Dr. G must first rule everything else out before she can

even consider the heart theory.

I don't really know at this point.

Things are quite making sense.

[music playing]

See it?

When you push and it goes away.
[ … ]

I do need to-- keep his bowel out though, I want to look at.

NARRATOR Dr. G's discovered that Vincent

Morehouse wasn't nearly as healthy

as his family said he was.

A lot of people argue with me that there

is no way their loved ones has heart disease.

If I'm looking at your heart and you have heart disease,

I've got the truth--

I've got the facts.

The body tells me otherwise.

NARRATOR But despite these findings,

Dr. G still doesn't have a definite cause of death.

So she must continue to hunt for the culprit.

Her next stop, the brain.

[music playing]

[sawing]

NARRATOR Morgue assistant, Brian Mikulski

saws open Vincent's skull.

Then Dr. G gently removes the skullcap

and gets her first look at the organ.

I take the calvarium off, and then I know there's trouble.

It is a mess.

And I can see that the brain is swollen and it's asymmetric.

One hemispheres a lot bigger than the other,

and that's not normal.

Now I know there's something going on in his brain.

NARRATOR Dr. G removes the brain from the skull

and weighs it.

Then she methodically begins to dissect

the organ in an effort to determine

the cause of the swelling.

And deep inside, she finds it.

He's got a large intracerebral hemorrhage.

Cerebral, the brain.

Intra is inside the brain tissue.

He's got a hemorrhagic stroke.

It's very large.

It's several inches in length, it

occupies a large portion of it.

And that's clearly why he d*ed.

He had an intercerebral hemorrhage.

NARRATOR And Dr. G believes she knows

why Vincent's brain started to bleed in the first place.

The vast majority of intracerebral hemorrhages,

particularly in that location, from high blood pressure.

Blood pressure blew the vessel in his brain.

NARRATOR And that massive hemorrhage

led to a deadly stroke.

[music playing]

Everything kind of makes sense.

-year-old guy, history of high blood pressure, dead in bed.

And I find that intracerebral hemorrhage,

all consistent with chronic hypertension.

There's other things that can cause these hemorrhagic strokes

but you don't-- in a -year-old guy with high blood pressure,

it's high blood pressure that caused it.

NARRATOR The autopsy of Vincent Morehouse is now complete.

And Dr. G is ready to close the case

with the manner of death determined as natural

on the death certificate.

But to be absolutely certain, her final step

is to review the toxicology report

and any possible revelations it may on earth about Vincent's

last moments alive.

[music playing]

When the lab results finally arrive at the morgue,

they reveal a secret that even Dr. G couldn't predict.

I'm certainly shocked when I see that toxicology.

He's got cocaine in his system.

He's got a lot of cocaine in his system.

He's got not just the breakdown products,

he's under the influence of cocaine

when he has that intracerebral hemorrhage.

He looks like a guy in his early s

who could be your grandfather.

I mean, what's he doing using cocaine?

NARRATOR Based on these shocking lab reports,

Dr. G was now amend the death certificate.

Because he is acutely intoxicated with cocaine

at the time he has that hemorrhage,

I can't ignore that because it's well-documented

fact that cocaine can precipitate these hemorrhages.

So it clearly played a role in my view.

And so I amend the death certificate in two ways.

He still d*ed from intracerebral hemorrhage

of hypertensive type, but in a contributing factor

is acute cocaine intoxication.

And what else changes, since I do

believe the cocaine contributed to his death,

I changed the manner of death from natural to accident.

NARRATOR With the stunning toxicology results in hand,

Dr. G can now officially closed the death investigation

and describe the events leading to Vincent

Morehouse's untimely death in the report of autopsy.

[music playing]

It's late at night and -year-old Vincent Morehouse,

an alcoholic and drug user who has

a history of high blood pressure,

is craving a hit of cocaine.

[music playing]
[ … ]

He's probably using it, you know,

more than once that evening.

And then decides maybe to go to bed.

He probably is feeling good.

He probably didn't have any ill effect from it at the time.

NARRATOR He might not be feeling it,

but as he sleeps next to his wife,

Vincent's body is reaching its breaking point.

The cocaine pulses through his blood vessels,

elevating his already high blood pressure even further.

When I talk about, you know, cocaine

increasing your blood pressure, you know, it's any stimulant.

Amphetamines, methamphetamine, cocaine they all

increase our blood pressure.

NARRATOR Finally, the pressure grows

too great for a delicate cerebral vessel

deep in the left hemisphere of his brain and it explodes.

It burst and it started bleeding.

The brain is damaged by the blood,

it starts to swell just like it reacts to an injury.

And eventually, the swelling and the pressure

puts pressure on the respiratory center.

NARRATOR Vincent quickly slips into a coma.

As the pressure builds in his brain,

his breathing grows labored, thin.

His wife thinks he's sleeping, but in reality,

Vincent is dying.

He's probably in a coma for a while.

Unconscious to the point then his heart and

his respiratory centers stop.

And he dies in bed.

NARRATOR Because of the unusual circumstances involved

in the death, Dr. G calls Vincent's wife, Audrey,

to inform her of the findings and the amendment

to Vincent's death certificate.

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

NARRATOR But she's worried as to how Audrey

will take the shocking news.

When I do something like that and it's out of the blue, I--

I tend to try to contact the family

because I'm never sure how much they knew or not new.

And if they get angry with me, they usually

probably didn't know anything.

If they said, oh, OK.

That means they probably knew.

In this case, I got more of an oh, OK.

So I think they knew more than they told.

[music playing]

(SINGING) I try and try, but I just don't know what to do.

You just never know.

I mean, you know, you try to get a history

and they just don't always tell you the truth.

That's why I still do toxicology on people

who are in their s, some of whom

are still using illicit dr*gs.

[music playing]

(SINGING) Help me, I can't even help myself.

In the end, the body is not going to lie.

The body will tell us the truth.

[music playing]

VOICE Atlas.