05x03 - Unlikely Suspects

[bunniefuu]

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NARRATOR Everyone thought Willie Booker was

in peak physical shape, until they

found him dead in his bedroom.

He's on the floor.

His pants are at his ankle.

NARRATOR Now his devastated family is

counting on Dr. G for answers.

It was very excruciating to not know what he had d*ed from.

This can't be true, not my father.

What happened to my father?

NARRATOR And then a disoriented man wanders

into the ER drunk and high.

Within hours, he is dead.

The son thinks that he was assaulted.

NARRATOR And now Dr. G wonders if she

has a m*rder on her hands.

If the person dies as a result of an act of another person,

that's a homicide.

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NARRATOR Altered lives, baffling medical mysteries,

shocking revelations, these are the everyday cases

of "Dr. G, Medical Examiner."

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DR. G (VOICEOVER) Most days, I'm

just the chief medical examiner for the District

morgue in Florida.

Oh, he's had surgery.

DR. G (VOICEOVER) But sometimes I get to also be a teacher.

I got the Girl Scouts here today.

Hello.

So you can see we have one, two, three, four,

actually five stations here.

DR. G So these are Girl Scouts that worked on their CSI badge.

And we went in the decomp morgue,

and I explained a little bit about bones.

From what we see on the skeleton, it will help us.

It's really cool to find out just the ways of how they d*ed

and helped the, like, family get through everything,

and it's really cool you could do that and help other people.

You know, I think it's wonderful

that women are going into--

DR. G I have a soft spot for Girl Scouts

because I was a Girl Scout.

You know, in my day, we made placemats.

And, you know, nowadays, these girls

are doing all sorts of things.

It's really exciting.

Oh, that's cool!

DR. G (VOICEOVER) I love sharing what I know with kids.

My next decedent also loved to teach,

but unfortunately, his career was cut tragically short.

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sh*t, boom!

NARRATOR -year-old Willie Booker had two great passions--

his family and coaching basketball.

He loved basketball.

He loved helping people.

He would go to any lengths to try to help you with something

you wanted to do, whether it was education,

whether it was playing sports.

NARRATOR So when Willie was asked to coach at the Athletic

Center in Maitland, an Orlando suburb,

he seized the opportunity and moved there

from his home across the state.

He was excited about his new job.

He was ready to get started, ready for basketball

season to get started because he was going

back on and throwing that court, and that's what he loved to do.

NARRATOR Sadly, Willie's dreams of coaching

a new team in a new town would soon be shattered.

According to the investigator's report,

Willie had just arrived in Maitland, when suddenly

he stopped returning his calls.

For about a week, nobody had heard from him.

NARRATOR But then one morning, Willie's nephew Joe

gets some troubling news.

JOSEPH WILLIAMS It was early.

I was headed to work, and I received

a call from his employer.

And they said that he had missed a very important meeting.

NARRATOR Concerned, Joe immediately calls

Mara, a friend in Willie's new neighborhood,

and asks her to check up on him.

She finds his car in the driveway,

but gets no answer at the door.

I knew something was seriously wrong at that point.

NARRATOR At Joe's urging, Mara begins to look around inside.

She finds one room after another empty,

until she steps into the bedroom.

He's on the floor.

His pants are at his ankle.

NARRATOR It's far too late for an ambulance

because Willie Booker is already dead.

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Willie's family is completely caught off guard

by his sudden and mysterious death.

I had just talked to him a couple of weeks before.

This can't be true, not my father.
[ … ]

There's nothing wrong with my father.

What happened to my father?

NARRATOR They find the tragedy inexplicable,

especially given Willie's lifelong commitment to fitness.

I don't ever remember my father being sick.

Always in good shape.

It was very excruciating to not know what he had d*ed from.

NARRATOR Now desperate for answers,

they hope Dr. G will shed light on how he d*ed.

At first, she sees little to work with in Willie's file.

We really don't have much history about him.

He's-- takes good care of himself.

He doesn't smoke.

He doesn't drink, doesn't use illicit dr*gs,

at least that's what the family says.

No health problems.

NARRATOR But then she discovers a small detail

in the investigator's report that raises her suspicions.

Apparently in the weeks before he d*ed,

Willie had a mild, but persistent cough.

He does have a cough.

Now people-- I don't want to scare people.

Certainly, most people who have coughs, it's a benign symptom.

NARRATOR The more serious causes of lingering coughs

include lung cancer, pneumonia, and even heart failure.

If Willie had suffered a heart att*ck,

it could explain the sudden collapse

and the unusual position of his body.

You know, when you just collapse,

you're often in odd positions.

And just think about all the things you do during the day,

and then what if you just happen to keel over at that point.

And so that's something I'll certainly look into.

NARRATOR But Dr. G must also explore another more

sinister scenario--

homicide.

And we know he lives alone.

There's certainly no witness to what's going on.

So we're going to keep our mind open.

NARRATOR For Willie's loved ones,

the possibility he may have been m*rder*d

is the ultimate nightmare.

I thought maybe somebody had broken

in and k*lled him or something.

I wouldn't be able to rest until I found

out who did it, why they did it, and make

sure they was punished.

NARRATOR Now the mystery of Willie's untimely death

and the family's haunting questions fall

squarely on Dr. G's shoulders.

And I hope that the autopsy tells us more.

We'll see.

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DR. G He's got some mummification,

drying of the fingertips, a little bit of discoloration.

It looks like he's been in there at least three days.

NARRATOR Discoloration of the skin

could camouflage bruising and other

possible evidence of injury.

Dr. G begins the external exam, looking

for any signs of foul play.

If there's enough trauma there to k*ll him,

I will be able to tell.

NARRATOR She looks for bruising on the neck,

fractures beneath the scalp, even damage to the fingernails

that could point to a struggle.

But she finds nothing.

In fact, what strikes her the most

is how good Willie he looks.

DR. G He looks actually younger than the mid to-- to early s.

He looks like he's actually in fairly good shape.

NARRATOR But then she detects a small clue.

DR. G On his lower leg just over the shinbone,

there are some contusions or bruises.

NARRATOR The injury was not inflicted by a w*apon.

Instead, the bruising pattern suggests

Willie fell to the floor and possibly hit

the bed frame on his way down.

For Dr. G, the scenario brings to mind some very

common causes of death.

DR. G Heart att*ck, coronary artery disease,

a stroke in his brain, all of those things

can strike you very quickly and cause you to go down.

NARRATOR To identify his k*ller,

Dr. G must now move on to the internal examination.

She'll first look for a stroke in his head.

But there's a problem.

If his brain is too decomposed, her search for answers

may be hindered.

DR. G So my biggest worry is going

to be, will I be able to come up with the cause of death?

NARRATOR She will be on the lookout

for signs of natural disease.

And until she gets a look inside Willie's body,

she can't rule out the possibility of foul play,

either.

You never know what you're going to find

until you do the autopsy.

My job is to find the answers.

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[ … ]

NARRATOR Using the saw blade to open the skull,

technician Tom Hemphill prepares for Dr. G

to inspect -year-old Willie Booker's brain.

See, I need a towel, though.

NARRATOR Willie's loved ones can't comprehend what

extinguished the life of a man whose vitality was

matched only by his compassion.

Not only was he there for family members,

people would call my uncle from all around,

not just in Florida, other states,

because they knew him and they knew what he was about

and how he wanted to help people.

It's very painful to lose him and not know why,

not knowing what happened to him.

And night after night, I just can't sleep.

What happened to my father?

NARRATOR Dr. G suspects a stroke may be the culprit

in Willie's untimely death.

But if his brain is decomposed, she may

never be able to prove that.

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We're ready then?

Yes, ma'am.

NARRATOR Dr. G carefully lifts open the top of Willie's skull

and immediately finds something quite unexpected.

DR. G I take the calvarium out, and the brain

looks pretty good actually for how decomposed

he was on the outside.

It was still held in shape.

It was still firm.

NARRATOR Quickly, she checks the external aspect

of the brain.

If Willie had a stroke, she would

expect to see either hemorrhaging

or areas of dead tissue, known as infarctions.

She makes sure to check also for pools of blood

from a fatal blow to the head.

But surprisingly, in both her initial examination

and the dissection, she detects nothing.

DR. G I don't see any bruising on the inner aspect

of the scalp, no skull fractures of the skull.

There was no evidence of hemorrhage.

There was no evidence of stroke.

It looked pretty good.

So whatever k*lled them really probably wasn't in the head.

NARRATOR But now the elimination

of this prime suspect points toward another illness

that could cause sudden death--

heart disease.

DR. G I don't know yet.

What I am suspecting is probably going to be in the heart,

though.

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Okey dokey.

NARRATOR Dr. G makes the standard Y incision

on -year-old Willie Booker.

She's looking for any indication that his untimely death

was the result of an att*ck.

DR. G Well, certainly when I make my Y incision, I always

look for blood underneath the skin,

see any bruises that I couldn't tell on the outside.

When I remove the skin, he doesn't

have any evidence of bruising.

NARRATOR Even with the tissue softened by decomposition,

she's certain that there's no abnormal hemorrhage

and that Willie was not the victim of a homicide.

But then the case quickly takes another turn.

As she lifts open the chest plate,

she discovers what could be a sign of serious trouble.

DR. G When I look at his lungs, they're heavy.

They're just congested, and they appear

to have edema fluid in them.

That's the fluid accumulation in the tissues of your lung

without the red blood cells, just

the fluid part of the bloodstream kind

of leaking into your lungs.

NARRATOR This edema fluid could explain

Willie's persistent cough, and Dr. G wonders if it's all

a symptom of a fatal illness.

DR. G Could be congestive heart failure.

Maybe his heart's giving out.

It cannot pump enough of the fluid out.

The fluid starts building up and backing up,

and that fluid starts going into the lungs.

But he certainly is the right age.

I mean, the early s, early to mid s,

you know, we see a lot of people that

succumb to sudden cardiac disease that never

knew they had heart disease.

NARRATOR To find out if heart failure was, in fact, Willie's

k*ller, Dr. G cuts open the pericardial sac

and extracts the muscle for dissection.

Dr. G carefully dissects the coronary arteries

and draws a conclusion.

DR. G When I look at his coronary arteries,

they look good.

There is no obstruction to flow.

He doesn't have coronary artery disease.

So I'm not sure what the etiology of the edema

fluid in his lungs are.
[ … ]

That's very non-specific.

His cough could just be something

I may never see at autopsy.

NARRATOR For Dr. G, the negative findings

are a setback.

So far, this case is leaving her with no clue

as to a cause of death.

DR. G OK, let me get clean gloves on.

NARRATOR Her only option now is to press on

with the rest of the autopsy.

As her next step, she begins searching the abdominal organs.

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At first, the search continues to be discouraging.

DR. G I look in the abdomen, and there really

isn't much abnormal there.

Bowel looked pretty good.

NARRATOR But then something grabs her attention.

Oh, gosh.

DR. G What really strikes me is that his liver is yellow.

It's rounded, it's enlarged, and yellow.

It was just fatty.

NARRATOR It's clear right away that Willie

has fatty liver disease.

This means that his liver cells are damaged,

greatly diminished in their ability

to process fat and cholesterol.

Fatty livers have long been associated with sudden death,

though the exact mechanism behind it is still unclear.

But what is certain is that the condition

is often caused by alcoholism.

DR. G It is a possibility that-- that he

d*ed from alcohol and alcohol-related liver disease.

The family is saying that he doesn't drink,

but maybe this is really the answer

and that they really don't know what's going on.

NARRATOR If Dr. G is correct, the news

could devastate those that admire Willie,

both family and athletes alike.

He was a really good mentor to a lot of them.

NARRATOR But these ramifications

aside, there's something about this diagnosis

that bothers even Dr. G.

DR. G It didn't give me a cause of death that's clear cut.

So in this case, you know, we're going to do a full toxicology.

We'll certainly look for alcohol.

The wait was very excruciating.

I had to know what was wrong with him.

NARRATOR But when the test results arrive a few weeks

later, what they reveal sends shockwaves

through Willie's family.

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Deep within the walls of Florida's Wuesthoff Reference

Laboratory, -year-old Willie Booker's eye fluid

spins inside a centrifuge.

The wait for results is sheer anguish for his loved ones.

You know it's coming.

You know it's coming.

You got to have a final answer.

It has to be a closure.

NARRATOR Now six weeks later, Dr. G finally receives

Willie's toxicology report, but the answer it holds

could be a rude awakening for the family.

Decedents give up their secrets

to me in the morgue, sometimes things

that they don't tell their family,

especially dr*gs, alcohol.

I can sometimes pick up on these things in the morgue

that the families don't know about.

NARRATOR In Willie's autopsy, she

found a fatty liver that suggests he may

have d*ed from alcohol abuse.

DR. G So when I look at the toxicology,

I'm expecting the alcohol to be fairly high.

But alcohol wasn't there.

Something that I really didn't expect was there,

and that was acetone.

NARRATOR Acetone, a flammable liquid well known for its use

in household items, such as nail polish remover,

is an oxidized form of alcohol and belongs to a group

of chemicals known as ketones.

In the human body, its presence can

signify disorders such as starvation

or advanced diabetes.

But the acetone in Willie's system mystifies Dr. G.

DR. G I'm thinking, could he?

Could he have d*ed from diabetes?

But we don't have any history of that.

Could be from starvation, but why would he be starving?

None of this is making sense.

I really don't know where-- how much farther to go with this.

I'd like to talk to a family member.

[phone ringing]

NARRATOR The next day, as though in answer,

she receives a phone call from Willie's daughter.

Hi.

I was trying to find out what was happening,

why was it taking so long.

DR. G And I was explaining to her that I don't know which

direction to go, that I suspected that he
[ … ]

d*ed from maybe diabetes.

And I asked her, did he ever-- was he ever?

And then she goes, well, he was diagnosed

with borderline diabetes about a year ago.

And after he d*ed, they actually contacted his secretary, which

we knew nothing about, and the secretary

gave a very odd history.

And she was saying that at one lunch,

he drunk glasses of water.

Then at another lunch, he had five big lemonades.

DR. G And that she thought something

was really odd about the guy because he

wouldn't stop drinking.

NARRATOR For Dr. G, the new information strongly

suggests Willie was diabetic.

Excessive thirst is a classic symptom

caused by dangerously high levels

of blood sugar or glucose.

DR. G That elevated glucose in your blood

actually causes your kidneys to try to dilute it,

and that gets washed out of your body

and you become very dehydrated.

All righty.

All right, bye bye.

NARRATOR There's just one problem.

According to Willie's toxicology tests,

his glucose may have been low, not

high, at the time of his death.

DR. G His glucose is almost zero.

It could be low just because he's so decomposed,

so I really would like better proof that he's a diabetic.

NARRATOR To get this proof, Dr. G decides

to take an unusual step.

She orders an additional test on Willie's blood cells

called the hemoglobin AC, a test normally conducted

on live patients only.

DR. G I went back to my clinical training.

That's a test that's common for people who have their glucose

monitored who are diabetic to see

how much glucose is attached to your hemoglobin

inside your red blood cells.

NARRATOR It takes another excruciating wait,

but at last, Dr. G gets her answer on Willie's glucose

level while he was alive.

DR. G And so when we get that hemoglobin AC,

we find out that it's off the chart.

His glucose wasn't controlled, and it was really high.

So that was the final piece of the puzzle

that put it all together.

NARRATOR The acetone, the dehydration,

the elevated blood sugar.

For Dr. G, the clues now add up to a clear cause of death--

diabetic ketoacidosis.

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It's a life-threatening complication of untreated

diabetes that develops when the body

cannot use glucose for fuel because it

lacks the hormone insulin.

The condition can even cause a fatty liver,

leading her to believe that Willie's liver

disease was completely unrelated to alcohol.

DR. G Right now, I've got no history of alcohol

and no alcohol in him.

So chances are, alcohol is not playing a role in his death

at this point.

NARRATOR With all the evidence in hand,

she finally can explain to Willie's family what

ultimately struck him down.

[music playing]

[whistle]

Bring it over this way.

sh**t it--

NARRATOR It's AM on a sunny Sunday,

and as Willie Booker begins his new coaching job,

the furthest thing from his mind is

what a doctor told him over a year ago,

that he might be developing diabetes.

As far as Willie is concerned, it's completely under control.

I think he was trying to fix it himself by eating healthier.

DR. G He was just starting a new job

as a coach at the age of, you know, mid-s, early s.

That, you know, you don't want somebody to know you're ill

or that--

you know, you want to seem strong.

And I think he probably was some-- in some denial.

And maybe he just didn't have time to deal with it,

and he ignored it.

Men are great at ignoring symptoms.

NARRATOR But Willie's fortitude alone is no match for diabetes."], index ,…}

He's got a lack of insulin.

The glucose starts building up in his blood.

NARRATOR The lack of insulin causes distortion

in the way the fat is metabolized in his body,

to the point where fat accumulates in his liver cells.

And as he sits down to lunch with his secretary,

even his kidneys are in overdrive battling the disease.

DR. G His body trying to flush that glucose out of his system,

he gets thirstier and thirstier.

NARRATOR But his body simply can't keep up.

On the day of his death, with no insulin to feed glucose
[ … ]

into his cells, Willie's condition

finally erupts into a full-blown crisis

known as diabetic ketoacidosis.

Starved of energy, his body begins to break down fat

and proteins for fuel instead.

This triggers a catastrophic side effect--

the buildup of ketones, byproducts that turn

his blood dangerously acidic.

DR. G Once your blood becomes very acidic,

it's incompatible with life.

You start getting confused.

Probably went down very quickly and didn't-- and passed out.

NARRATOR Willie needs emergency help,

and he desperately needs insulin.

But sadly, neither is in reach, and ultimately, he

dies alone in his bedroom.

Upon hearing the final results of the autopsy,

Willie's family is torn between relief and regret.

Boy, I tell you this really was a shock,

and I was very disappointed that something so preventable

took his life in the manner it did.

DR. G The mortality for diabetic ketoacidosis

with proper fluid management and replacement with insulin

is less than %.

So tremendous step forward from medical science

that this isn't such a deadly disease.

But if you ignore the symptoms, you're going to die from it.

If he had been to the doctor, it could have saved him.

Being on medication and besides all

the other healthy things he was doing,

it would have made him live a lot longer.

It still hurts a lot.

NARRATOR Thankfully, there is one consolation,

that through his death, Willie was

able to save others in his family,

including his beloved daughter.

DR. G She went to the doctor after that

and got diagnosed with diabetes and now takes

very good care of her levels.

It's made me so much aware of diabetes.

I tell everybody now, go to the doctor.

DR. G Things can be happening inside of you

that you just don't know.

You know, we know so little about each other,

and sometimes we know so little about ourselves.

[music playing]

NARRATOR Willie's family was shocked to discover how little

they knew about his health.

But in Dr. G's next case, it's what the family does

know that's disturbing them.

We have the son telling us that an as*ault occurred.

NARRATOR And now Dr. G wonders if she

has a homicide on her hands.

We need to look inside at that brain.

[music playing]

[music playing]

We take each other to lunch on our birthdays,

which is kind of counterproductive

because our birthdays are in the same month.

But it's the thought that counts.

So probably since ', we take each other

out for lunch on our birthdays.

STEVE HANSON And sometimes Dr. G remembers the right day.

One day I brought Steve a birthday cake.

STEVE HANSON A really nice cake.

DR. G A really good birthday cake, homemade.

But I got his birthday wrong.

I thought it was in, like, early part of September,

and his birthday's not till September .

So here I brought it in, and we were going

to all sing happy birthday.

And he goes, why are you guys doing that?

My birthday's not for three weeks.

STEVE HANSON [laughs]

Me bad.

We had the cake anyway.

DR. G Yeah.

NARRATOR For Dr. G and her staff,

lunch helps them clear their minds as they prepare

for the afternoon's autopsies.

And today, they'll need the break more than ever

because getting to the bottom of the next case

will take every bit of their concentration and know-how.

[music playing]

Dr. G opens the file of -year-old Johnny Diaz.

And on page , there's some surprising information.

Records provided by the local hospice where he passed away

have already determined his cause of death.

DR. G He d*ed from a subdural and intracerebral hemorrhage,

meaning hemorrhage inside the brain tissue,

and hemorrhage over the brain.

NARRATOR But as she quickly discovers,

what caused the fatal bleed in the first place

remains unknown.

According to the investigator's report,

Johnny first arrived at a Kissimmee area hospital

two nights ago, when he wandered into the emergency

room disoriented and confused.

Sir, can you tell me your name?

NARRATOR At first, ER workers are puzzled,
[ … ]

but routine tests soon reveal why he's so incoherent.

Johnny is drunk and high.

DR. G He definitely had amphetamine in his urine,

and he had a very high alcohol level.

So they were treating him for the acute intoxication

and possible drug overdose.

NARRATOR But strangely, as time passes,

Johnny doesn't seem to sober up.

DR. G Things are slowly getting worse.

He becomes more confused and finally becomes lethargic.

He clearly goes downhill quite precipitously

after about two hours.

NARRATOR Alarmed, the ER doctors perform

a CAT scan on his brain.

DR. G And that's when they found

the inner cerebral bleed, some kind

of bleed inside of his brain.

NARRATOR The computer imaging reveals a serious amount

of hemorrhage, enough to cause irreparable brain

damage and possibly death.

[beeping]

Yeah, going to move you into surgery.

NARRATOR The medical team immediately

preps him for surgery to find and repair

the source of the bleeding.

But the surgeon soon realizes that their patient

is beyond help.

DR. G They realize that his brain

is swelling because the hemorrhage was so bad.

There's nothing they can do for him.

NARRATOR Doctors immediately transfer

Johnny to the hospital's hospice center for what they

expect will be his final hours.

The hospice is a situation where

a person is admitted once they've

been diagnosed as terminal.

They'll go ahead and provide palliative care to the person,

plus support to the family to help them deal with the death

of their-- of their loved one.

NARRATOR A staff member there manages to locate Johnny's son

Matt, who rushes in to discover that his father is

quickly declining.

Just a few hours later, Johnny's brain stops functioning

and he dies.

[heart monitor flatlining]

DR. G He'd only spent less than,

I think, six hours in hospice before he d*ed.

NARRATOR Johnny's sudden death comes as a major blow

to his son.

Now he's counting on Dr. G to find out exactly what happened.

It's kind of confusing at this point.

We have a lot of different versions of what's going on.

NARRATOR At the core of the mystery

is what caused Johnny's fatal brain hemorrhage.

DR. G The doctor treating him thought

it was a spontaneous intracerebral hemorrhage,

meaning it just occurred naturally.

NARRATOR Dr. G notes that Johnny

did test positive for amphetamines,

a stimulant which can increase the risk

of a cerebral hemorrhage.

But another possibility is that the cerebral hemorrhage was

caused by trauma to the head.

In this case, the injuries could have

been sustained in a recent bar brawl that went too far.

The story that we got was that several weeks earlier, he

had supposedly been in some sort of a fight

or had been assaulted.

The son or the next of kin advised that he believed

there might have been another as*ault possibly

a couple of days before he d*ed, and that's

what we had to check out.

NARRATOR Matt confirms that his father

was prone to drunken brawls.

Now he fears that Johnny may have been beaten to death.

We have the son telling us that an as*ault occurred.

We have the emergency room knowing nothing about as*ault.

So we're definitely going to have to see what's going on.

I need to get the facts on the autopsy

because, you know, forensics, you

don't just jump to conclusions, you

see where the facts lead you.

What caused this blood inside the brain?

NARRATOR It's now up to Dr. G to provide Johnny's son

with the answers he seeks and possibly pave the way

for a m*rder investigation.

[music playing]

As Dr. G begins the external examination,

she finds clues that prove Johnny led a troubled life.

DR. G He's thin.

He looks unkempt.

He looks the part of an alcoholic.

NARRATOR Dr. G's first step is to search

for any sign of injury that may have

been sustained during a fight.

She starts with his head.

DR. G Clearly something was going on in his head, so,

of course, I'm looking at him very carefully

for any evidence of trauma.

NARRATOR Initially, his face and skull
[ … ]

show no signs of a struggle.

DR. G I see no fractures to his face,

and I don't see any trauma to his head.

NARRATOR Next, she gently palpates Johnny's scalp.

If he suffered a head wound, her fingers

may discern bumps, broken bones, or even pockets of blood

pooled underneath the skin.

DR. G But even in palpation, I don't feel anything.

I felt nothing unusual or saw anything

usual to his face or head.

NARRATOR But in order to rule out a possible homicide,

she must carefully examine the rest of his body as well.

DR. G You know, does he have defensive marks?

Does he have abrasions on his knuckles?

Was he in a fight?

NARRATOR At first, she finds nothing out of the ordinary.

But then, as she examines his chest,

her eyes are drawn to something unusual.

All right, see what we have here.

DR. G The chest has got a little aging contusions

over the sternal region.

NARRATOR The bruise could have been a result of resuscitation

efforts, such as CPR.

But it's also possible that the imprint

was the product of an as*ault, just as Johnny's son fears.

DR. G If this is a homicide, I need to gather the information

and see what we can say.

[music playing]

NARRATOR -year-old Johnny Diaz

d*ed two nights ago of a mysterious brain hemorrhage.

Now his son Matt fears that it may have been the result

of a recent barroom brawl.

The son thinks that he was assaulted.

If the person dies as a result of an act of-- of another

person, that's a homicide.

So that's why we-- it's important for us to figure out.

NARRATOR The bruise that Dr. G discovered on Johnny's chest

could be evidence of as*ault, but she must

investigate further to be sure.

[music playing]

Dr. G makes the standard Y incision down his torso.

But when she peels back his skin and subcutaneous

fat, what she sees is inconsistent with the exterior

bruise.

DR. G There is an old fracture to his first rib.

And this already had a well-formed callus,

bony callus, so it's--

it's old.

It's not just a week old or a couple days old,

it's-- it's old.

NARRATOR The fracture could be a result of the alleged as*ault

that his son claims happened a few weeks earlier,

but the bruise is more recent, and thus, unrelated.

DR. G So there is nothing yet to support an as*ault.

NARRATOR Now Dr. G wonders if Johnny's doctors were right

and his brain hemorrhage was simply

triggered by a medical condition or even drug abuse.

[music playing]

One by one, she begins checking each organ for signs

of natural disease, and it isn't long

before she finds some serious damage in his liver.

That is one big liver, huh?

DR. G He clearly had liver damage

and was on his way to cirrhosis.

NARRATOR Cirrhosis, or the scarring of tissue,

can lead eventually to liver failure and death.

In the United States alone, the disease kills more

than , people each year.

Johnny's liver disease doesn't appear advanced enough

to have k*lled him.

But for Dr. G, the condition does

shed new light on the circumstances of his death.

DR. G It didn't surprise me that he

showed up drunk to the emergency room with this liver.

NARRATOR Next, she moves on to Johnny's chest.

And there in his lungs, she discovers

yet another potential k*ller.

DR. G His lungs have a pneumonia

to them, not uncommon for people who are

unconscious, on a respirator.

NARRATOR Many intensive care patients never

recover from this type of infection,

and it can lead to their death.

[music playing]

But in Johnny's case, where the cause of death

is a cerebral hemorrhage, finding pneumonia

adds little to Dr. G's investigation.

So she quickly proceeds to her next stop--

his heart.

Carefully, Dr. G cuts open the heart's pericardial sac

and detaches the blood vessels anchoring it.

And there, she immediately notices a problem.

DR. G His heart was mildly enlarged,

particularly considering he-- how thin he was.

NARRATOR She weighs the organ, then begins slicing it into

millimeter-thick sections.

And with each draw of the blade, she finds alarming evidence.

DR. G He had severe atherosclerosis,

narrowing to the blood vessels that

supply the oxygen in his heart.
[ … ]

NARRATOR Dissecting the vessels,

she discovers that Johnny's atherosclerosis

was so bad that it had previously

required surgical intervention.

DR. G Looks like he had a stent put in, meaning they go up

through the vessel and put the little wire mesh to help

keep that coronary artery open.

He had two of those.

NARRATOR But that's not all.

In his heart muscle, Dr. G also spots pale scar

tissue, telltale signs of a heart att*ck,

or a myocardial infarction.

DR. G There's actually an evidence

of an old myocardial infarction in the lateral wall, the side

wall, but there's also a slightly newer

myocardial infarction, still not fresh, but slightly

less old than the other one.

[music playing]

NARRATOR Although the previous heart att*cks are clearly not

the cause of death, Dr. G believes

the other findings in his heart are still significant.

Johnny's heart is enlarged, and this is often

linked to high blood pressure.

And high blood pressure is seen in % to %

of Americans who suffer a spontaneous

intracranial hemorrhage, like the one that k*lled Johnny.

Furthermore, his high blood pressure

may have been compounded by the amphetamines

found in his system.

DR. G But what I'm worried about

is that stimulant, the amphetamine,

and did that play a role in causing that,

what they called, spontaneous hemorrhage inside the brain?

NARRATOR Now, it's looking like Johnny's son was wrong.

His father's death does not appear

to have been the result of a fatal as*ault,

but rather a consequence of his high blood

pressure and possibly drug use.

DR. G It's looking like maybe the hospital's right.

It's just a spontaneous bleed.

But I've got to investigate the head.

The head's where the money is on this one.

[music playing]

NARRATOR Dr. G makes a long incision around Johnny's head

from ear to ear.

Then, she peels back his scalp to access the skull and brain.

And suddenly, she's thrown off track.

There's a portion of the inside of his scalp

that's clearly bruised.

DR. G Now I see the bruise that you couldn't

really see on the outside.

It was on the back left side.

It's about and / by maybe and /, inches.

That's a pretty good contusion.

NARRATOR So while there was no detectable evidence of trauma

on the outside of Johnny's head, the inside

tells a different story.

What's more disturbing, she can see further damage

in the galea aponeurotica, the tough membrane

that covers and protects the upper part of the skull.

DR. G He's got hemorrhage also not just in the scalp,

but in the galea covering over the bone itself,

which indicates more force.

NARRATOR As she wipes the bone clean,

she makes the most shocking discovery of the autopsy.

Oh, wow.

DR. G Whoa.

Lo and behold, there is a skull fracture.

It's a -inch skull fracture, though, that goes across,

and it's somewhat horizontal what-- right as what

we'd call the hat rim area.

NARRATOR Johnny's hospital report

made no mention of a fractured skull,

but Dr. G is not surprised by the oversight.

DR. G They miss that on CAT scan.

That actually is not unusual for a CAT scan

to miss a skull fracture like that that's low on the skull.

I see that all the time.

NARRATOR Suddenly, the autopsy has come ,

and it's looking like Johnny son's

theory about a deadly as*ault may have been right after all.

DR. G This is not a spontaneous hemorrhage.

We've got a scalp contusion.

We have blood under the galea.

And now underneath that, we have a skull fracture.

So now this is really looking like trauma.

NARRATOR But as the evidence adds up,

Dr. G still needs to answer a disturbing question.

DR. G How did he get that trauma?

Did somebody hit him on the back of the head?

[music playing]

NARRATOR Dr. G carefully documents

the large fracture she's just discovered

on Johnny Diaz's cranium.

Six inches, pretty good skull fracture back there.

This is all recent.

This is all pointing to the reason

he has blood inside his skull.

NARRATOR She is now wondering if Johnny's

brain hemorrhage was caused by head trauma
[ … ]

from a deadly as*ault.

[music playing]

If so, evidence she finds in autopsy

could help convict the k*ller in court.

Her next step, dig deeper.

DR. G We need to look inside the cranial cavity.

We need to look inside at that brain.

[music playing]

[music playing]

NARRATOR Technician Ashley Shaughnessy

cuts through the skull cap with an oscillating saw.

And as she removes the skull cap,

Dr. G can see the full extent of damage to Johnny's brain.

Immediately, she notices bleeding

in the back of the brain at the site of the fracture.

But then, something totally unexpected

captures her attention on the front side of the brain.

Here she discovers a bigger second area of bleeding.

[music playing]

DR. G He has a massive amount of blood on the tips

of his frontal lobe.

NARRATOR After complete dissection of the brain

and finding no other bleeding, Dr. G can identify

the nature of the trauma.

The two-pronged damage is characteristic of an injury

pattern known as a coup contrecoup injury.

It occurs when the brain moves violently

in one direction because of one impact,

then hits the far side of the skull in a secondary impact.

DR. G The coup is the slight contusion when he actually

got the skull fracture, so the contrecoup contusion

is that secondary impact, with the brain

moving forward hitting the inside of the skull.

NARRATOR For Dr. G, the injury pattern

has staggering forensic implications

because it's not consistent with a homicidal blow.

DR. G Just standing there and getting whacked,

you don't usually get that severe contrecoup.

NARRATOR Instead, Johnny's double brain injury points to

an unforeseen manner of death--

an accident.

DR. G His injuries are not consistent with an as*ault.

They're not consistent with spontaneous

intracerebral hemorrhage.

Typically, we see them with a fall,

and everything is consistent with a fall for him.

NARRATOR Looking back on the autopsy,

all the evidence seems to support the scenario.

DR. G Particularly the location of where he impacted his head.

Single impact site, not multiple.

Multiple would suggest an as*ault.

We see a horizontal skull fracture right at the hat brim

area, which is the prominent portion of the skull

consistent with a fall.

And then we have that severe contrecoup

contusion, the massive injuries to the exact opposite location.

His brain is massively swollen.

It's inconsistent with life.

This is clearly why he d*ed.

NARRATOR Now Dr. G can finally reveal to Johnny's son

the tragic truth behind his father's sudden death.

[music playing]

It's AM on a Wednesday, but for Johnny Diaz,

who struggles with addiction, it's

not too early for a drink and a couple of amphetamine pills.

Over the years, alcohol has damaged his liver,

and dr*gs have likely driven his blood

pressure up, possibly even causing

his two previous heart att*cks.

But today, the dr*gs and alcohol take

their toll in a different way.

They dramatically impair his motor functions.

And this time, the result is deadly.

DR. G You know, I think alcohol and drug

use played a big role here.

So he fell back, probably in a stuporous state

with his dr*gs and alcohol, hits the back of his head,

cracking the skull.

The sudden deceleration causes his brain to bounce forward,

impact the inside of the skull, causes those hemorrhage.

NARRATOR Severely bruised and bleeding, Johnny's brain

begins to swell, though he still maintains

enough function to seek help.

He didn't die immediately, makes it to the emergency room.

NARRATOR But the more the brain swells,

the more it impedes his bodily functions.

In the ER, doctors assume that intoxication is the sole cause

of Johnny's incoherence.

DR. G (VOICEOVER) They actually watch him for a possible drug

overdose because there is a little bit

of confusion at the beginning.

NARRATOR Precious time slips by before his doctors realize

something is terribly wrong.

DR. G They do an emergency CAT scan.

They find this blood inside his brain and over the brain.

NARRATOR But the damage is already done.

Johnny's brainstem is so compressed,

the nerve cells within it can no longer relay

vital signals to his body.

His breathing and heartbeat wind down to a halt and he dies.
[ … ]

[heart monitor flatlining]

Upon hearing that his father's death was not a homicide,

Matt reacts with mixed emotions.

DR. G I'm not so sure that my information

gave him any comfort.

Is it better to have d*ed from an as*ault

or better to have d*ed drunk hitting your head?

He was on his way of dying a slow not pleasant death

associated with alcohol when you die from liver failure,

and his liver was on the way to having cirrhosis.

But alcohol can k*ll you acutely, too,

by the effects it has on you, and in this case, most likely

precipitating that fall.

Alcohol plays a huge role in the unintentional deaths

that we see here in the morgue.

[music playing]

MAN (WHISPERING) Atlas.