06x04 - Fatal Twist

[bunniefuu]

[music playing]

NARRATOR A young life is tragically cut short.

DR. G I think they're always sad.

The babies are just such innocent,

pure, little sweetness.

We just hate to autopsy them.

NARRATOR And Dr. G is forced to consider

the worst case scenario.

DR. G It is horrific to think that people

do that to children.

And unfortunately, I have seen it happen far too many times.

NARRATOR Then, a woman dies after being

released from the hospital with a simple case of bronchitis.

DR. G They gave her some antibiotics

and sent her on her way.

NARRATOR But an autopsy, Dr. G's findings

reveal an astonishing oversight.

DR. G Nothing trumps that.

That's as bad as a b*llet through the head.

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations.

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

It's AM at the District morgue in Orlando, Florida.

And Dr. G's staff is busy preparing for the day's cases.

This morning, there's a suspected drug

overdose, a possible heart att*ck victim,

and a motor vehicle fatality.

But Dr. G's attention is drawn to one

case in particular, Carlos Lopez,

a four-month-old baby boy.

[music playing]

A lot of sadness in the morgue today.

Unfortunately, we have a four-month-old baby, found

unresponsive by his parents.

I've been doing baby autopsies for over years.

I think they're always sad.

They're always extremely sad.

The babies are just such innocent,

pure, little sweetness that we just hate to autopsy.

The story is that the parents, very young parents

in a poor, rural area of one of my counties,

put the baby to bed.

In the morning, they noticed that the baby is unresponsive.

It doesn't appear to be breathing.

Of course, they panic.

They don't own a phone.

They rush the baby to the fire station,

which isn't too far away.

My baby's not breathing.

DR. G They start CPR.

They rush the baby to the nearest pediatric hospital.

NARRATOR There, ER doctors immediately

put the four-month-old on life support,

but by then it's too late, Carlos Lopez

is already brain dead.

The baby's too far gone.

And they eventually take it off the respirator within hours.

NARRATOR By all accounts, the sudden unexpected loss

of their only child comes as a devastating blow

to Carlos young parents, Marco and Isabella.

DR. G They were just absolutely floored that they

have a baby that d*ed.

It was just unbelievable to them.

NARRATOR Sadly, Dr. G sees babies

like Carlos all too often.

DR. G Four months old is a very common age for us

to see the baby.

The babies get sick really fast when they're very young.

They can die from pneumonia, meningitis.

And it's also not an uncommon age

to see SIDS, Sudden Infant Death Syndrome, the kids that just

die suddenly and unexpectedly.

NARRATOR But as she combs through the investigator's

report, she finds two potentially troubling clues.

Her investigator has noted that Carlos' abdomen appeared

bloated and there seemed to be an area of swelling

on the back of his head.

These findings lead her to weigh a more disturbing possibility--

child abuse.

It is unimaginable hitting a baby, to me,

but unfortunately, we see it.

Blows to the abdomen, believe it or not.

We see lacerated livers.

We see contused bowels, from blows to the belly.

Certainly, one of the more common

things we will see in this age group is inflected head trauma.

We get kids here that are m*rder*d and have

trauma inflicted on them.

NARRATOR Now Dr. G can't help but wonder if the mounting

pressures of parenthood could have driven Marco and Isabella

to do the unthinkable.

DR. G There's frustration, they're poor.

There's probably a lot of pressures on them.

You do worry that maybe they took it out on the baby.

So we'll have to do an autopsy and see

really what's wrong with him.

[music playing]

Cute, cute kid, though.

Yeah.

Feel how soft his hair is.
[ … ]

Yeah, soft hair and long eyelashes.

Before we start, I think we take a look

and appreciate the beauty of the child.

Just as we see a baby out in public, you take a second look

and you appreciate what beautiful little creatures they

are.

And we do that in the morgue too.

We just kind of stare at them and just

appreciate how cute they are.

He is a precious little baby boy.

I mean he's a cutey bunny.

Has he got any teeth there?

I see two lowers, cute.

I know with some of the techs, they have

a harder time with children.

And some of the detectives won't come in when we do children.

Why does everyone hate working on babies.

They can't talk for themselves.

We got to talk for them.

ASHLEY SHAUGHNESSY Babies can be difficult.

Sometimes you do get tied into it,

and you feel like a gut-wrenching feeling,

like how could they do this to this baby, or this poor child.

But at the same time, I try not to let myself get involved

or attached in that manner, because you

can't work here if you do that.

DR. G I'm still there to get the answer.

And that's what I have to do.

After you get over how cute they are,

then you start looking for what you need to look at.

I'm looking for a lot of things.

I'm going to have to chart what kind of shape

the baby's in, what kind of medical intervention they did.

I'm going to look for rashes.

I'm going to look for subtle signs of trauma.

I'm going to look for bruises on the skin.

So I'm just looking and seeing what I find.

As a first step, Dr. G meticulously

records the general state of Carlos' body.

You can see he's obviously been in the hospital.

He's got a lot of needle puncture marks

and he's kind of all swollen.

But even with that, even with all that medical intervention,

he is a little cutie.

NARRATOR Prompted by her.

Investigator's report, Dr. G turns her attention

first to Carlos' head.

My investigator first felt, when he saw him

in the hospital, he's got this bump or this abnormality

in the scalp.

And I'm looking very carefully for that.

He does have some cradle cap.

That's just kind of a scaly, oily, flaky skin that's

kind of attached to the scalp.

It doesn't mean that he was not well cared for.

It's a common finding.

NARRATOR And sure enough, just behind the ear,

she finds an area of swelling.

DR. G I don't know what it is, but I'm

worried about some type of inflicted trauma, particularly

inflicted head trauma.

NARRATOR But that's not the only abnormality noted

in the investigator's report.

Now, I find a distended abdomen.

Well, at this stage, I'm a little worried.

Could be from a blow to the belly.

Maybe it's blood in the belly.

Huh.

I'm anxious to get inside.

And I'm really hoping to get answers

when I do the internal exam, because you never

know what the autopsy's going to show,

particularly with children.

[music playing]

NARRATOR -month-old Carlos Lopez d*ed

late last night in the ICU.

And to her dismay, Dr. G has already found two ominous signs

that suggest he may have been the victim

of fatal child abuse--

swelling in the head and the abdomen.

It is horrific to think that people do that to children.

And unfortunately, I've seen it happen far too many times.

NARRATOR And based on her experience,

Dr. G knows exactly where to start the autopsy.

DR. G One of the most prominent ways in the infant age group

that we see that these children are m*rder*d

is through inflicted head trauma.

You got to hold that open and get a picture [inaudible]

All right.

Because there's a little piece right there,

NARRATOR First, Dr. G reflects the infant's scalp,

peeling back the skin to expose the top of Carlos' skull.

What's really important was inflicted head trauma is

to see any type of scalp bruising that you

may not see externally.

Oftentimes, we see that subtle bruising on the inner aspect

without really seeing much on the outer aspect.

But with this cute little boy, we don't see anything.

He has no scalp contusions, no bruising

on the inner aspect of the scalp.
[ … ]

He's got no skull fractures.

NARRATOR But she still needs to look

inside for signs of trauma.

To gain access to the brain, morgue technician Brian

Machulski opens the infant's skull, or calvarium,

with an oscillating saw.

Now a four-month-old, we're still going

to have to saw the calvarium.

Their skulls are certainly more pliable.

With a really, really young infant, around the age of one

month, we can actually cut between the suture lines,

and just kind of, what we call, pedal it

out, just kind of open it up.

With a four-month-old, we'll still use the saw.

So we'll open that brain just like we would an adult.

It's just much thinner and much more pliable.

It's much easier to open.

NARRATOR Here Dr. G will be looking for signs of trauma

or any evidence that suggests Carlos was a victim of abuse.

Like slamming them against the mattress,

slamming them against the wall, blows to the head.

MARTY ELLINGTON Children or babies' brains

do not tolerate the same amount of force to the head

as an adult would, whether that's actual

shaking or unfortunately the child being thrown,

or dropped, or hit.

And based on that, they can have brain injury.

NARRATOR But while there's no immediate sign of blood

on the brain surface, Dr. G realizes they have

another problem on their hands.

That brain is very, very soft and friable.

I already know what that is.

That's respirator brain.

This was a telltale sign that Carlos

was brain dead on life support.

What happens when you're brain dead

and they just keep you alive is your brain

starts to break down.

And those baby brains are so soft to begin with,

that by the time I get them, they're

like jello that's been left out, just really,

really soft and friable.

But I'm looking past that.

NARRATOR Carefully, Dr. G removes

the fragile organ from the skull and carries it

to the dissecting table.

But she knows the brain's delicate state will make

the exam extremely challenging.

DR. G With respirator brains, you have to look quickly,

because they're so friable, they almost break up in your hand,

and they're difficult to examine.

Dr. G quickly scours the disintegrating

organ for signs of injury, such as blood or swelling.

But after a thorough inspection, she can find no evidence

whatsoever of internal trauma.

So I really don't have anything

positive from that brain that would indicate

what his cause of death is.

As for the swelling on the back of Carlos' head,

it appears to have simply been the result

of fluids being pumped into his body while on life support.

They've given him a lot of fluids

to try to increase his blood pressure

and it just kind of goes into his tissues.

You know, just like you get a swelling, a swelling of a joint

or swelling of tissue.

By the end of the cranial exam, we have ruled

out inflicted head trauma.

But I haven't totally ruled out trauma.

I don't like the fact that his abdomen is distended.

[music playing]

So then it's time to do the Y incision.

You know, with a baby, you have littler spaces to work.

So when I do a baby, some of our instruments are smaller.

I like to use smaller scissors, smaller pickups.

But my scapel's still the same.

I go across the chest and I go from the shoulder down.

NARRATOR With one small incision,

Dr. G opens the infant's tiny torso.

And right away, something catches her by surprise.

When I get to the abdomen, though, there's trouble.

This little belly is so distended, you

don't want to cut that bowel when you open it.

I see ccs of turbid, kind of p*ssy looking fluid.

Something is wrong.

I'm going to try to peel that.

Something's happened to his abdomen.

This is not a trivial incident that happened to this child.

[music playing]

NARRATOR Dr. G has just made a shocking

discovery in the tiny abdominal cavity of four-month-old

Carlos Lopez--

a mixture of pus and fluid.

And this finding raises an ominous red flag.

DR. G Now, I'm immediately worried

that he's got that injury to the small bowel,

which we often see with kids with blows to the abdomen.

NARRATOR To get a closer look, Dr. G

empties the fluids from Carlos' belly one ladle at a time.

And it isn't long before she comes face
[ … ]

to face with a serious problem.

Just as she feared, it's the baby's bowel.

DR. G It's not looking good.

It was swollen, and green, and definitively dead.

The bowel looks like that's the cause of death.

NARRATOR But the question is what

could have caused the infant's bowel

to fail so catastrophically?

DR. G Although I have the cause of death,

I've really got to figure out what's

going on with this bowel.

NARRATOR And what she discovers next

takes her completely by surprise.

DR. G I don't think I'll ever see another one of these again.

NARRATOR With this finding, Dr. G can now piece together

the tragic combination of events that culminated in the death

of four-month-old Carlos Lopez.

[music playing]

It's late in the afternoon and four-month-old Carlos Lopez

is crying.

His young parents, Marco and Isabella,

think he's just being fussy.

But they couldn't be more wrong.

Carlos is in the throes of a dire medical crisis

and it isn't child abuse.

On the contrary, it's the result of an undetected birth defect.

He's got a congenital problem where his right colon was

not attached to the bowel wall.

The bowel, in effect, is floating freely in the abdomen

when the child is born.

NARRATOR The development of the intestinal tract

begins in utero, as a single central tube.

When you're just developing in the uterus,

you got a little straight GI tract.

And then, after about fourth week, it really is kind

of cool, it kind of herniates.

And that's actually where it starts growing,

and twisting, and turning.

And then, after about , weeks,

it comes back and starts attaching

to the abdominal wall.

The intestine has a whole, both the small

and the large intestine, probably

equal, in a small baby, at least to feet of organ.

And so in order for that organ to fit properly in the abdomen,

it needs to be attached in certain places.

NARRATOR As Carlos' intestines develop,

a small section of his large bowel

does not attached to the abdominal wall as it should.

Normally, children born with this birth defect

don't suffer any long-term problems.

% to % of the population have that and live with it.

NARRATOR But sometime in the days just before his death,

Carlos develops a very rare and deadly complication.

His unattached bowel begins to rotate abnormally,

a condition called a volvulus.

A volvulus is when part of the intestine

has twisted around itself and causes obstruction

to the blood flow to the bowel.

NARRATOR As its blood supply becomes compromised,

the bowel literally begins to die.

This causes the bacteria to leak from his bowel, which in turn,

triggers a massive bacterial infection

in the baby's abdominal cavity.

On the evening of his death, Carlos is critically ill

and in significant pain.

Having your bowel strangulated and then having that die off,

it causes a lot of abdominal pain.

They'd have terrible abdominal pain, like a burst appendix.

That's how it would feel.

You would expect the child to cry

and to cry inconsolably and show other signs of distress.

As the disease progresses, you would have further evidence

of a very sick infant.

NARRATOR But Carlos' young and inexperienced parents

likely misinterpret his desperate cues.

DR. G And they probably didn't pick up on signs of him

not doing well--

irritability, lethargy, not wanting to eat.

Just couldn't express it in a way

that the parents understood it.

NARRATOR Eventually, the bacteria

in the four-month-old's abdomen begins

to leak into his bloodstream, unleashing a life threatening

infection known as sepsis.

The result is swift and catastrophic.

Once that bacteria goes into your blood,

it sets off a cascade of events that cause

your blood pressure to drop.

And you end up losing your heart rate,

losing your blood pressure, and you stop breathing.

By the time his parents saw him in the morning,

he didn't have a pulse, he didn't have a respiration.

Even if he lived next to the hospital,

I don't think they could've saved him at that point.

[music playing]

NARRATOR Dr. G meets with Carlos' parents

to explain the tragic and complex

circumstances that led to their son's too early passing.

And they're stunned by her conclusions.
[ … ]

DR. G The parents, at that point, were just in shock.

I can guarantee you, though, that they

are glad they have a cause of death than no cause of death.

Because ultimately, never knowing why they d*ed

is really hard.

And also, having that specific cause of death

removes any suspicion that it's trauma from the parents.

NARRATOR For Dr. G, a parent of two

boys herself, the death of the infant

serves as a stark lesson.

DR. G I always tell parents, if the baby's starting to look

a little different, and you just don't feel comfortable

with the way he's acting, I always

say err on the side of caution, give

your pediatrician or your nurse practitioner a call.

[music playing]

NARRATOR Sadly many of Dr. G's cases

involve deaths that could have been avoided.

And for -year-old Ellen Walters,

a correct diagnosis comes too late.

DR. G Her death could have been totally prevented.

It's just really a shame that it slipped through the cracks.

[music playing]

NARRATOR This morning, Dr. G is starting

her day outside of the morgue.

I have to warm up.

Working out in general is a wonderful stress reliever.

I really look, actually, forward to and dread

these personal training sessions.

Because when you're working out by yourself,

you can go at your own pace.

When you're working out with a personal trainer,

they really push you.

Good deal, let's get started.

DR. G Before I started working with her,

I could not do a push up.

It's great.

We brought her from where she was a little intimidated.

Now she's doing pushups with a ball.

DR. G When she asked me to do this,

I thought this was the craziest thing I'd ever heard.

This squat thing, you notice they're filming from behind.

Piece of cake.

Down, down, squat, jump, squat.

When I give her a dirty look, she knows it's a good one.

And you always like to do an extra.

I concentrate on full body exercises with Dr. G,

because you kind of get the most bang for your buck.

You burn the most calories.

You're doing lower body as well as upper body.

And I also work on external rotations,

help open up the chest, strengthen

your rotator cuff muscles.

Which, if you're doing a lot of this and moving around, then

hopefully that'll help strengthen

and reverse her posture.

I think getting in better shape gives you more stamina,

without a doubt.

It just makes you feel better.

And I think the best part, and was totally unexpected,

is my posture.

Don't you think my posture's getting better?

Absolutely.

DR. G Furthermore, if you're toned all over,

it's just easier moving the bodies around

and, just standing on your feet.

NARRATOR Having the necessary strength

and endurance to get through long days in the morgue

is essential.

But equally important to Dr. G is

her ability to maintain a heightened

level of concentration.

That's the beauty, actually, of doing an autopsy,

is I don't think about what's for dinner.

I don't think about the problems with my kids.

All I think about is trying to find the answer.

You tune out the rest of the world and you focus.

I haven't done anything on her yet, so--

Athletes call it in the zone, so I think

I can call it in the zone.

This morning we have a -year-old Caucasian

female who is supposedly having a seizure on the bus.

Pretty much, by the time she gets to the hospital,

she's dead, and is now in my morgue.

[music playing]

NARRATOR It's a typical summer morning

in Orlando, hot and muggy.

Braving the heat, -year-old housekeeper Ellen Walters

is waiting for the bus which will drop her off

just a few blocks away from the home

she'll be cleaning that day.

She was going to work on the bus.

The bus driver said he could see something was wrong.

Alarmed, the driver quickly pulls his bus

to the side of the road.

He sees her have a seizure.

He calls .

NARRATOR Paramedics arrive within minutes.

PARAMEDICS Anybody here know anything about her?

NARRATOR And rush Allen to the hospital.
[ … ]

DR. G But by the time they get there, she's dead.

She's dead on arrival.

[music playing]

NARRATOR As a first step, Dr. G begins

reading through the investigator's report.

And right away, she spots a red flag.

It appears Ellen had gone to the hospital

the night before she d*ed.

DR. G She goes into the emergency room,

complaining of feeling lightheaded and some chest

pain.

The emergency room does an X-ray.

They give her an exam.

The chest X-ray was normal.

They heard some wheezing.

And they thought she had some bronchitis.

NARRATOR Bronchitis is an inflammation

in the lungs' airways, that's extremely

common and usually harmless.

That's certainly not going to be what k*lled her.

But I'm worried that she goes to the ER

just the night before with complaints of chest

pain and difficulty breathing.

I don't like coincidences.

NARRATOR Now Dr. G wonders if Ellen's symptoms were

actually signaling a far more serious ailment,

like a heart att*ck.

It's certainly something we see in the morgue.

NARRATOR But then, something else in the report

catches her attention.

DR. G Looking into her history a little bit,

it's kind of interesting.

She's got a mental disability.

Now, of course, with her disability,

we don't know really what type of disability she has.

They don't have a diagnosis for her.

NARRATOR According to the investigator,

Ellen lived in a group home for adults with disabilities.

And now, her sister Deborah believes

the home's caretakers may be responsible for her death.

DR. G The sister, she's pretty upset.

She thinks the group home is to blame.

They let her take care of her medication on her own.

NARRATOR Without proper supervision,

Ellen could have easily taken too

much of her prescription dr*gs and d*ed

of an accidental overdose.

They'd just given her a couple new medications when

she went to the emergency room.

She already takes some medications

for behavioral problems.

So maybe if she's unsupervised and is

not used to taking her own medication,

maybe she took too much.

She'd taken that medication unsupervised about

minutes before she dies.

NARRATOR But Dr. G knows she must also consider an even

more disturbing scenario.

When a person dies in a group home setting

or in any type of institutional setting,

it's very important for the medical examiner

to get involved, because there's always a question of how

they're being treated, if there's

any type of abuse, or neglect, or if possibly

there's unrecognized trauma.

She doesn't communicate as well.

And so maybe something happened that she's not telling.

NARRATOR And it's now her job to coax

the truth from Ellen's body.

DR. G So we have a whole host of problems.

But we're not going to know for sure until we do the autopsy.

[music playing]

OK, so when I start the autopsy, I just

do a general over appearance.

I look for anything that'll give me clues.

NARRATOR And it isn't long before Dr.

G spots something slightly odd.

DR. G Hey what is that?

Now her legs were a little asymmetric.

OK, let's see.

Her right leg was a little bigger than her left.

It wasn't that big of a difference.

It could mean a deep venous thrombosis,

or a blood clot developing in the vein of a lower leg.

NARRATOR Blood clots in the legs

can be dangerous if they break off and travel through the body

to the heart and lungs, stopping vital blood flow.

But they're usually associated with risk factors,

such as immobility, heavy smoking, and recent surgery,

none of which appear anywhere in Ellen's history.

It could be just asymmetry of her lower extremities

that some people have, because they tend to favor

one leg over the other.

A lot of people will have one calf bigger than the other.

NARRATOR She makes note of the measurements

and then begins looking for any signs that

could suggest Ellen had been neglected,

or worse, beaten by her caretakers.

Well, certainly, for abuse what I'm looking for

is evidence of any type of bruising, trauma.
[ … ]

I'm looking to see how clean she is, whether she's well taken

care of, clean nails, clean hair, not lice in her hair,

no sores anywhere.

You just want to do the whole overall?

She appears to be well cared for, well nourished.

In fact, she's overweight, but not badly so.

No evidence of trauma.

So overall, the external examination

didn't tell me a lot.

NARRATOR But years of experience

do tell Dr. G that it's far too early to dismiss

the specter of abuse.

DR. G Even though she didn't have any external evidence

of trauma, she's certainly still could

have delayed effects of trauma, particularly

a delayed head injury.

So until we get into her head, we won't know for sure.

[music playing]

NARRATOR Dr. G's morgue techs Brian Machulski saws

through the calvarium of -year-old

Ellen Walters, a mentally disabled woman who

lived in a group home.

DR. G When there's any type of institutional setting

or a group home setting, there's always suspicion on that group

home that something happened.

NARRATOR Dr. G is now exploring the possibility that Ellen was

assaulted by her caretakers and sustained

a fatal blow to the head.

This could easily explain the seizure she

suffered just before she d*ed.

I take the calvarium off.

I certainly don't see any fractures.

I'm looking for accumulations of blood.

I'm looking for maybe swelling, asymmetric swelling

of the brain, anything that's abnormal.

NARRATOR But after a careful examination,

she can find no evidence of an injury.

There's also no sign of natural disease

that could explain Ellen's seizure.

DR. G Her brain looks normal.

OK, well I don't see anything.

So at this point, now that I've done the brain exam,

I suspect that that seizure may be due to something

else going on inside her body.

I have my suspicions, but no one thing is

pointing more than the other.

I'd like the autopsy to speak to me on this one.

[music playing]

All righty--

NARRATOR Dr. G draws her blade from Ellen's shoulders

to her sternum and down her abdomen.

First and foremost, she'll be on the lookout for any damage

to the organs that could signal abuse.

DR. G Do you remember, the night before, she

was a little lightheaded.

Maybe she's even losing blood internally somewhere.

Sometime we get a delayed effect from a spleen rupture

or blow to the spleen.

NARRATOR Peeling back the skin and fat,

she gets her first look at Ellen's abdominal cavity.

And it doesn't take long to rule out another potential culprit.

DR. G I certainly didn't find any trauma.

She doesn't have any trauma.

Her abdomen looks normal inside too.

Liver looks of normal color, size.

Her spleen's OK.

Her bowels are intact.

They don't have anything wrong with them.

Her appendix is fine.

She doesn't have any accumulation of blood.

She hasn't ruptured a spleen or a lacerated any liver.

NARRATOR And upon closer examination,

the only abnormality she detects is a mild aberration

in the uterus.

DR. G Her uterus, though, is misshapen.

It's a relatively small uterus, but with a rather lumpy,

bumpy appearance, I call it.

And she's got some large leiomyomas.

Leiomyomas are smooth muscle tumors which are benign.

They're usually as a result of people who

are still producing estrogens.

They're estrogen sensitive.

So they tend to be enlarged in this age group

if you have them.

And usually post-menopause, they go away.

For the most part, a lot of women

don't have any problems with them.

And you certainly aren't expecting to die from them.

NARRATOR Now Dr. G is convinced of one thing.

Ellen did not suffer any physical abuse

at her group home.

But that doesn't exonerate the staff.

They could still be held responsible for her death

if they failed to supervise her medications properly.

We're still worried about some of the medication she's taking.

So it's very important at this point

that I take my toxicology, because that may be the answer.

NARRATOR Dr. G collects samples of Ellen's blood and urine

and sends them off to the lab for a full analysis.

Then she turns her attention to the heart.
[ … ]

We've got the night before, with the chest

pain and the lightheadedness.

Then we've got the witnessed seizure and she's dead.

So it could be a result of a lack of oxygen to your brain,

maybe because of something wrong with her heart.

Now, we don't know really what type of disability she has,

but sometimes these disabilities are associated

with other problems, strictly in the heart

and other congenital problems.

We don't have that history with her.

So again, we'll be looking for any kind of

congenital abnormalities also.

NARRATOR But as Dr. G cracks open Ellen's rib cage

and gets her first look at the organ,

she's surprised by what she sees, or doesn't see.

DR. G Her heart, I take it out and it looks normal.

So many of the hearts I see are enlarged

from high blood pressure.

Her's was not.

It was of normal weight.

I look at where the fat's accumulated.

I look at the surface, is it nice and shiny?

The overall shape.

The overall shape appeared normal.

What else we got going on here?

NARRATOR But appearances can be deceiving.

So she dissects the tissue inch by inch, looking for anything

out of the ordinary.

DR. G I look at coronary arteries.

Do they have atherosclerosis?

In this case, normal, normal coronary arteries.

Coronaries looked great.

I then look at the muscle of the heart.

I look at the blood, how the blood flows to the heart.

I look at the valves.

What's wrong with her?

She has a completely normal appearing heart.

Both externally, and internally, including

the muscle, the cornea arteries, the valves, all appear normal.

NARRATOR With not a shred of evidence

so far pointing to a cause of death,

Dr. G is now beginning to wonder if Deborah's suspicions

may prove true after all.

Well, her sister really feels that somehow it's

the group home's fault. And at this point,

we're running out of organs to blame her death on.

I'm worried about that.

[music playing]

NARRATOR -year-old Ellen Walters

d*ed yesterday on a city bus.

And her sister, Deborah, believes that her caretakers

may be to blame.

She thinks that it might have been

a result of them letting her take the medication or too

much of it.

NARRATOR Toxicology tests will help determine the truth,

but the results won't be in for weeks.

And for now, Dr. G still has one place left to look--

the lungs.

Based on Ellen's diagnosis at the hospital the night

before she d*ed, Dr. G expects to find nothing more

than evidence of bronchitis.

So to take the lungs out, I lift them up.

I do notice a discoloration, some kind of reddish,

firmness on the back of the lower lobe of one of her lungs.

NARRATOR Dr. G then begins a careful dissection

of the pulmonary arteries.

And what she finds is a far cry from bronchitis.

Nothing trumps that.

That's incompatible with life.

That's as bad as a b*llet through the head.

OK.

[music playing]

NARRATOR It's a steamy Thursday night in Orlando.

And Ellen Walters is having no fun at all.

Feeling short of breath and lightheaded,

she's rushed to the ER, where doctors

conduct a thorough examination.

They do a chest X-ray.

They can't find anything.

They listen to her lungs.

They really don't hear much, maybe some wheezing.

They give her a diagnosis of bronchitis

and send her on her way.

NARRATOR Little do they know, something much more serious

is going on inside Ellen's body.

DR. G At some point, she developed

a blood clot in the veins of her leg, most likely her right leg."], index ,…}

It probably explains the asymmetry of the legs.

NARRATOR However, these clots are usually harmless.

DR. G Your blood is clotting all the time.

And so your body's always making little blood clots.

And then it breaks down the little blood clots,

and it makes little blood clots, and it breaks

down the little blood clots.

And that's just-- you know, it's in balance.

And that's what it should do.

NARRATOR But unfortunately, for Ellen that's not the case.

For reasons unknown, there's an imbalance in her blood clotting

mechanism.
[ … ]

And what started as a small clot in her leg

is now growing at an alarming rate.

Unfortunately, she was a ticking time b*mb.

Some small pieces of the blood clot

were breaking loose and traveling her vessels

and getting caught into her lungs.

NARRATOR And it's only a matter of time

before these breakaway clots, known as pulmonary emboli,

begin to impede the flow of blood and oxygen

within the lungs.

DR. G That probably was causing her to get short of breath

and having some chest pain and probably

is what really precipitated her going to the emergency room.

Unfortunately, they didn't pick up on it in the ER.

And that's not uncommon.

Between , and , people

die every year with misdiagnosed or undiagnosed

pulmonary emboli.

It's because it's a great pretender.

It can mimic other things.

A lot of people come in with just some shortness of breath,

because they have a viral infection,

and it's hard to pick up.

it's hard to test far.

It's hard to find on your scans, on your X-rays.

But now a days, they do have better tests.

Certainly, the CT angiogram is much better now at picking up

these pulmonary emboli.

NARRATOR But in Ellen's case, doctors

had no reason to suspect pulmonary embolism,

and hence, didn't run any of the potentially lifesaving tests.

As a result, her condition goes undiagnosed.

And by the next morning, her symptoms

have diminished, just enough to provide

a false impression of recovery.

She had breakfast.

She was in good spirits.

She wanted to go to work.

NARRATOR But moments after Ellen boards the bus,

her condition takes a catastrophic turn, when

several massive pieces of the clot

break off and travel to her lungs.

They look like worms.

They look like-- they can be as big as your finger.

NARRATOR Swept along in the blood stream,

these larger clots bombard the arteries

that connect the heart and lungs, until eventually they

get stuck.

It just clogs the plumbing.

It clogs the big pipes going into her lung.

No blood ends up going into her lungs.

No blood's getting back to her heart either.

She's not getting enough blood to her brain.

So in the process of dying, she has a seizure.

And by the time she gets to the emergency room, she's dead.

And it's just really a shame that it

slipped through the cracks in the emergency room.

It just wasn't on their radar.

NARRATOR Unfortunately, Dr. G will never

know what caused these deadly cloths to form

in the first place, because Ellen

didn't have any of the common risk

factors for pulmonary embolism.

We don't have any history of mobility.

Works as a maid, she's walking around.

She's certainly not pregnant.

She's not on any kind of estrogen.

She hasn't had any kind of long trip.

It could certainly be one of the congenital abnormalities,

where she has a problem with some over the proteins

that help clot the blood.

Some people, their blood becomes hypercoagulate,

more apt to clot.

So why her system got out of whack, of the clotting,

and the unclotting, and keeping it balanced,

the balance that we all have, why her's got out of whack,

we'll never know.

[music playing]

NARRATOR A few weeks later, toxicology results

arrive and confirm that dr*gs had nothing

to do with Ellen's death.

With the case finally closed, Dr. G

can now deliver her findings directly

to Ellen's sister, Deborah.

Well, what we found is--

I think her sister was surprised.

She was really blaming the group home for not

monitoring her medication.

And the other interesting thing we found--

But I don't think the group home is responsible.

--we'll take it out of that--

And I suggested for her to watch out for blood clots too.

Since her sister was at a young age--

-- to die from that, and so that

might be something that she should look out for.

All right, bye-bye.

[music playing]

(SINGING) Farewell, but soon I'll have to go.

You know, your life is on such a balance, isn't it?

[music playing]
[ … ]

(SINGING) --but you are what I'll miss the most.

It's just that slight imbalance caused

just that cascade of events that caused her death.

[music playing]

(SINGING) --will get me through.

I mean we're just all so lucky to be alive because there's so

many things that can go wrong.

[music playing]