06x07 - Deadly Storms

[bunniefuu]

NARRATOR A healthy -year-old boy

starts shaking uncontrollably and dies in his mother's arms.

By the time EMS gets there, his heart's just quivering,

and they just can't revive him.

NARRATOR And as Dr. G searches for clues,

the mystery surrounding his death only deepens.

So I don't know what's going on.

Nothing really was giving me any hints.

NARRATOR Then, a man falls asleep on his couch

after a night of heavy drinking and never wakes up.

He could have been a ticking time b*mb.

We just don't know until we do the autopsy.

NARRATOR And his sister is desperate for answers.

I wanted to know what happened to my brother.

He was too young to die.

[theme music]

NARRATOR Altered lives, baffling medical mysteries,

shocking revelations--

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

JAN GARAVAGLIA OK.

NARRATOR When chief medical examiner Dr. Jan Garavaglia

begins work on an autopsy, she is

often driven by a sense of responsibility

to the victims' families.

JAN GARAVAGLIA This is a sad one.

NARRATOR Especially in cases involving children.

Beautiful little baby.

He has soft hair and long eyelashes.

Obviously, the mother is going to suffer the most.

JAN GARAVAGLIA Being in forensics for something

years, it clearly is hardest for the parents when a child dies.

I don't think anybody should have a child die

and then not know why.

NARRATOR It's a sizzling hot August in Kissimmee, Florida.

And like children everywhere, -year-old Nick Balzano

is determined to enjoy his summer break to the fullest.

But just one week before school starts,

the teenager begins to feel sick.

He'd complained of an earache.

And then after that, he started having a headache.

And then he really started to get sick.

He started having a fever.

He was vomiting.

NARRATOR Over the next three days,

Nick's condition rapidly deteriorates

while his mother, Linda, grows increasingly alarmed.

JAN GARAVAGLIA She was giving him electrolyte fluids,

and she was giving him something to try

to bring down his vomiting.

NARRATOR But nothing seems to help.

Suddenly, the teenager's entire body

begins to shake uncontrollably.

Terrified, Linda immediately dials .

JAN GARAVAGLIA By the time EMS gets there,

his pupils are fixed and dilated.

And his heart's just quivering.

They take him to the hospital in the ambulance.

Unfortunately, they just can't revive him.

NARRATOR Nick is pronounced dead in the ER

with his grief stricken mother by his side.

You know, it's all happened so fast.

I'm sure the mother is devastated.

And she is going to want answers.

OK, let me see about the, um--

Dr. G, did you get these weights?

I'm getting all confused.

Where do you want me to put his stuff?

NARRATOR Thursday, PM.

It's already been a long day for the hardworking staff

at the District morgue.

Does it seem warm in here today to you guys?

It's hot.

It's the worst time of the year--

August, September in Florida.

NARRATOR But the case of -year-old Nick Balzano

is last up on Dr. G's roster.

A -year-old is rare to come in my morgue.

The children past one year of age, two years of age,

up until, you know, the late teens, we don't really

see very often in the morgue.

Because by that time, most of the congenital abnormalities

have been diagnosed.

They tend not to get so sick so fast.

If I see them, they tend to be in automobile accidents.

They tend to be falls or drownings.

They tend not to come in my morgue.

OK, so.

NARRATOR She begins by reviewing the case file,

searching for any clues that might

help explain the teenager's mysterious death.

We really are not sure what he has.

We do know that he's got about a three day history of fever,

not feeling well, headache, and some vomiting.

NARRATOR But according to his medical report,

the ER physicians who treated Nick

already have their suspicions as to what k*lled him.

They feel that this was probably bacterial meningitis,

and he d*ed too quick to get it diagnosed.

NARRATOR Bacterial meningitis is a deadly inflammation

of the meninges, the protective membranes that cover
[ … ]

the brain and spinal cord.

Classically, the symptoms that you worry about with meningitis

would be fever, and then probably

headache and stiff neck and then vomiting.

NARRATOR Meningitis can also be caused by a virus,

but unlike its bacterial counterpart,

viral meningitis is rarely fatal.

With viral meningitis, you know, the mortality

rate's less than %.

It's much more common, and you rarely are ever

going to have problems with it.

And you don't necessarily need to treat it.

If it's a bacterial meningitis, they

need to treat you very quickly because oftentimes, you can get

sicker and sicker and sicker.

You may die relatively quickly, and you may have long term

complications besides death if you don't

get those antibiotics quickly.

Do you think that they would do a temperature?

Let's see.

NARRATOR Based on Nick's symptoms and rapid decline,

Dr. G believes that the ER doctors may be on to something.

The hospital thought he had meningococcal meningitis, which

is a type of bacterial meningitis.

And that's really number one for me, too.

NARRATOR But if this theory proves true,

there could be a serious cause for concern.

If it truly is meningitis, we do

have to worry about his household

contacts, his friends, the people in the emergency room.

NARRATOR Should the diagnosis of meningococcal meningitis

be confirmed, Dr. G and the public health department

will have to move fast to prevent any further cases.

So we needed answers quickly.

NARRATOR But it's too late in the evening

to start a new autopsy.

Most of the morgue staff have already clocked out.

And although Dr. G can't examine Nick's body until the morning,

there's one thing she can do immediately that could yield

a quick result. But it does call for a small personal sacrifice.

I thought he'd call me.

I was planning on going out for dinner with my husband.

So I just told him I had to stay a little later

and that I was going to do an LP.

NARRATOR An LP, or Lumbar Puncture,

is often performed in suspected cases of meningitis.

During this procedure, fluid surrounding the spinal cord

is extracted to check for bacteria.

- Give up? - Yeah.

I'll bring you a latte.

It's on that.

JAN GARAVAGLIA A latte?

It's there for you.

JAN GARAVAGLIA Oh, I can't drink it in here.

NARRATOR As it turns out, Dr. G's husband, Dr. Mark Wallace,

an infectious disease specialist,

is already on his way to the morgue when he gets her call.

So Mark goes over, and I get the body ready.

NARRATOR But this simple procedure carries

with it an element of risk.

Even post-mortem, bacterial meningitis

can still be contagious.

Dr. G and her husband must take precautions

to protect themselves from possible infection.

My chance of getting it in the morgue is just not that great.

But there is a risk.

And so it's stupid to be cavalier about it.

NARRATOR Carefully, she inserts a and / inch needle

into Nick's spinal canal and draws

out a small amount of fluid.

And then we sent it immediately over to the lab.

He walked it over there for me.

Can't get better service than that.

I love you.

Thanks for bringing that.

Unfortunately, we couldn't get the answer that night.

We were just going to have to wait till the next day.

NARRATOR When Dr. G arrives at the morgue at

AM the following morning, the lab

report is already on her desk.

And it's a short read.

Lo and behold, there really wasn't

any evidence of meningitis.

NARRATOR But that doesn't mean that she can positively

rule out the disease just yet.

About % of the time with Lumbar Puncture,

you may just not see that bacteria.

I've got to keep my options open.

I don't know for sure that it's meningitis.

There is just a whole myriad of things

that you can be infected by.

So we really need to do the complete autopsy.

NARRATOR Dr. G is on a quest to discover what caused

-year-old Nick Balzano to die mysteriously

after three days of fever, headaches, and vomiting.

That family wants to know what happened to my beautiful child.

He was well.

And now he's dead.

NARRATOR And this autopsy will be particularly

difficult for Dr. G.
[ … ]

I have a -year-old boy.

I can't imagine that he would be there

one minute and dead the next.

That would be devastating for me.

NARRATOR Based on the teenager's symptoms,

Dr. G initially suspected meningitis.

But so far, tests have failed to reveal any sign of infection.

Maybe it isn't a bacterial meningitis.

Maybe it's a viral encephalitis from a mosquito.

Maybe there's another type of infection going on,

and it's my job to figure that out.

And why don't we put masks on?

Because I don't know what he's d*ed from.

NARRATOR As with all cases where

there's a possibility of contagion, Dr. G and her team

must take some basic precautions before beginning the autopsy.

If ever, ever, ever you have anybody coming in with any kind

of symptomatology of fever, illness, or not feeling well,

we have to really be careful.

You know, chances are we're not going to get anything,

but there's no reason to even take that chance.

NARRATOR With morgue technician Tom Hemphill by her side,

Dr. G gets her first good look at the teenager.

JAN GARAVAGLIA Cute, cute kid, though.

NARRATOR Inch by inch, she scans

Nick's body, her eyes peeled for any signs of infection.

Did you do an overall?

Does he look healthy?

Does he look ill?

Does he have a rash?

That's what I'm looking for.

NARRATOR But from the outside at least,

the boy appears to be in good shape.

You know, there's precious few clues on his body.

He doesn't have a rash.

He doesn't even particularly look sick.

You're saying, well, he's dead.

Well, some people come in the morgue and they look sick.

Some people don't.

He didn't look particularly sick for being supposedly

sick for three or four days.

There was really nothing on the external

that would definitively give me the answer.

NARRATOR Dr. G makes a standard Y incision,

cutting carefully from shoulders to sternum

and revealing Nick's internal organs.

JAN GARAVAGLIA As I'm opening him up,

I'm looking for anything abnormal.

But I don't see anything.

All right, so I'm going to do some cultures.

NARRATOR Her next priority is to collect fluids

for toxicology and blood samples so the lab can

check for the presence of an infection.

I really don't suspect a drug overdose because of his fever

and that he was under the care of his mother.

She's by his side.

All she's really giving him is electrolyte fluids

and a little bit of medication for his nausea and vomiting.

But you know, we never know, and we'll always do toxicology.

OK, so I wanted to see.

NARRATOR She then begins a thorough examination

of the heart itself.

Also high on my list is possibly

a myocarditis or inflammation of the heart muscle,

usually from a virus.

He was initially complaining of chest pain.

So that is something I would really need to rule out.

NARRATOR But right away, she can cross the organ

off her list of suspects.

The heart looks good.

His heart looked normal.

NARRATOR Next, she moves on to Nick's lungs,

and there she spots a problem.

JAN GARAVAGLIA Oh, something's funky over here.

NARRATOR They are heavy with fluid.

It's making the autopsy rather difficult here.

The problem with fluid in the lungs,

it sometimes makes it more difficult for me

to tell if pneumonia is there or not.

It didn't appear to me that there was,

but we will certainly look under the microscope.

I would keep that one in for me.

Yeah, yeah.

NARRATOR Finally, she turns her attention

to the abdominal cavity.

And she notes that the boy's kidneys

appear to be in good condition.

Kidneys looked what we call streaked.

Usually, what that tells me is he

had some low blood pressure for a period of time.

But they don't look like they're infected.

Everything was fairly normal.

NARRATOR As she wraps up the internal exam,

Dr. G still has no solid leads on what could have k*lled

the teenager so suddenly.

JAN GARAVAGLIA I don't know what's wrong with him.

He doesn't have any evidence of any type of infection

that I could see in his chest or abdomen.

Now I'm a little worried.

I need to diagnose what he has.
[ … ]

So at this point, I'm hoping the answer is in the brain.

NARRATOR Using an oscillating saw,

morgue technician Tom Hemphill cuts through the upper portion

of Nick's skull.

Head's ready for you, doctor.

NARRATOR And as Dr. G gently removes the skull cap,

she discovers something very disturbing.

Oh my god.

Look at that.

It appears there's something wrong with his brain.

Wow.

The brain was definitely swollen.

It showed evidence of herniation.

Things are not looking good.

NARRATOR Nick's brain has herniated,

or pushed through the opening at the base of his skull.

What a mess.

Once you herniate, it's a bad thing.

The brain starts compressing your respiratory centers

and your cardiovascular centers and your brainstem.

And you die.

Tragic, tragic.

When I see the brain, I know that is his cause of death.

NARRATOR But this autopsy is far from over.

In fact, the alarming finding raises

more questions than answers.

JAN GARAVAGLIA Even though I have the cause of death,

we still need to put it all together with the reason why.

What caused this swelling of his brain?

So now we gotta dig a little deeper.

NARRATOR Dr. G knows from experience

that a swollen brain can often be

traced to bacterial meningitis.

Ah, what else have we got going gone on here?

I look to see if the cerebral spinal fluid looks clear.

If it was meningitis, it looks very cloudy, giving it kind

of almost a milky cloudy look.

But the meninges don't look that bad.

There was nothing really that could give us the answer.

In conclusion, I don't have answers.

NARRATOR This case is becoming more puzzling by the minute.

Until I look under the microscope,

I can't say for sure that that kid didn't have meningitis.

NARRATOR Dr. G collects tissue samples from the teenager's

brain and other major organs.

These will be mounted onto slides

for microscopic examination.

Along with his blood work and toxicology,

they are Dr. G's last hope of figuring out what k*lled

-year-old Nick Balzano.

I'm very anxious to get those back.

I really would like to put this to rest why this child d*ed.

NARRATOR It's been three days since the inconclusive autopsy

of -year-old Nick Balzano.

And his blood culture results have just arrived

at the District morgue.

They wanted you to know that if there

was anything on the child, they'd ask you to call.

NARRATOR Despite a series of frustrating dead ends,

Dr. G still believes that a hidden infection most likely

caused the teenager's fatal brain swelling.

Now, she's hoping the lab work will help her

put the troubling case to bed.

I need to know why that child d*ed.

NARRATOR But as Dr. G scans the culture report,

she's surprised by what she sees.

They were negative.

There really is no evidence of infection.

NARRATOR Once again, they've come up empty.

And the toxicology report is more of the same.

All of those were negative.

I'm back to the beginning.

I have no answer whatsoever.

It was very frustrating.

NARRATOR Dr. G's options are quickly running out,

and there was only one place left to look.

At this point, the microscopic slides are going to be

my last hope to get the answer.

NARRATOR Dr. G slips the slide of Nick's brain tissue

underneath the microscope.

And what she sees next is nothing short of shocking.

JAN GARAVAGLIA I really couldn't

believe what I was seeing--

something very, very rare.

I've never had a case like this before.

NARRATOR But for this bizarre finding to make sense,

there is one last thing she needs to know.

When I asked the family what his recent activities were,

they did mention that he went swimming

just prior to being sick.

NARRATOR Armed with this new clue

and the astonishing microscopic results,

Dr. G is confident she can now solve the riddle behind Nick

Balzano's mysterious death.

At this point, really, I think we had the answer.

NARRATOR It's August.

School is out, and the temperatures

in Kissimmee, Florida are cresting in the hundreds.

But -year-old Nick Balzano has a plan to escape the heat.

I don't think we ever determined
[ … ]

where he went swimming.

But somehow, anywhere from days to three days

prior to dying, he's in a body of water.

NARRATOR Little does Nick know, as he begins to swim,

his body is being invaded by a microscopic and deadly

parasite.

I've been working as a pathologist

for at least years.

I've never seen it firsthand.

This is extremely rare.

He had amoeba.

NARRATOR An amoeba is a single celled microorganism.

There are many different kinds of amoeba.

But this is an amoeba that's known to infect the human body.

It's Naegleria Fowleri.

NARRATOR Naegleria Fowleri is known

as the brain eating amoeba.

Surprisingly, it lives in bodies of warm freshwater

all over the world.

However, the risk of actually developing an infection from it

is very low.

It really only causes infection and people

get the amoeba when the water temperature

is at least degrees.

NARRATOR Unfortunately for Nick,

that August, central Florida is experiencing

record high temperatures and very little rainfall.

It was an exceptionally hot, dry summer,

so the water tables went down, concentrating the Naegleria.

NARRATOR It's a tragic set of circumstances that

poses a troubling question.

If this amoeba thrives in warm freshwater everywhere,

why aren't more swimmers infected every year?

A lot of kids are swimming in the summer,

but hardly anybody will ever get it.

Really, nobody knows why some people will get this deadly

disease and some people don't.

NARRATOR Although science may never have an answer,

one thing is certain.

As soon as the amoeba infested water enters Nick's nose,

it sets into motion a deadly chain of events.

But whatever reason, that amoeba

is able to take hold through his nose,

and it goes past his normal defenses.

And then it follows a nerve into his brain.

NARRATOR Once inside, the amoeba begins

to eat away at the tissue.

The effect on the teenager is immediate and disastrous.

JAN GARAVAGLIA He starts out with a headache

at the beginning, starts out with not feeling well.

He seems even more nausea, he gets vomiting.

NARRATOR Nick's brain begins to swell,

and it isn't long before it compresses his brain stem,

the part of the organ that controls

vital functions such as breathing and heart rate.

That's probably when he sees he didn't

have brain function anymore.

And within minutes of getting to the hospital, he's dead.

It's devastating to see somebody so young and just innocent

die so quickly.

Hi, this is Dr. Garavaglia from the medical examiner's office.

Hi.

NARRATOR Dr. G now faces the difficult task

of sharing her findings with Nick's mother, Linda.

Although she is grateful to finally know

what k*lled her son, the grieving mother still

struggles to find closure.

Oh, I'm very sorry.

My answer sometimes helps people and sometimes doesn't.

It doesn't bring the child back.

But I do the best I can.

My job is to get the answer.

If he'd gone to the doctor earlier,

could he have been saved?

If you get this amoeba into your brain,

chances are you're going to die from it.

NARRATOR Dr. G immediately alerts the health department,

and they soon issue a public warning.

There's going to be a big news conference with the mayor.

NARRATOR But there is not much else they can do.

Sara, what time is the press conference?

We don't know where he got this amoeba.

Oh, no, is this the new one?

Every fresh body of water here in central Florida

has got it in the summer.

There's nothing I can do about that.

There's no way you can know that.

I'm not sure there's anything you can do.

I'll bet it'll be the lead story of the noon news.

It would be extremely rare to get it from a pool

because chlorination should k*ll the amoeba.

You're not going to get it from an ocean,

but you can get it from canals.

You can get it from lakes.

Puddles people have even got it from.

So not a bad day--

just tragedy.

We are at the epicenter for amoeba.

But it's not really something to worry about.

It takes some mild precautions of either not swimming
[ … ]

in water over degrees.

And if you do, wear nose plugs.

It's simple as that.

NARRATOR Many of Dr. G's cases involve

unpredictable circumstances that lead to untimely deaths.

But more often than not, she sees fatalities

that could have been prevented.

JAN GARAVAGLIA He shouldn't have d*ed.

It was his choices that he made that caused

him to die that day.

The new morgue has been under construction for months.

And today, we're checking in on its progress.

Wait till you see the morgue.

OK, we're in the new morgue.

They still have some final touches,

so workstations are in.

They're still putting in some cabinetry.

Lights are in.

We're excited about the lights.

Three coolers.

Our everyday workload was getting

to the point we didn't have enough room to keep

the bodies in the cooler.

We have a real special floor.

They put in.

The mother of all autopsy rooms.

See the kind of room?

Oh, that's nice.

You don't even have to push anything?

Oh, nice.

A lot of times after we do an autopsy, the rest of the staff

doesn't allow us to eat in the break room.

So we have an outside dining area,

so we can eat out here after doing

an autopsy, particularly at decomp,

and nobody will be bothered.

Well, believe it or not, the smell lingers.

Easily accessible.

The employees that are bad, they have to go in.

We've got one in this building and one in the other building.

They have to go in here and stand here for as long as Dr.

G has put them in timeout.

We got to get back to work, though.

Now we gotta get back to our old office.

NARRATOR It's a sweltering summer

day in Kissimmee, Florida.

But despite the heat, -year-old John Sullen

and his roommate Charlie have decided

to spend the day outdoors, grilling,

drinking, and playing cards.

At around PM, Charlie calls it a day and goes to bed--

Good night, man.

NARRATOR --leaving John alone on the couch.

The next morning, the roommate sees him in the same position

as when he went to bed.

NARRATOR Concerned, Charlie tries to wake him.

John.

John.

NARRATOR But John is unresponsive.

JAN GARAVAGLIA He immediately calls .

But he was dead when they checked in.

NARRATOR The -year-old's unexpected passing

shocks his sister, Janice.

It really upset me a little bit because you know,

I loved my brother.

He was special to me.

NARRATOR Now the family must put their trust in Dr. G

to see if she can explain why John was

taken from them so suddenly.

It's definitely something we need to answer for that family.

NARRATOR It's AM at the District morgue,

and the workday is just beginning.

Good morning.

Good morning.

NARRATOR But Dr. G can tell that it's going to be hectic.

JAN GARAVAGLIA And then we just have a whole assortment

of things going on.

We have car accident going at a high rate of speed.

We have a man who was surfing on the back of a car.

NARRATOR But the first case on the docket

is the unexplained death of John Sullen.

JAN GARAVAGLIA So today, we have

a -year-old African-American man who's

basically dead on the couch.

NARRATOR As her technicians prepare John's body

for autopsy, Dr. G pores over the events

leading up to his death.

And immediately, she spots a red flag.

The family said he'd been drinking.

He doesn't usually drink, and they thought

that very unusual behavior.

NARRATOR And according to his roommate,

John wasn't just drinking casually.

When we hear somebody is drinking heavily,

you know, you worry about alcohol poisoning,

particularly in someone who's not used to alcohol.

NARRATOR As she reads on, however,

Dr. G discovers that John had another vice.

Wow.

NARRATOR One that also may have threatened his life.
[ … ]

JAN GARAVAGLIA He does smoke about a pack

of cigarettes a day.

And smoking is a risk factor for stroke

and cardiovascular disease and is probably

the number one risk factor.

NARRATOR She now wonders if smoking,

along with the binge drinking, could have k*lled

this seemingly healthy man.

But it isn't long before Dr. G comes across another alarming

revelation.

JAN GARAVAGLIA He had his leg amputated about a year ago

because his toe was gangrenous.

NARRATOR Gangrene occurs when a part of the body

is receiving insufficient blood supply

due to an injury, infection, or underlying

illness such as diabetes.

Left untreated, the tissue eventually begins to die.

And once you have dying tissue,

it's more apt to be infected.

NARRATOR According to the medical report,

John had contracted an infection on his left foot

sometime in December of the previous year.

But amazingly, he ignored his symptoms until the gangrene

was already out of control.

His entire foot and ankle has become black,

so they had to do an emergency of below the knee amputation.

It was his life or his leg, and they had to take his leg.

NARRATOR At the time, John's doctors attributed the gangrene

to atherosclerosis, a buildup of fatty plaque

in his blood vessels.

They felt he had severe atherosclerosis on the vessels

going to his legs.

If the vessel is narrowed, the blood can't get to it.

That oxygen can't get to the muscle.

And eventually, like this man, he can get death of the tissue.

NARRATOR After the surgery, a pathologist did a full exam

on John's amputated leg to confirm the doctor's

theory about atherosclerosis.

But these results are missing from his medical records.

JAN GARAVAGLIA I only got a portion of that medical record.

I clearly still need to see that pathology report.

What did his leg really look like?

Did he really have atherosclerosis in his leg?

NARRATOR If it was atherosclerosis that caused

his gangrene, she wonders if it had blocked other blood

vessels in his body as well.

And the most common and deadly place for the disease to strike

is the heart.

You know, I need to look at his heart.

We just don't know what k*lled him.

And the family they just wanted to make sure we did an autopsy.

As you know, not everybody that comes through the morgue

gets an autopsy necessarily.

If you have significant medical history

or you're expected to die, we may not

do an autopsy once we confirm that you have no trauma.

Yeah, just kind of wipe the blood off.

But this family was very concerned with him.

I wanted to know what happened to my brother.

Because he was young, too young to die.

JAN GARAVAGLIA I agreed he was too young.

We need to figure out what happened.

So with the external examination,

we're just going to look for any clues

that could give us information about what happened to him.

Just his chest.

NARRATOR Dr. G begins the external exam

with a careful inspection of John's amputation stump.

Really, what you worry about is sometimes

they can get chronic poor wound healing.

But the amputated stump looked OK.

It didn't look infected, anything wrong with that.

Clearly, that's healed and he's moved on.

NARRATOR Next, she scours John's head

for any swelling or suspicious injuries

JAN GARAVAGLIA When you're drinking,

you know, trauma is a real possibility.

And you may not tell anybody that you stumbled

and fell and hit your head.

But I don't see any direct trauma.

NARRATOR Still, the absence of external clues

only deepens the mystery.

And given John's medical history,

the possibilities are sobering.

You know, he clearly doesn't go to the doctor

unless it's a crisis.

He didn't do anything about his leg until it almost k*lled him.

He could be a ticking time b*mb.

NARRATOR Dr. G prepares to cut open the body of John Sullen.

No, thanks for worrying about me, Brian.

NARRATOR The -year-old amputee

was found lifeless in his living room

after a night of heavy drinking.

His unexpected death has shaken the family

already wrought with tragedy.

I loved my brother, and I had just

a couple of years buried my mama and buried

another of my brother.

So when this happened with him it was just like, oh my god.

Thanks.
[ … ]

It's always hard for the family to have to wait.

We're going to just have to do the internal exam

to get the answer.

OK.

So I do my initial Y incision, and

before I look at any of the organs,

I need to take the toxicology.

Because we're so worried about possibly alcohol poisoning.

NARRATOR Dr. G draws samples of John's blood and urine

to send to the lab for testing.

Then she moves on to the abdominal organs.

Still concerned that alcohol might

have played a role in his death, she starts with the liver.

Sometimes people can drink enough on a binge

that you get tremendous fatty liver.

So is it a large fatty liver associated

with his binge drinking?

And it wasn't.

NARRATOR Dr. G continues to scour the rest of John's

abdominal organs, looking for anything that could

help explain his sudden death.

But after a thorough search, she comes up empty.

Overall, his abdominal organs looked relatively normal.

NARRATOR Next, she turns her attention

to John's chest cavity.

And when she opens the chest plate,

she immediately sees the first sign of disease in his lungs.

When I look at his lungs, his lungs show some emphysema.

It goes along with the smoking.

NARRATOR And that's not all.

When she removes the lungs, she finds a puzzling clue--

a small patch of fibrosis or scarring.

JAN GARAVAGLIA It's nothing that would have k*lled him,

but I'm not quite sure what it's from.

So I'm going to take a biopsy of that,

look under the microscope.

Yeah, go ahead.

NARRATOR Finally, she turns her attention to the heart.

The medical records suggest he had atherosclerosis in his leg.

And Dr. G wonders if he might also have a fatal buildup

of plaque in his heart vessels.

To find out, she begins dissecting

the coronary arteries--

JAN GARAVAGLIA All right.

NARRATOR --one by one.

JAN GARAVAGLIA So the first thing I look at

is the left main coronary artery,

and I slice it down a few millimeters at a time.

It looks completely normal, not a bit of atherosclerosis.

I do his diagonal branches.

There's no atherosclerosis.

I do the right coronary artery.

No atherosclerosis.

Not a bump in the road.

And I was really shocked, actually.

He didn't have any.

Hm.

NARRATOR But then she cuts into the left anterior descending

artery, and right away, she finds

what she's been looking for.

There is some yellow atherosclerosis

buildup of that plaque in an adjacent thrombus.

NARRATOR The thrombus, or blood clot,

is large enough to have blocked the entire artery.

And that ultimately caused his heart

to have lack of blood going to the front of his heart.

That's a classic heart att*ck.

That was ultimately what k*lled him.

NARRATOR It's the kind of discovery that would normally

bring the autopsy to a close.

But it isn't long before Dr. G notices

something else, something quite odd.

He got heart muscle damage in places that don't make sense.

NARRATOR Damage to the heart muscle

can be seen after a heart att*ck,

but only where the blocked artery

deprives the tissue of blood.

In John's case, she can see muscle

damage in multiple locations.

And surprisingly, it's everywhere except in the area

supplied by the blocked artery.

There's only one coronary artery

I can find that has narrowing, and that's

the least damaged area.

He's got heart muscle damage in places not even supplied

by that coronary artery.

Why does he have all that heart muscle damage

with no other plaque?

NARRATOR This extensive damage could have been the result

of a virus, disease, or even a genetic abnormality,

which means his sister, Janice, could also be at risk.

There's a lot of questions to be answered, some of which

has some definite implications for the family.

I don't really have the true answer.

And I'm hoping maybe my microscopic slides could tell

me what's going on with him.

NARRATOR Dr. G has just learned that John Sullen d*ed

from a heart att*ck and that it was caused

by a huge coronary thrombus, a blood clot in the artery that

leads to the heart.
[ … ]

But she's also found something extremely puzzling--

damage to the heart muscle in unexpected places.

The pattern of heart muscle damage

doesn't fit what I'm seeing in the coronary artery.

Some of this is not making sense.

NARRATOR In the meantime, John's

grieving family is struggling to make sense of his sudden death."], index ,…}

Every day I think about my brother--

you know, every day.

I have a picture of him and me when we were younger.

And I look at it every day.

I really can't wrap it up for him until after the micros.

Hopefully the micros would give me the answer.

NARRATOR Two weeks later, Dr. G receives the microscopic slides"], index ,…}

of John's tissue samples.

Hoping to identify his mysterious condition,

she inspects his heart tissue at times magnification.

It confirmed what I saw with my naked eye.

He had death of the heart muscle in various ages of healing.

NARRATOR But then, she spots an incredible clue,

one she couldn't see at all during the autopsy.

So when I'm looking under the microscope of the heart,

I actually find something I'm not expecting.

What I saw was another thrombus in that heart muscle.

NARRATOR But that's not all.

Looking next at his lung tissue, she's shocked to find

yet another clot.

I can actually see a blood clot, which

has reabsorbed and just left the remnants of the clot

in the pulmonary artery.

NARRATOR This discovery is alarming

evidence that something terribly wrong

was going on inside John's body.

And when Dr. G finally received the pathology records

for John's amputated leg, all the pieces of the puzzle

fall into place.

JAN GARAVAGLIA I was assuming that he

had a severe atherosclerosis on the leg.

But they did, like, a mini autopsy on his leg

after it was amputated.

And as it turns out, they didn't find any atherosclerosis.

NARRATOR On the contrary, what they

found were several clots that were

preventing blood flow to the lower part of John's left leg.

As it turns out, the clots were the real cause

of John's gangrene and eventual amputation.

It's a critical clue and one that

finally reveals the truth behind John Sullen's mysterious death."], index ,…}

I think we've hit upon what the ultimate cause of death is.

NARRATOR It's a sizzling summer afternoon,

and John Sullen, along with his roommate,

Charlie, is outside grilling and playing cards.

But today, John isn't quite himself.

He's drinking and that's very unusual for him.

NARRATOR Still, as Dr. G determines

from the final tox report, he's hardly drowning in liquor.

He was drinking, but not all that much.

He was just at the legal limit of driving and intoxicated.

He had about a ..

To k*ll you, you need at least around a ..

So he wasn't anywhere near that.

He was drinking, and he was drinking heavily, but not

anywhere enough to k*ll you.

NARRATOR Instead, there's a far greater thr*at to his life,

one that began long before his leg amputation.

He's probably got a hypercoagulable state.

His blood clots very easily.

That can be due to some genetic problems, where you're missing

some proteins in your blood and your blood

will clot more easily.

And that fits with the blood clot I'm finding in his heart,

you know, in his lung.

NARRATOR This also explains the gangrene.

Additional blood clots in John's left leg

likely cut off the blood supply to his foot.

And just like the little heart muscle areas were dying,

the lower leg was dying.

NARRATOR But doctors mistakenly concluded

that John's gangrene was caused by atherosclerosis

and that the amputation resolved his problem when,

in fact, deep inside his body, his blood

continued to form new clots.

Slowly, they begin to damage his heart and lungs.

I'm sure this fellow is not feeling well.

I'm sure he's ignoring a lot of his symptoms.

He might have even had chest pain,

and that's one theory why he started drinking, that he

was treating his own pain.

NARRATOR But while alcohol may help mask John's discomfort,

nothing can stop the chain of events

taking place inside his body.

His heart was starting to give out

because there are multiple areas of heart muscle

missing because it had d*ed.

NARRATOR And on that same night,

he forms a blood clot that completely blocks

the opening of the one coronary artery

already narrowed by plaque.

Boy, that's unlucky.

You got one little narrowing by atherosclerosis,
[ … ]

and then you get the clot associated with it.

That clot occluded and blocked all blood

flow in a heart that's already failing, already irritable.

And that was the coup de grace and caused

him to go into an arrhythmia.

NARRATOR His heart spasms, unable

to establish a regular rhythm.

Without fresh blood and oxygen, his vital organs

begin to shut down.

And the -year-old dies on his living room couch.

Dr. G's first call is to John's sister, Janice, who reacts

to the news with some relief.

Dr. G gave me closure because I would have never knew

what really happened with my brother

if she wouldn't have did that autopsy.

I would have never knew.

NARRATOR She also provides the family

with some critical information that

could help prevent the same thing

from happening to one of them.

There also could be a genetic abnormality that they

might have trouble with.

So that's something for them to let their doctor know,

that their brother had a problem with multiple blood clots

and make sure that they're tested.

NARRATOR Dr. G's only regret is that she couldn't

prevent John's death as well.

That's the old saying.

Pathologist knows everything but can do nothing.

I wish he'd had that diagnosed while he was still alive.

You know, you can give him medication

to keep his blood from clotting, but it's too late now.