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[DRAMATIC MUSIC]
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NARRATOR: An elderly man dies at home
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from apparent natural disease.
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He has severe coronary artery disease.
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He has hypertension, he has diabetes.
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NARRATOR: But when his family discovers his car is missing,
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they wonder if something more sinister is to blame.
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JAN GARAVAGLIA: I think everybody is thinking,
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could this be foul play.
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NARRATOR: Now, Dr. G must solve this puzzling mystery.
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JAN GARAVAGLIA: We're going to bring him back
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from the funeral home, and I'm going to make sure there's
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no evidence of trauma.
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NARRATOR: And then, a 73-year-old grandfather
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takes a relaxing trip to Orlando with his family,
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only to find himself wracked with pain on his first night
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in town.
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JAN GARAVAGLIA: The next morning,
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he eats breakfast and then just doubles over in abdominal pain.
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As soon as he went down, he was dead.
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NARRATOR: Can Dr. G determine what suddenly overwhelmed
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this seemingly healthy man?
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I have to think a what could cause the abdominal pain
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and then kill you?
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NARRATOR: Altered lives, baffling medical mysteries,
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shocking revelations.
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These are the everyday cases of "Dr. G, Medical Examiner."
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This morning, Dr. G's day won't start in the morgue.
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Instead, in an effort to stay fit and healthy,
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she's off for a jog.
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JAN GARAVAGLIA: I got the radio on, the Bee Gees going.
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I listen to some great music.
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Usually something to get your blood going.
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And then I'll start running, and I can run a couple miles.
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Even though I have a hectic home life,
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you gotta make time for yourself in one good way,
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and you can kill two birds with one stone,
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I find, is if you exercise, because you're
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doing something good for yourself,
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and it's a great stress reliever.
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I would love to be a couch potato,
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but I know it's good for me, and I it's a good way to relax.
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NARRATOR: But by 8:15 AM, she is in the morgue, ready to start
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work on the day's autopsies.
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This morning, Dr. G's first case is a man
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who was found dead in his home in Deltona, Florida
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late last night.
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JAN GARAVAGLIA: So this is a fellow
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we got a call from yesterday.
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He's an older man, 81.
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He has a locked apartment.
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NARRATOR: As a first step, Dr. G reviews the case
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file of Ricardo Sanchez and learns the events
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leading to his death.
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According to investigator, Bill Stratton, friends and family
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last saw Ricardo four days earlier
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when he left a small get-together just before dusk.
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BILL STRATTON: The decedent was going
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to drive home before dark, because he
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didn't like driving at night because
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of his age and his eye--
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he had some minor eye problems.
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NARRATOR: Bill Stratton learned from his family
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that Ricardo was an energetic man
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with a great sense of humor.
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During the last several years, he had spent most of his time
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with his close-knit family, enjoying his retirement.
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Like many of the elderly, Ricardo,
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who had lived alone since his divorce 10 years earlier,
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clung to his independence.
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He insisted on driving rather than rely
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upon others for transportation.
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He also refused any professional home care
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despite his failing health.
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As far as his family and friends knew,
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Ricardo made it home safely that evening.
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However, four days later, no one has heard from him.
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JAN GARAVAGLIA: His family worried about him.
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They did a welfare check on him and found him deceased
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in his locked apartment.
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NARRATOR: Ricardo's son and sister discover him face down
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on the floor wearing the same outfit he had
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on at the family get-together.
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JAN GARAVAGLIA: He is just dead right
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there as if he had collapsed.
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NARRATOR: According to the police officer who was called
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to the scene, the body is already beginning to decompose,
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but there were no signs of foul play.
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HAROLD FELSHAW: There was nothing
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that appeared to be out of the ordinary or suspicious
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in nature.
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His door was locked.
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There was nothing in disarray.
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He had his car keys in his pocket.
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He had his billfold in his pocket.
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He had his jewelry on.
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His clothes were intact.
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Everything seemed fine.
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It looked as if he had just collapsed.
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Our belief, the police department's belief,
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and the medical examiner's office
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was that this was a natural death.
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We didn't have any reason to believe otherwise.
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NARRATOR: And when contacted, Ricardo's private physician
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agrees with the assessment.
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JAN GARAVAGLIA: We called the doctor,
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the doctor said, yeah, he has severe coronary artery disease.
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He has hypertension.
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He has diabetes.
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He could have died at any time.
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NARRATOR: Ricardo's death is classified as natural,
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and his body is transferred to a funeral home for burial.
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But only hours later, his family makes a startling discovery,
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one that raises new suspicions.
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His car is missing.
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JAN GARAVAGLIA: The detective gave us a call
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and said, you know, the fellow that we released,
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everything was still--
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it was fine, except where's his car?
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So that right there is kind of a red flag to indicate
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that something's not right.
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I think everybody is thinking, could this be foul play?
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I said, well, you know, we should look at him.
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We should go back.
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We should go to the funeral home,
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bring him in, at least do X-rays and look at him externally.
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NARRATOR: Based on this new information,
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Dr. G wonders if Ricardo did not die from natural causes
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after all.
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JAN GARAVAGLIA: We'll go ahead, we'll
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check on him any type of trauma, and we'll
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go ahead and do X-rays and see if we see anything.
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NARRATOR: Before the examination,
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morgue technicians take extensive X-rays
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of Ricardo's body.
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JAN GARAVAGLIA: We did an X-ray of his skull.
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We did an X-ray of his ribs and long bones.
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NARRATOR: While soft tissue internal injuries may not
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be detectable in an X-ray, if Ricardo
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sustained any fractures in an attack,
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these will show up on the film.
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While the images are being developed,
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Dr. G prepares for the external exam.
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She will search for any signs of trauma
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that might indicate Ricardo was the victim of an assault.
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JAN GARAVAGLIA: But I certainly didn't
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see any major trauma on him.
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NARRATOR: And when Dr. G reviews the X-rays a few minutes later,
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she finds no fractures or skeletal injuries either.
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JAN GARAVAGLIA: We really don't have any foul play.
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We don't have anything really that suspicious.
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NARRATOR: Because she finds nothing out of the ordinary,
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Dr. G decides not to perform a full autopsy.
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Instead, just after noon, Ricardo's body is
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returned to the funeral home.
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However, with explanations wanting,
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the Sanchez family remains unsettled
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by the elderly man's death.
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JAN GARAVAGLIA: They're concerned what happened to him.
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But they're more concerned what happened to the car
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and did it relate at all to his death?
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NARRATOR: Then, just hours after Ricardo's body
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is released from the morgue, the Orlando
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Police Department calls Dr. G with startling new information.
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[PHONE RINGS]
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Ricardo's vehicle has been located in an auto wrecker lot.
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Yeah.
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We ran into a little difficulty.
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Now we knew that this man was involved
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in a motor vehicle crash.
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JAN GARAVAGLIA: Now I have to worry,
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was he injured from the car accident?
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NARRATOR: Given the unusual circumstances surrounding
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Ricardo's death and to bring closure to his family,
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Dr. G must perform a full autopsy.
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JAN GARAVAGLIA: And so lo' and behold,
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this changes the complexity of the case.
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NARRATOR: When his family receives the disturbing news
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that Ricardo's death may be due to a car accident,
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their distress and grief are compounded by another emotion.
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JAN GARAVAGLIA: The family feels a lot of guilt
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because they know that their loved
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one's older family member's driving
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skills aren't probably as good.
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But yet, they don't want to take it away, because then
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you take away their freedom.
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NARRATOR: The body must be immediately transported
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from the local funeral home to the morgue for a second time.
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JAN GARAVAGLIA: So what we're going to do
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is figure out what killed him.
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NARRATOR: Coming up next, Dr. G opens
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the body of Ricardo Sanchez, and the case takes a sharp turn.
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JAN GARAVAGLIA: He was a walking time bomb.
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He could have died at any time.
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NARRATOR: When "Dr. G, Medical Examiner" continues.
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[DRAMATIC MUSIC]
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Early in the morning, the body of 81-year-old Ricardo Sanchez
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returns to the District 9 morgue in downtown Orlando.
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Orlando police have just discovered
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that he was in an auto accident on the day of his death.
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Now, his family and Dr. G want to know if Ricardo's death was
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caused by an injury in the accident and not
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natural disease, as they had suspected.
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JAN GARAVAGLIA: If I hadn't have called that booty back,
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I would have been remiss in my duties as a medical examiner.
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NARRATOR: Before beginning the examination,
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Dr. G learns the specifics of the crash
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from the investigating officer at Orlando PD.
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JAN GARAVAGLIA: Classic kind of old-person accident.
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He fails to yield and makes the turn in front of a car
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that's coming in that lane.
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NARRATOR: Now, Dr. G must determine
00:11:01
if Ricardo Sanchez's death was in fact caused
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by a tragic car accident.
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JAN GARAVAGLIA: So what we're going to do is look for trauma,
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look for natural disease.
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Bottom line, figure out why he died.
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And so I do the Y incision.
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Keep in mind, he's decomposed.
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He won't have any blood left.
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So I'm having a hard time doing tox.
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He does have some maroon bloody decomposition
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fluid that we typically see in his chest cavity.
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I would remove that for toxicology.
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NARRATOR: Dr. G then examines Ricardo's internal organs.
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She's looking for any signs of internal trauma
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that may have been sustained from the accident.
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JAN GARAVAGLIA: One thing that I'd worry about
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is maybe a delayed complication would be a spleen that
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had ruptured or maybe a liver laceration,
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where blood is accumulating.
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I was worried about that.
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Didn't have that.
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Didn't really have any trauma to his abdomen.
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OK.
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I don't see anything.
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NARRATOR: But Dr. G sees no ruptures or lacerations.
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And she finds no sign of internal bleeding.
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JAN GARAVAGLIA: And I don't see any free blood anywhere.
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I don't see any free blood in his chest, just
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that decomp fluid in his belly.
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NARRATOR: Based on these findings,
00:12:30
it seems that Ricardo's death was not related to the accident
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after all.
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Dr. G is now left with the original hypothesis,
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that the 81-year-old man died of natural causes.
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His medical history certainly supports this possibility.
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According to Ricardo's doctor, he
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suffered from high blood pressure,
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emphysema, and heart disease.
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Dr. G will now weigh and dissect each organ to search for signs
00:13:01
of fatal natural disease.
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She starts with the heart.
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He has narrowing of every vessel sectioned.
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They were at least 75% narrowed in every section
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that I looked at.
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So he was a walking time bomb as far as dying from that heart.
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NARRATOR: At this point, Ricardo's diseased heart
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is looking like the culprit.
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JAN GARAVAGLIA: And that is a possibility.
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And that's right now all we can find.
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NARRATOR: But she must complete the full autopsy
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to know for sure.
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JAN GARAVAGLIA: I have to make sure there's
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nothing that trumps that heart.
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NARRATOR: Coming up next, Dr. G examines another organ,
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and the case veers off course yet again.
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JAN GARAVAGLIA: I find blood, and it's fresh blood.
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NARRATOR: When "Dr. G, Medical Examiner" continues.
00:14:06
[DRAMATIC MUSIC]
00:14:20
OK.
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So he's ready to go up to the head.
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- Up to the head. - OK.
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NARRATOR: Dr. G prepares to examine the brain
00:14:26
of 81-year-old Ricardo Sanchez.
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Internally, she's discovered evidence of extensive heart
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disease and suspects that he may have suffered a fatal heart
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attack only a few hours after being involved
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in a minor car accident.
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This would mean that Ricardo did,
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in fact, die of natural causes, as was first suspected.
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JAN GARAVAGLIA: He certainly had enough heart
00:14:48
disease to have killed him.
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NARRATOR: But before she can close the case,
00:14:53
she must complete the autopsy and rule out everything else.
00:14:58
Was there anything else that could've killed
00:15:00
him instead of that heart?
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NARRATOR: As a next step, Dr. G examines
00:15:09
the skull of Ricardo Sanchez to feel for any softness
00:15:13
that might indicate trauma.
00:15:16
But this exam is particularly difficult due
00:15:19
to the state of decomposition.
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It was just a little bit mushy throughout because
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of the decomp.
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You know, a lot of gases form and fluid collects.
00:15:29
And particularly, as you're on your back,
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there's some fluid that collects in the back.
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NARRATOR: Next, she cuts open the scalp
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and reflects it to expose the top of the skull.
00:15:41
And there she sees for the first time something unmistakable.
00:15:44
He's got a bruise on the back.
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There was just a bruise there.
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This was quite clear as soon as I cut open.
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It was a bruise in the back of his head,
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and it was also what we call subgaleal.
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It was over that thin covering over the bone.
00:16:04
How that relates to any of this, we're not sure yet.
00:16:07
We just know he bumped his head.
00:16:10
So the next thing we have to do is look inside the brain.
00:16:12
And I know I only have a second here, because that brain
00:16:15
is going to be very soft.
00:16:17
NARRATOR: As the brain decomposes,
00:16:18
it turns into a semi-liquid state, which can obscure
00:16:22
signs of trauma or disease.
00:16:24
JAN GARAVAGLIA: I'm not going to be
00:16:25
able to see subtle things on his brain,
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because it's going to be green and pasty.
00:16:30
And it's going to lose a lot of its contour.
00:16:32
So I'm hoping there's something either
00:16:35
very obvious or nothing at all.
00:16:38
NARRATOR: And in this case, it's very obvious.
00:16:42
JAN GARAVAGLIA: As my assistant cuts open the calvarium,
00:16:44
and I'm kind of looking.
00:16:45
I'm the one that then takes it off
00:16:47
and immediately looks and, oh.
00:16:51
I find blood overlying the cerebral hemispheres,
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overlying the brain, and it's fresh blood.
00:16:59
You know what?
00:17:00
Let's get time to collect this, my love.
00:17:02
NARRATOR: What Dr. G finds is a subdural hematoma, a bleed
00:17:06
in the brain that occurs under the dura,
00:17:09
the protective membrane that covers the brain.
00:17:12
And these little bridging veins with some trauma
00:17:15
can shear, and then blood starts collecting.
00:17:18
Well, where's that blood going to go?
00:17:21
It doesn't have a lot of places to go,
00:17:23
because you have that brain usually up tight against there.
00:17:28
So it starts pushing on the brain.
00:17:30
Well, at this point, it's fairly clear.
00:17:32
He definitely has trauma to the brain.
00:17:35
NARRATOR: It's a shocking discovery.
00:17:37
Lo' and behold, that's his cause of death.
00:17:41
NARRATOR: Dr. G now knows for certain
00:17:43
what killed Ricardo Sanchez, a significant head injury.
00:17:48
And she also knows how the fatal trauma must have occurred.
00:17:52
JAN GARAVAGLIA: And it's consistent with a car accident.
00:17:54
It's typically what we will see with a car accident
00:17:56
with shearing forces tearing those bridging veins.
00:18:03
Wow, he really hit hard.
00:18:06
Lo' and behold, he did die from the car accident.
00:18:08
It's an accidental death.
00:18:09
You know, initially we thought it was going to be natural.
00:18:12
You could not see the trauma.
00:18:18
Do you have one that's kind of clean?
00:18:20
At least we eventually got the right answer.
00:18:24
NARRATOR: It's an unexpected ending
00:18:26
to a highly unusual case.
00:18:31
After several stops and starts, Dr. G
00:18:35
can at last inform Ricardo Sanchez's bereaved family
00:18:38
of her tragic findings.
00:18:50
According to family and friends, Ricardo
00:18:52
leaves a get-together to drive himself
00:18:54
home sometime near dusk.
00:18:59
JAN GARAVAGLIA: He is a smart enough fellow
00:19:01
to know he has to leave the party
00:19:03
before it gets dark, because his vision is not as good.
00:19:07
He has trouble with glare, most likely.
00:19:10
NARRATOR: Unfortunately, only a few miles from home,
00:19:13
his trip is cut short.
00:19:16
JAN GARAVAGLIA: He's trying to make a left-hand turn.
00:19:19
He probably either doesn't see the car
00:19:21
or doesn't react well enough to the car coming
00:19:24
and turns right in front of the car,
00:19:28
causing that car to hit him.
00:19:30
NARRATOR: The force of the impact
00:19:31
causes the blood vessels beneath his dura to tear
00:19:34
and slowly begin to bleed.
00:19:37
JAN GARAVAGLIA: The subdurals are venous blood,
00:19:39
and it may not bleed real fast.
00:19:42
NARRATOR: Had he requested medical attention at the scene,
00:19:44
Ricardo might have survived.
00:19:48
But Ricardo likely did not realize
00:19:50
the severity of his condition for two reasons.
00:19:53
Initially, the bleeding can be slow
00:19:55
and often does not cause any problems.
00:19:58
Also, like many elderly individuals,
00:20:01
Ricardo's brain has atrophied with age
00:20:03
and is actually better able to accommodate the bleeding.
00:20:07
JAN GARAVAGLIA: As you get older, your brain shrinks.
00:20:11
Now that is the reason why he might not have noticed it right
00:20:14
after the accident, because there is a little space there
00:20:18
for the blood to collect, not causing
00:20:20
so much trouble to his brain.
00:20:23
NARRATOR: After the accident, Ricardo's car
00:20:25
is towed to an auto wrecker yard and someone from the yard
00:20:30
drives him home.
00:20:35
Once in his apartment, the delayed effects of the injury
00:20:38
begin to hit full force.
00:20:41
JAN GARAVAGLIA: He probably isn't home
00:20:43
very long when the blood just starts
00:20:45
accumulating more and more.
00:20:48
It gets to the point, by the time he gets home,
00:20:51
that there is no space left.
00:20:53
But the blood keeps pumping, and then it puts
00:20:56
too much pressure on the brain.
00:20:59
NARRATOR: As Ricardo gets up from his chair,
00:21:01
the increasing pressure on the vital centers of his brain
00:21:04
suddenly causes him to lose consciousness.
00:21:08
Soon, he slips into a coma.
00:21:11
JAN GARAVAGLIA: If you increase the pressure
00:21:12
into the cranial cavity, you're putting
00:21:14
pressure on the whole brain, the cerebral hemispheres.
00:21:18
Eventually, you're going to pass out.
00:21:19
You're going to stop breathing, and your heart will stop.
00:21:30
NARRATOR: The news devastates Ricardo's family.
00:21:34
They now know that his death may have been preventable, if only
00:21:38
he had requested medical treatment
00:21:41
or if he had not insisted on continuing to drive.
00:21:46
It was sad for the family to know,
00:21:48
because this is their loved one driving.
00:21:51
They think he's still probably OK to drive,
00:21:53
and it ends up killing him.
00:21:58
I think it was a little more comforting to think
00:22:00
that he just had an arrhythmia from his heart disease
00:22:02
and died.
00:22:03
I mean, I wish I could have told them that.
00:22:05
But unfortunately, I have to tell them the truth
00:22:09
of what really happened.
00:22:18
NARRATOR: Coming up next, a grandfather
00:22:20
travels from England to Orlando to visit his family.
00:22:24
But in an instant, his long-awaited vacation
00:22:27
turns tragic.
00:22:29
They were just very surprised and maybe a little guilty.
00:22:33
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:22:37
[DRAMATIC MUSIC]
00:22:52
It's been a long day for Dr. Jan Garavaglia,
00:22:55
chief medical examiner of Orange and Osceola Counties.
00:22:59
And the stress of multiple cases is beginning to take its toll.
00:23:03
If it's a busy day, and I have a lot of cases,
00:23:06
you're basically on your feet the whole time
00:23:09
you're down here.
00:23:09
You're standing on your feet, and you're literally cutting.
00:23:14
Let's just think about standing at your kitchen counter,
00:23:17
constantly cutting for eight hours, six hours, seven hours.
00:23:22
And so it is very exhausting.
00:23:25
NARRATOR: But she can't rest yet.
00:23:27
Well, I mean, you want to keep going, because everybody
00:23:29
wants your answer.
00:23:31
And you want to do a good job, and you
00:23:33
want to keep going because there's work to be done.
00:23:35
There's answers to be had.
00:23:38
NARRATOR: Her last body of the day
00:23:40
is an elderly man named Julian Noble.
00:23:48
As a first step, Dr. G reads the investigator's report
00:23:51
and learns about the circumstances
00:23:53
surrounding Julian's death.
00:23:56
JAN GARAVAGLIA: We have a 73-year-old man
00:23:57
this morning that I may or may not autopsy somebody that age.
00:24:02
But he's got a very interesting presentation.
00:24:05
He just comes in from Europe.
00:24:07
He's on vacation here.
00:24:09
So I don't know anything about him.
00:24:10
He's got atypical symptomatology of like doubling over
00:24:14
in abdominal pain and then just dying.
00:24:17
It'll be interesting to see what that is.
00:24:20
NARRATOR: Yesterday, the widowed businessman from England
00:24:22
arrived in Orlando to visit his family,
00:24:25
whom he hadn't seen in over a year.
00:24:30
JAN GARAVAGLIA: When he landed, the plane
00:24:32
landed, he started complaining of some of abdominal pain.
00:24:38
By that evening, he tries to eat some soup
00:24:45
and still has some abdominal pain.
00:24:48
NARRATOR: His son, Thomas, is concerned.
00:24:51
But Julian assures him that he'll be fine,
00:24:53
and he goes to bed.
00:24:56
The next morning, he is able to eat breakfast but then just
00:24:58
doubles over in pain in his abdomen and then collapses.
00:25:08
NARRATOR: Thomas immediately calls 9-1-1.
00:25:13
In minutes, paramedics arrive on the scene and attempt
00:25:17
to stabilize Julian.
00:25:21
But their efforts are in vain.
00:25:25
By the time they get him to the hospital,
00:25:26
he's already without a pulse.
00:25:29
Dead on arrival.
00:25:32
NARRATOR: Now, Julian's son is desperate to know what
00:25:35
killed his father so suddenly.
00:25:46
Because he's from abroad, there was little background
00:25:49
information on Julian, making it difficult to narrow down
00:25:53
the possible causes of death.
00:25:56
JAN GARAVAGLIA: He's complaining of abdominal pain.
00:25:58
So it'll be interesting to see what we find on him.
00:26:02
There are many things that can cause
00:26:03
abdominal pain in the elderly.
00:26:05
And sometimes it can be a real fooler,
00:26:08
and it can be from other causes, even heart attacks.
00:26:12
It can be a very atypical presentation.
00:26:15
But I have to think, what could cause the abdominal pain
00:26:18
and kill you?
00:26:19
NARRATOR: Keeping this question in mind,
00:26:21
Dr. G hopes the external exam will provide some useful clues.
00:26:34
JAN GARAVAGLIA: Well, what we're looking
00:26:36
for externally is anything that would give us
00:26:39
any hint about his lifestyle.
00:26:42
All I know is that he smoked some, and he doesn't drink,
00:26:45
according to the family, or drinks socially.
00:26:49
And so I'm looking for kind of lifestyle.
00:26:51
I look to see if he's obese.
00:26:53
He's not. he's normal weight and height.
00:26:57
NARRATOR: Given Julian's complaint of stomach pains
00:26:59
immediately before his death, Dr. G pays close attention
00:27:03
to one particular area.
00:27:06
JAN GARAVAGLIA: I feel the abdomen, and a lot of times,
00:27:09
like with a peritonitis or inflammation
00:27:12
in the abdominal cavity, I'll feel very tense abdomen.
00:27:15
Even after death, believe it or not,
00:27:17
they can get a very kind of bloated, tense abdomen.
00:27:20
NARRATOR: But after careful inspection,
00:27:22
the external condition of the abdomen is yielding few clues.
00:27:27
JAN GARAVAGLIA: His wasn't particularly tense.
00:27:30
But again, I've been fooled before after death.
00:27:33
The cause of death may still be there.
00:27:35
Once I open it up, I'll know.
00:27:47
NARRATOR: To begin the internal exam,
00:27:49
Dr. G makes her standard Y incision
00:27:52
just below Julian's clavicles and all
00:27:55
the way down to his navel.
00:27:58
Her techs draw samples of Julian's fluids
00:28:00
to send to the toxicology lab.
00:28:05
And then Dr. G begins the exam, focusing on the abdomen.
00:28:10
JAN GARAVAGLIA: I will think, wow, something in his abdomen
00:28:13
must have killed him.
00:28:14
He had abdominal pain, relatively acute onset.
00:28:19
NARRATOR: Based on Julian's symptoms,
00:28:21
Dr. G considers several conditions
00:28:24
that could have killed him.
00:28:26
JAN GARAVAGLIA: Abdominal aortic aneurysm, diverticulitis,
00:28:30
perforated bowel.
00:28:31
There's many things that could kill you relatively quickly
00:28:34
that we see in here that might be
00:28:37
preceded with abdominal pain.
00:28:41
NARRATOR: First, Dr. G searches Julian's abdominal cavity
00:28:44
for signs of an aneurysm.
00:28:47
An abdominal aneurysm develops when the aorta, which
00:28:50
runs from the heart to the abdomen,
00:28:52
becomes blocked with cholesterol or plaque.
00:28:55
This blockage can in turn cause the aorta to weaken
00:28:59
and eventually rupture.
00:29:01
JAN GARAVAGLIA: It gets a thinned wall,
00:29:03
and then it bursts.
00:29:06
NARRATOR: Blood then quickly rushes into the abdomen,
00:29:08
and the victim dies within minutes from internal bleeding.
00:29:13
JAN GARAVAGLIA: What I will look for as soon
00:29:14
as I open that abdominal cavity is free blood.
00:29:18
NARRATOR: But Dr. G gets her first clue
00:29:20
in what she does not see.
00:29:24
JAN GARAVAGLIA: He doesn't have free blood
00:29:25
in the abdominal cavity.
00:29:27
So he didn't die from an aortic aneurysm.
00:29:31
NARRATOR: She next examines Julian's colon,
00:29:33
looking for signs of a deadly condition
00:29:35
called diverticulitis.
00:29:38
Diverticulitis develops when pouches form
00:29:41
on the outside of the colon.
00:29:42
JAN GARAVAGLIA: You have out-pocketing of the colon
00:29:45
because of just pretty much a lifestyle problem, lack
00:29:49
of fiber, lack of exercise.
00:29:51
NARRATOR: If the pockets of the colon
00:29:53
become inflamed and burst, this can lead to a fatal infection
00:29:57
in the abdomen.
00:29:58
JAN GARAVAGLIA: And you can get severe abdominal pain
00:30:00
or infection in those.
00:30:02
And you can eventually die.
00:30:04
NARRATOR: If this happened to Julian,
00:30:06
Dr. G would find the telltale signs of infection
00:30:09
in his abdominal cavity, free fluid or pus.
00:30:13
But after a thorough examination,
00:30:16
she comes up empty.
00:30:17
JAN GARAVAGLIA: He didn't have free fluid in his abdomen.
00:30:19
So he didn't die from infection of his abdomen.
00:30:21
The walls of the abdomen looked fine.
00:30:24
NARRATOR: But Dr. G still has one last condition
00:30:27
to look for within Julian's intestines, an infarcted bowel.
00:30:33
JAN GARAVAGLIA: Another main reason why older people can die
00:30:37
from abdominal pain is infarcted bowel, meaning that the blood
00:30:42
doesn't get to the bowel.
00:30:43
Basically, the bowel itself dies inside the body.
00:30:47
NARRATOR: Dr. G carefully dissects
00:30:49
Julian's bowels, looking for signs of dead tissue.
00:30:53
But once again, her search yields
00:30:55
nothing out of the ordinary.
00:30:57
JAN GARAVAGLIA: It looks normal.
00:31:00
The bowels look good.
00:31:01
The walls of the abdominal cavity
00:31:04
look just smooth and pink and shiny,
00:31:06
just like they're supposed to look.
00:31:08
NARRATOR: Dr. G now knows that Julian did not
00:31:11
die from an aortic aneurysm, an abdominal infection,
00:31:16
or infected bowel.
00:31:17
JAN GARAVAGLIA: And lo' and behold,
00:31:19
we've ruled out a lot of things right from the start,
00:31:21
but what killed him?
00:31:22
I still don't know.
00:31:30
NARRATOR: Coming up next, Dr. G makes an unexpected discovery.
00:31:35
JAN GARAVAGLIA: It's peaking out at me.
00:31:36
I can see that it's inflamed and that it's thickened.
00:31:40
NARRATOR: When "Dr. G, Medical Examiner" continues
00:31:44
[DRAMATIC MUSIC]
00:31:58
Dr. G lifts up the intestines of 73-year-old Julian Noble
00:32:03
so she can examine the rest of his abdominal cavity.
00:32:07
Julian was on vacation from England
00:32:10
when he began experiencing severe abdominal pains.
00:32:14
The next morning, he collapsed and died.
00:32:17
As soon as he went down, he was dead.
00:32:21
NARRATOR: So far, Dr. G has ruled out three potentially
00:32:24
fatal conditions, an abdominal aneurysm, a fatal infection,
00:32:29
and an infarcted bowel.
00:32:31
Unfortunately, he's dead, and I still don't have a reason.
00:32:41
NARRATOR: Next, Dr. G inspects the rest
00:32:43
of Julian's abdominal cavity inch by inch,
00:32:46
eventually coming to the gallbladder.
00:32:50
This pear-shaped organ sits at the base of the liver
00:32:53
and plays an essential role in digestion.
00:32:58
And here, Dr. G gets her first clue.
00:33:02
JAN GARAVAGLIA: I can see that it's inflamed
00:33:04
and that it's thickened.
00:33:06
NARRATOR: As she cuts into Julian's gallbladder,
00:33:09
she immediately can see what's causing the inflammation.
00:33:13
JAN GARAVAGLIA: I can feel that there's at least
00:33:15
three gallstones in there.
00:33:17
NARRATOR: These gallstones are likely
00:33:19
the cause of Julian's abdominal pain,
00:33:23
but the question is, did they kill him?
00:33:27
Gallstones are a common condition that affect 1 in 10
00:33:30
adults in Europe in America.
00:33:31
JAN GARAVAGLIA: Oh, my.
00:33:32
They're so crunchy.
00:33:34
NARRATOR: They develop when excess cholesterol
00:33:36
builds up in the bile.
00:33:38
JAN GARAVAGLIA: You have this increased
00:33:39
amount of cholesterol, and these form stones.
00:33:43
NARRATOR: In Dr. G's experience, gallstones are rarely fatal.
00:33:47
And at first glance, it appears that they
00:33:49
did not cause Julian's death.
00:33:53
He's just got a little bit of an inflamed gallbladder,
00:33:56
not by infection, but because of the gallstones itself.
00:33:59
So that in and of itself is not going to cause his death.
00:34:04
NARRATOR: But it is possible that Julian's
00:34:06
gallstones could have led to a more serious disease.
00:34:11
JAN GARAVAGLIA: Gallstones can kill you with pancreatitis,
00:34:14
and that's an inflammation of the pancreas.
00:34:16
Well, how does a gallstone cause inflammation of the pancreas?
00:34:21
NARRATOR: If gallstones get stuck in the bile duct,
00:34:24
they can block the flow of digestive juices
00:34:26
in the tubes that lead from the pancreas.
00:34:30
JAN GARAVAGLIA: It will cause then the pancreas to kind
00:34:32
of start digesting itself.
00:34:34
And you can die from that.
00:34:35
And sometimes you can die relatively quickly from that.
00:34:38
And so that's a possibility, and so I'll still
00:34:41
need to check the pancreas.
00:34:45
NARRATOR: Dr. G lifts up the stomach
00:34:47
and liver to view the pancreas.
00:34:49
And there, she finds her answer.
00:34:53
His pancreas looks like normal,
00:34:56
kind of tanned, nice, lobular structure that I normally see.
00:35:00
So in no way did he have pancreatitis
00:35:02
and in no way did that kill him.
00:35:04
NARRATOR: She now wonders if Julian's
00:35:06
abdominal pain was completely unrelated to his death.
00:35:10
Maybe
00:35:11
All of his pain was his gallbladder, which had
00:35:15
nothing to do with his death.
00:35:18
NARRATOR: Or perhaps there is another explanation.
00:35:21
JAN GARAVAGLIA: Maybe he's having
00:35:22
atypical heart pain, which is causing his abdominal pain.
00:35:25
OK.
00:35:26
I'm going to go ahead and take the heart.
00:35:27
NARRATOR: With this thought in mind,
00:35:29
Dr. G next removes Julian's heart.
00:35:33
JAN GARAVAGLIA: Could have had an arrhythmia
00:35:35
from lack of oxygen and blood to the heart from atherosclerosis,
00:35:39
a common problem in my office.
00:35:41
And I guess that's part of why.
00:35:43
NARRATOR: But when she sees Julian's heart up close,
00:35:45
she is shocked by the shape it's in.
00:35:49
JAN GARAVAGLIA: His heart actually looked great.
00:35:51
I will be so lucky if at 73 my coronaries look so clean.
00:35:56
And his heart muscle looked fine.
00:35:59
No anatomic reason for that heart to have killed him.
00:36:03
NARRATOR: Now, she finds herself at a crucial crossroads.
00:36:08
I've ruled out any type of abdominal problem.
00:36:12
I've ruled out the next most common
00:36:14
culprit would be his heart.
00:36:16
We're pretty much back where we started.
00:36:24
NARRATOR: Coming up next, an unexpected discovery
00:36:28
changes the course of the autopsy
00:36:31
and shocks Julian's family.
00:36:33
They had a hard time believing it.
00:36:35
You don't think that grandpa's going to die because you
00:36:38
took him to Orlando.
00:36:40
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:36:44
[DRAMATIC MUSIC]
00:36:57
That's a good point.
00:37:01
NARRATOR: Dr. G removes Julian Noble's lungs,
00:37:04
one of her last hopes for finding a cause of death
00:37:07
in the internal exam.
00:37:10
Her examination of Julian's abdomen and heart
00:37:13
yielded no clues.
00:37:15
In fact, his organs were in surprisingly good shape.
00:37:20
Now, Dr. G is more determined than ever
00:37:23
to unravel the mystery behind this seemingly healthy man's
00:37:27
death.
00:37:28
I want an answer at the end of the autopsy.
00:37:37
NARRATOR: Dr. G begins the dissection of Julian's lungs,
00:37:40
hoping to find some sort of clue.
00:37:43
And right away, she hits paydirt.
00:37:46
Sticking out right at me are blood clots in both right
00:37:52
and left main pulmonary artery.
00:37:55
NARRATOR: These blood clots in the arteries
00:37:57
leading to Julian's lungs are also known as thromboemboli.
00:38:02
They form when blood in the veins
00:38:04
begins to harden and congeal.
00:38:07
Basically, blood clots are platelets
00:38:10
and a protein called fibrin and then enmeshed
00:38:14
in that are your cells.
00:38:16
And basically, for whatever reason,
00:38:19
the platelets start sticking together and forming a clot.
00:38:23
NARRATOR: In Julian's case, these clots
00:38:25
lodged in his lungs, cutting off his blood and oxygen supply.
00:38:30
JAN GARAVAGLIA: Once they clog up
00:38:31
your main vessel that goes and brings blood to the lungs,
00:38:35
you can't live.
00:38:37
Incompatible with life.
00:38:39
No question, this is why he died.
00:38:42
NARRATOR: After an exhaustive examination,
00:38:45
Dr. G has finally found Julian's killer.
00:38:48
However, one mystery remains.
00:38:52
So the question is, where did these emboli come from?
00:38:55
These are blood clots that formed
00:38:56
in another part of the body.
00:39:00
NARRATOR: Dr. G knows the vast majority of pulmonary blood
00:39:03
clots form in the legs.
00:39:06
And this is the first place she looks.
00:39:09
I dissect the backs of the legs
00:39:11
to look at the veins in the legs,
00:39:13
and sure enough, he still has residual thrombi in the veins.
00:39:22
NARRATOR: Now that Dr. G has discovered exactly what killed
00:39:25
Julian, she can at last piece together
00:39:29
the chain of events that led up to his tragic death.
00:39:41
Julian Noble has just flown more than 4,000 miles
00:39:45
from London, England to visit his son
00:39:47
and grandkids in Orlando.
00:39:50
But the long flight has had an unexpected effect.
00:39:53
Hours of immobility on the airplane
00:39:55
have caused Julian's blood to become sluggish.
00:39:59
And if it's sluggish, the platelets start sticking
00:40:02
together and forming a clot.
00:40:05
NARRATOR: When Julian walks off the plane, pieces of this clot,
00:40:09
which formed in his legs, break off and flow
00:40:12
up through the vascular system.
00:40:14
He started complaining of some of abdominal pain.
00:40:19
Sometimes these pulmonary emboli are asymptomatic.
00:40:22
Maybe all of his pain was his gallbladder.
00:40:27
I don't know.
00:40:28
It was atypical referred pain to his abdomen
00:40:30
or was his pain all the time due to his gallbladder, which had
00:40:33
nothing to do with his death?
00:40:35
I don't know.
00:40:39
NARRATOR: The next morning, the pains are still there,
00:40:42
but Julian joins his family for breakfast anyway.
00:40:49
He eats breakfast and then just kind of doubles
00:40:54
over in abdominal pain.
00:40:56
Falls to the floor and they have to call an ambulance
00:41:03
to take him to the hospital.
00:41:06
NARRATOR: Two large blood clots have traveled to his lungs
00:41:08
and lodged in the pulmonary arteries, the blood
00:41:12
vessels leading to the lungs.
00:41:15
He's not even responding.
00:41:17
JAN GARAVAGLIA: It's a death sentence.
00:41:18
You're not getting any oxygen. You have no way to get oxygen.
00:41:22
NARRATOR: As his family looks on in horror,
00:41:24
paramedics arrive and attempt to save Julian.
00:41:27
Stop.
00:41:28
I'm going to check for pulse.
00:41:29
Still no pulse.
00:41:30
All right.
00:41:32
NARRATOR: But before they even reach the hospital,
00:41:34
Julian's heart, deprived of oxygen-rich blood,
00:41:38
ceases to beat, and he dies in the ambulance.
00:41:47
Flying is one of the safest ways to travel.
00:41:50
In fact, 30 times more people die in car accidents
00:41:54
than in plane crashes each year.
00:41:57
But deep vein thrombosis is a hidden danger
00:42:00
that Dr. G sees several times a year in her morgue.
00:42:05
JAN GARAVAGLIA: It's a syndrome.
00:42:06
It's called economy class syndrome.
00:42:08
You're like squished up in the little economy seats,
00:42:12
and you don't move.
00:42:14
You have no way to stretch.
00:42:16
You get a little bit dehydrated, which
00:42:18
then predisposes you also.
00:42:21
And the immobility and the probably
00:42:25
little bit of dehydration causes the blood
00:42:29
to just kind of not move.
00:42:32
NARRATOR: Fatal deep vein thrombosis resulting
00:42:34
from air travel is uncommon.
00:42:37
But Julian Noble was among the unlucky few.
00:42:40
But for anyone who is about to fly,
00:42:43
Dr. G has a few words of wisdom.
00:42:46
JAN GARAVAGLIA: It is scary.
00:42:47
And you know, when I'm sitting in the airplane, and I'm cheap.
00:42:50
I fly economy class.
00:42:51
What I make sure is that I'm well hydrated.
00:42:55
You need to exercise your legs.
00:42:57
You need to put pressure on them.
00:42:58
You need to squeeze your calf muscles,
00:43:00
move around, try to get up every hour.
00:43:04
NARRATOR: Unfortunately, this advice
00:43:06
has come too late for Julian Noble and his grieving family.
00:43:12
JAN GARAVAGLIA: They're surprised,
00:43:13
because a lot of people have no clue that a risk
00:43:17
factor for dying is sitting on an airplane
00:43:20
for a long period of time.
00:43:22
And so I think they were shocked.
00:43:24
They had a hard time believing it.
00:43:26
You don't think that grandpa's going
00:43:27
to die because you took him to Orlando
00:43:30
and made him sit on an airplane.
