00:00:18
NARRATOR: A healthy 14-year-old boy
00:00:20
starts shaking uncontrollably and dies in his mother's arms.
00:00:24
By the time EMS gets there, his heart's just quivering,
00:00:27
and they just can't revive him.
00:00:29
NARRATOR: And as Dr. G searches for clues,
00:00:32
the mystery surrounding his death only deepens.
00:00:35
So I don't know what's going on.
00:00:37
Nothing really was giving me any hints.
00:00:41
NARRATOR: Then, a man falls asleep on his couch
00:00:44
after a night of heavy drinking and never wakes up.
00:00:48
He could have been a ticking time bomb.
00:00:50
We just don't know until we do the autopsy.
00:00:54
NARRATOR: And his sister is desperate for answers.
00:00:57
I wanted to know what happened to my brother.
00:01:00
He was too young to die.
00:01:03
[THEME MUSIC]
00:01:06
NARRATOR: Altered lives, baffling medical mysteries,
00:01:09
shocking revelations--
00:01:11
these are the everyday cases of "Dr. G, Medical Examiner."
00:01:24
JAN GARAVAGLIA: OK.
00:01:25
NARRATOR: When chief medical examiner Dr. Jan Garavaglia
00:01:29
begins work on an autopsy, she is
00:01:31
often driven by a sense of responsibility
00:01:34
to the victims' families.
00:01:36
JAN GARAVAGLIA: This is a sad one.
00:01:38
NARRATOR: Especially in cases involving children.
00:01:40
Beautiful little baby.
00:01:42
He has soft hair and long eyelashes.
00:01:45
Obviously, the mother is going to suffer the most.
00:01:49
JAN GARAVAGLIA: Being in forensics for 20 something
00:01:51
years, it clearly is hardest for the parents when a child dies.
00:01:57
I don't think anybody should have a child die
00:01:59
and then not know why.
00:02:08
NARRATOR: It's a sizzling hot August in Kissimmee, Florida.
00:02:12
And like children everywhere, 14-year-old Nick Balzano
00:02:16
is determined to enjoy his summer break to the fullest.
00:02:20
But just one week before school starts,
00:02:23
the teenager begins to feel sick.
00:02:27
He'd complained of an earache.
00:02:29
And then after that, he started having a headache.
00:02:33
And then he really started to get sick.
00:02:35
He started having a fever.
00:02:37
He was vomiting.
00:02:40
NARRATOR: Over the next three days,
00:02:42
Nick's condition rapidly deteriorates
00:02:45
while his mother, Linda, grows increasingly alarmed.
00:02:49
JAN GARAVAGLIA: She was giving him electrolyte fluids,
00:02:52
and she was giving him something to try
00:02:54
to bring down his vomiting.
00:02:57
NARRATOR: But nothing seems to help.
00:03:01
Suddenly, the teenager's entire body
00:03:04
begins to shake uncontrollably.
00:03:06
Terrified, Linda immediately dials 911.
00:03:10
JAN GARAVAGLIA: By the time EMS gets there,
00:03:12
his pupils are fixed and dilated.
00:03:15
And his heart's just quivering.
00:03:19
They take him to the hospital in the ambulance.
00:03:21
Unfortunately, they just can't revive him.
00:03:26
NARRATOR: Nick is pronounced dead in the ER
00:03:29
with his grief stricken mother by his side.
00:03:32
You know, it's all happened so fast.
00:03:35
I'm sure the mother is devastated.
00:03:38
And she is going to want answers.
00:03:46
OK, let me see about the, um--
00:03:48
Dr. G, did you get these weights?
00:03:51
I'm getting all confused.
00:03:52
Where do you want me to put his stuff?
00:03:54
NARRATOR: Thursday, 5:00 PM.
00:03:56
It's already been a long day for the hardworking staff
00:04:00
at the District 9 morgue.
00:04:02
Does it seem warm in here today to you guys?
00:04:04
It's hot.
00:04:05
It's the worst time of the year--
00:04:06
August, September in Florida.
00:04:09
NARRATOR: But the case of 14-year-old Nick Balzano
00:04:12
is last up on Dr. G's roster.
00:04:18
A 14-year-old is rare to come in my morgue.
00:04:21
The children past one year of age, two years of age,
00:04:25
up until, you know, the late teens, we don't really
00:04:29
see very often in the morgue.
00:04:31
Because by that time, most of the congenital abnormalities
00:04:35
have been diagnosed.
00:04:36
They tend not to get so sick so fast.
00:04:39
If I see them, they tend to be in automobile accidents.
00:04:42
They tend to be falls or drownings.
00:04:45
They tend not to come in my morgue.
00:04:49
OK, so.
00:04:50
NARRATOR: She begins by reviewing the case file,
00:04:53
searching for any clues that might
00:04:55
help explain the teenager's mysterious death.
00:04:59
We really are not sure what he has.
00:05:02
We do know that he's got about a three day history of fever,
00:05:05
not feeling well, headache, and some vomiting.
00:05:09
NARRATOR: But according to his medical report,
00:05:12
the ER physicians who treated Nick
00:05:14
already have their suspicions as to what killed him.
00:05:18
They feel that this was probably bacterial meningitis,
00:05:22
and he died too quick to get it diagnosed.
00:05:27
NARRATOR: Bacterial meningitis is a deadly inflammation
00:05:31
of the meninges, the protective membranes that cover
00:05:34
the brain and spinal cord.
00:05:37
Classically, the symptoms that you worry about with meningitis
00:05:41
would be fever, and then probably
00:05:43
headache and stiff neck and then vomiting.
00:05:47
NARRATOR: Meningitis can also be caused by a virus,
00:05:51
but unlike its bacterial counterpart,
00:05:53
viral meningitis is rarely fatal.
00:05:56
With viral meningitis, you know, the mortality
00:05:59
rate's less than 1%.
00:06:01
It's much more common, and you rarely are ever
00:06:03
going to have problems with it.
00:06:04
And you don't necessarily need to treat it.
00:06:07
If it's a bacterial meningitis, they
00:06:08
need to treat you very quickly because oftentimes, you can get
00:06:12
sicker and sicker and sicker.
00:06:14
You may die relatively quickly, and you may have long term
00:06:18
complications besides death if you don't
00:06:21
get those antibiotics quickly.
00:06:26
Do you think that they would do a temperature?
00:06:28
Let's see.
00:06:31
NARRATOR: Based on Nick's symptoms and rapid decline,
00:06:34
Dr. G believes that the ER doctors may be on to something.
00:06:38
The hospital thought he had meningococcal meningitis, which
00:06:42
is a type of bacterial meningitis.
00:06:44
And that's really number one for me, too.
00:06:49
NARRATOR: But if this theory proves true,
00:06:51
there could be a serious cause for concern.
00:06:54
If it truly is meningitis, we do
00:06:57
have to worry about his household
00:06:58
contacts, his friends, the people in the emergency room.
00:07:03
NARRATOR: Should the diagnosis of meningococcal meningitis
00:07:06
be confirmed, Dr. G and the public health department
00:07:09
will have to move fast to prevent any further cases.
00:07:13
So we needed answers quickly.
00:07:19
NARRATOR: But it's too late in the evening
00:07:20
to start a new autopsy.
00:07:22
Most of the morgue staff have already clocked out.
00:07:26
And although Dr. G can't examine Nick's body until the morning,
00:07:30
there's one thing she can do immediately that could yield
00:07:34
a quick result. But it does call for a small personal sacrifice.
00:07:39
I thought he'd call me.
00:07:41
I was planning on going out for dinner with my husband.
00:07:44
So I just told him I had to stay a little later
00:07:46
and that I was going to do an LP.
00:07:50
NARRATOR: An LP, or Lumbar Puncture,
00:07:52
is often performed in suspected cases of meningitis.
00:07:56
During this procedure, fluid surrounding the spinal cord
00:08:00
is extracted to check for bacteria.
00:08:03
- Give up? - Yeah.
00:08:04
I'll bring you a latte.
00:08:05
It's on that.
00:08:05
JAN GARAVAGLIA: A latte?
00:08:07
It's there for you.
00:08:08
JAN GARAVAGLIA: Oh, I can't drink it in here.
00:08:09
NARRATOR: As it turns out, Dr. G's husband, Dr. Mark Wallace,
00:08:13
an infectious disease specialist,
00:08:16
is already on his way to the morgue when he gets her call.
00:08:19
So Mark goes over, and I get the body ready.
00:08:24
NARRATOR: But this simple procedure carries
00:08:26
with it an element of risk.
00:08:29
Even post-mortem, bacterial meningitis
00:08:31
can still be contagious.
00:08:34
Dr. G and her husband must take precautions
00:08:37
to protect themselves from possible infection.
00:08:41
My chance of getting it in the morgue is just not that great.
00:08:45
But there is a risk.
00:08:47
And so it's stupid to be cavalier about it.
00:08:51
NARRATOR: Carefully, she inserts a 3 and 1/2 inch needle
00:08:54
into Nick's spinal canal and draws
00:08:57
out a small amount of fluid.
00:08:59
And then we sent it immediately over to the lab.
00:09:01
He walked it over there for me.
00:09:03
Can't get better service than that.
00:09:04
I love you.
00:09:05
Thanks for bringing that.
00:09:07
Unfortunately, we couldn't get the answer that night.
00:09:10
We were just going to have to wait till the next day.
00:09:14
NARRATOR: When Dr. G arrives at the morgue at 7:30
00:09:17
AM the following morning, the lab
00:09:19
report is already on her desk.
00:09:22
And it's a short read.
00:09:24
Lo and behold, there really wasn't
00:09:26
any evidence of meningitis.
00:09:28
NARRATOR: But that doesn't mean that she can positively
00:09:31
rule out the disease just yet.
00:09:33
About 40% of the time with Lumbar Puncture,
00:09:36
you may just not see that bacteria.
00:09:39
I've got to keep my options open.
00:09:42
I don't know for sure that it's meningitis.
00:09:44
There is just a whole myriad of things
00:09:46
that you can be infected by.
00:09:48
So we really need to do the complete autopsy.
00:10:11
NARRATOR: Dr. G is on a quest to discover what caused
00:10:15
14-year-old Nick Balzano to die mysteriously
00:10:18
after three days of fever, headaches, and vomiting.
00:10:22
That family wants to know what happened to my beautiful child.
00:10:26
He was well.
00:10:27
And now he's dead.
00:10:30
NARRATOR: And this autopsy will be particularly
00:10:33
difficult for Dr. G.
00:10:34
I have a 14-year-old boy.
00:10:36
I can't imagine that he would be there
00:10:39
one minute and dead the next.
00:10:40
That would be devastating for me.
00:10:46
NARRATOR: Based on the teenager's symptoms,
00:10:48
Dr. G initially suspected meningitis.
00:10:52
But so far, tests have failed to reveal any sign of infection.
00:10:57
Maybe it isn't a bacterial meningitis.
00:10:59
Maybe it's a viral encephalitis from a mosquito.
00:11:03
Maybe there's another type of infection going on,
00:11:06
and it's my job to figure that out.
00:11:14
And why don't we put masks on?
00:11:15
Because I don't know what he's died from.
00:11:19
NARRATOR: As with all cases where
00:11:20
there's a possibility of contagion, Dr. G and her team
00:11:24
must take some basic precautions before beginning the autopsy.
00:11:29
If ever, ever, ever you have anybody coming in with any kind
00:11:32
of symptomatology of fever, illness, or not feeling well,
00:11:36
we have to really be careful.
00:11:38
You know, chances are we're not going to get anything,
00:11:40
but there's no reason to even take that chance.
00:11:44
NARRATOR: With morgue technician Tom Hemphill by her side,
00:11:47
Dr. G gets her first good look at the teenager.
00:11:50
JAN GARAVAGLIA: Cute, cute kid, though.
00:11:52
NARRATOR: Inch by inch, she scans
00:11:54
Nick's body, her eyes peeled for any signs of infection.
00:11:58
Did you do an overall?
00:12:00
Does he look healthy?
00:12:01
Does he look ill?
00:12:02
Does he have a rash?
00:12:04
That's what I'm looking for.
00:12:06
NARRATOR: But from the outside at least,
00:12:08
the boy appears to be in good shape.
00:12:11
You know, there's precious few clues on his body.
00:12:14
He doesn't have a rash.
00:12:16
He doesn't even particularly look sick.
00:12:18
You're saying, well, he's dead.
00:12:19
Well, some people come in the morgue and they look sick.
00:12:21
Some people don't.
00:12:22
He didn't look particularly sick for being supposedly
00:12:24
sick for three or four days.
00:12:27
There was really nothing on the external
00:12:28
that would definitively give me the answer.
00:12:39
NARRATOR: Dr. G makes a standard Y incision,
00:12:41
cutting carefully from shoulders to sternum
00:12:44
and revealing Nick's internal organs.
00:12:46
JAN GARAVAGLIA: As I'm opening him up,
00:12:47
I'm looking for anything abnormal.
00:12:50
But I don't see anything.
00:12:52
All right, so I'm going to do some cultures.
00:12:55
NARRATOR: Her next priority is to collect fluids
00:12:57
for toxicology and blood samples so the lab can
00:13:01
check for the presence of an infection.
00:13:04
I really don't suspect a drug overdose because of his fever
00:13:08
and that he was under the care of his mother.
00:13:11
She's by his side.
00:13:13
All she's really giving him is electrolyte fluids
00:13:17
and a little bit of medication for his nausea and vomiting.
00:13:21
But you know, we never know, and we'll always do toxicology.
00:13:26
OK, so I wanted to see.
00:13:28
NARRATOR: She then begins a thorough examination
00:13:31
of the heart itself.
00:13:33
Also high on my list is possibly
00:13:35
a myocarditis or inflammation of the heart muscle,
00:13:38
usually from a virus.
00:13:40
He was initially complaining of chest pain.
00:13:43
So that is something I would really need to rule out.
00:13:47
NARRATOR: But right away, she can cross the organ
00:13:49
off her list of suspects.
00:13:51
The heart looks good.
00:13:52
His heart looked normal.
00:13:55
NARRATOR: Next, she moves on to Nick's lungs,
00:13:58
and there she spots a problem.
00:14:00
JAN GARAVAGLIA: Oh, something's funky over here.
00:14:03
NARRATOR: They are heavy with fluid.
00:14:05
It's making the autopsy rather difficult here.
00:14:09
The problem with fluid in the lungs,
00:14:10
it sometimes makes it more difficult for me
00:14:12
to tell if pneumonia is there or not.
00:14:14
It didn't appear to me that there was,
00:14:17
but we will certainly look under the microscope.
00:14:19
I would keep that one in for me.
00:14:21
Yeah, yeah.
00:14:23
NARRATOR: Finally, she turns her attention
00:14:26
to the abdominal cavity.
00:14:28
And she notes that the boy's kidneys
00:14:30
appear to be in good condition.
00:14:32
Kidneys looked what we call streaked.
00:14:34
Usually, what that tells me is he
00:14:36
had some low blood pressure for a period of time.
00:14:40
But they don't look like they're infected.
00:14:43
Everything was fairly normal.
00:14:46
NARRATOR: As she wraps up the internal exam,
00:14:49
Dr. G still has no solid leads on what could have killed
00:14:53
the teenager so suddenly.
00:14:55
JAN GARAVAGLIA: I don't know what's wrong with him.
00:14:57
He doesn't have any evidence of any type of infection
00:15:00
that I could see in his chest or abdomen.
00:15:03
Now I'm a little worried.
00:15:05
I need to diagnose what he has.
00:15:08
So at this point, I'm hoping the answer is in the brain.
00:15:20
NARRATOR: Using an oscillating saw,
00:15:22
morgue technician Tom Hemphill cuts through the upper portion
00:15:25
of Nick's skull.
00:15:27
Head's ready for you, doctor.
00:15:29
NARRATOR: And as Dr. G gently removes the skull cap,
00:15:32
she discovers something very disturbing.
00:15:35
Oh my god.
00:15:37
Look at that.
00:15:39
It appears there's something wrong with his brain.
00:15:42
Wow.
00:15:43
The brain was definitely swollen.
00:15:46
It showed evidence of herniation.
00:15:48
Things are not looking good.
00:15:50
NARRATOR: Nick's brain has herniated,
00:15:52
or pushed through the opening at the base of his skull.
00:15:57
What a mess.
00:15:57
Once you herniate, it's a bad thing.
00:16:00
The brain starts compressing your respiratory centers
00:16:03
and your cardiovascular centers and your brainstem.
00:16:07
And you die.
00:16:09
Tragic, tragic.
00:16:11
When I see the brain, I know that is his cause of death.
00:16:18
NARRATOR: But this autopsy is far from over.
00:16:21
In fact, the alarming finding raises
00:16:24
more questions than answers.
00:16:26
JAN GARAVAGLIA: Even though I have the cause of death,
00:16:28
we still need to put it all together with the reason why.
00:16:32
What caused this swelling of his brain?
00:16:34
So now we gotta dig a little deeper.
00:16:37
NARRATOR: Dr. G knows from experience
00:16:39
that a swollen brain can often be
00:16:41
traced to bacterial meningitis.
00:16:44
Ah, what else have we got going gone on here?
00:16:47
I look to see if the cerebral spinal fluid looks clear.
00:16:51
If it was meningitis, it looks very cloudy, giving it kind
00:16:54
of almost a milky cloudy look.
00:16:57
But the meninges don't look that bad.
00:16:59
There was nothing really that could give us the answer.
00:17:07
In conclusion, I don't have answers.
00:17:09
NARRATOR: This case is becoming more puzzling by the minute.
00:17:12
Until I look under the microscope,
00:17:15
I can't say for sure that that kid didn't have meningitis.
00:17:19
NARRATOR: Dr. G collects tissue samples from the teenager's
00:17:22
brain and other major organs.
00:17:25
These will be mounted onto slides
00:17:27
for microscopic examination.
00:17:30
Along with his blood work and toxicology,
00:17:32
they are Dr. G's last hope of figuring out what killed
00:17:36
14-year-old Nick Balzano.
00:17:39
I'm very anxious to get those back.
00:17:41
I really would like to put this to rest why this child died.
00:18:03
NARRATOR: It's been three days since the inconclusive autopsy
00:18:06
of 14-year-old Nick Balzano.
00:18:09
And his blood culture results have just arrived
00:18:12
at the District 9 morgue.
00:18:14
They wanted you to know that if there
00:18:16
was anything on the child, they'd ask you to call.
00:18:19
NARRATOR: Despite a series of frustrating dead ends,
00:18:22
Dr. G still believes that a hidden infection most likely
00:18:26
caused the teenager's fatal brain swelling.
00:18:30
Now, she's hoping the lab work will help her
00:18:33
put the troubling case to bed.
00:18:35
I need to know why that child died.
00:18:41
NARRATOR: But as Dr. G scans the culture report,
00:18:44
she's surprised by what she sees.
00:18:46
They were negative.
00:18:47
There really is no evidence of infection.
00:18:51
NARRATOR: Once again, they've come up empty.
00:18:54
And the toxicology report is more of the same.
00:18:57
All of those were negative.
00:19:00
I'm back to the beginning.
00:19:01
I have no answer whatsoever.
00:19:04
It was very frustrating.
00:19:06
NARRATOR: Dr. G's options are quickly running out,
00:19:09
and there was only one place left to look.
00:19:12
At this point, the microscopic slides are going to be
00:19:16
my last hope to get the answer.
00:19:25
NARRATOR: Dr. G slips the slide of Nick's brain tissue
00:19:27
underneath the microscope.
00:19:29
And what she sees next is nothing short of shocking.
00:19:34
JAN GARAVAGLIA: I really couldn't
00:19:35
believe what I was seeing--
00:19:36
something very, very rare.
00:19:39
I've never had a case like this before.
00:19:42
NARRATOR: But for this bizarre finding to make sense,
00:19:45
there is one last thing she needs to know.
00:19:47
When I asked the family what his recent activities were,
00:19:50
they did mention that he went swimming
00:19:52
just prior to being sick.
00:19:55
NARRATOR: Armed with this new clue
00:19:57
and the astonishing microscopic results,
00:20:00
Dr. G is confident she can now solve the riddle behind Nick
00:20:04
Balzano's mysterious death.
00:20:08
At this point, really, I think we had the answer.
00:20:17
NARRATOR: It's August.
00:20:18
School is out, and the temperatures
00:20:21
in Kissimmee, Florida are cresting in the hundreds.
00:20:25
But 14-year-old Nick Balzano has a plan to escape the heat.
00:20:30
I don't think we ever determined
00:20:31
where he went swimming.
00:20:33
But somehow, anywhere from 14 days to three days
00:20:37
prior to dying, he's in a body of water.
00:20:43
NARRATOR: Little does Nick know, as he begins to swim,
00:20:46
his body is being invaded by a microscopic and deadly
00:20:51
parasite.
00:20:55
I've been working as a pathologist
00:20:57
for at least 21 years.
00:20:59
I've never seen it firsthand.
00:21:01
This is extremely rare.
00:21:03
He had amoeba.
00:21:07
NARRATOR: An amoeba is a single celled microorganism.
00:21:10
There are many different kinds of amoeba.
00:21:13
But this is an amoeba that's known to infect the human body.
00:21:17
It's Naegleria Fowleri.
00:21:20
NARRATOR: Naegleria Fowleri is known
00:21:22
as the brain eating amoeba.
00:21:24
Surprisingly, it lives in bodies of warm freshwater
00:21:28
all over the world.
00:21:30
However, the risk of actually developing an infection from it
00:21:33
is very low.
00:21:36
It really only causes infection and people
00:21:39
get the amoeba when the water temperature
00:21:42
is at least 80 degrees.
00:21:45
NARRATOR: Unfortunately for Nick,
00:21:46
that August, central Florida is experiencing
00:21:49
record high temperatures and very little rainfall.
00:21:53
It was an exceptionally hot, dry summer,
00:21:56
so the water tables went down, concentrating the Naegleria.
00:22:02
NARRATOR: It's a tragic set of circumstances that
00:22:04
poses a troubling question.
00:22:07
If this amoeba thrives in warm freshwater everywhere,
00:22:10
why aren't more swimmers infected every year?
00:22:14
A lot of kids are swimming in the summer,
00:22:16
but hardly anybody will ever get it.
00:22:18
Really, nobody knows why some people will get this deadly
00:22:22
disease and some people don't.
00:22:25
NARRATOR: Although science may never have an answer,
00:22:28
one thing is certain.
00:22:30
As soon as the amoeba infested water enters Nick's nose,
00:22:33
it sets into motion a deadly chain of events.
00:22:38
But whatever reason, that amoeba
00:22:40
is able to take hold through his nose,
00:22:43
and it goes past his normal defenses.
00:22:46
And then it follows a nerve into his brain.
00:22:50
NARRATOR: Once inside, the amoeba begins
00:22:53
to eat away at the tissue.
00:22:55
The effect on the teenager is immediate and disastrous.
00:23:00
JAN GARAVAGLIA: He starts out with a headache
00:23:02
at the beginning, starts out with not feeling well.
00:23:07
He seems even more nausea, he gets vomiting.
00:23:12
NARRATOR: Nick's brain begins to swell,
00:23:14
and it isn't long before it compresses his brain stem,
00:23:18
the part of the organ that controls
00:23:19
vital functions such as breathing and heart rate.
00:23:23
That's probably when he sees he didn't
00:23:26
have brain function anymore.
00:23:29
And within 10 minutes of getting to the hospital, he's dead.
00:23:36
It's devastating to see somebody so young and just innocent
00:23:40
die so quickly.
00:23:42
Hi, this is Dr. Garavaglia from the medical examiner's office.
00:23:44
Hi.
00:23:45
NARRATOR: Dr. G now faces the difficult task
00:23:48
of sharing her findings with Nick's mother, Linda.
00:23:52
Although she is grateful to finally know
00:23:54
what killed her son, the grieving mother still
00:23:57
struggles to find closure.
00:23:59
Oh, I'm very sorry.
00:24:01
My answer sometimes helps people and sometimes doesn't.
00:24:04
It doesn't bring the child back.
00:24:06
But I do the best I can.
00:24:08
My job is to get the answer.
00:24:11
If he'd gone to the doctor earlier,
00:24:13
could he have been saved?
00:24:16
If you get this amoeba into your brain,
00:24:19
chances are you're going to die from it.
00:24:26
NARRATOR: Dr. G immediately alerts the health department,
00:24:29
and they soon issue a public warning.
00:24:31
There's going to be a big news conference with the mayor.
00:24:34
NARRATOR: But there is not much else they can do.
00:24:37
Sara, what time is the press conference?
00:24:40
We don't know where he got this amoeba.
00:24:42
Oh, no, is this the new one?
00:24:43
Every fresh body of water here in central Florida
00:24:46
has got it in the summer.
00:24:47
There's nothing I can do about that.
00:24:49
There's no way you can know that.
00:24:51
I'm not sure there's anything you can do.
00:24:52
I'll bet it'll be the lead story of the noon news.
00:24:55
It would be extremely rare to get it from a pool
00:24:58
because chlorination should kill the amoeba.
00:25:02
You're not going to get it from an ocean,
00:25:03
but you can get it from canals.
00:25:05
You can get it from lakes.
00:25:07
Puddles people have even got it from.
00:25:09
So not a bad day--
00:25:12
just tragedy.
00:25:14
We are at the epicenter for amoeba.
00:25:19
But it's not really something to worry about.
00:25:22
It takes some mild precautions of either not swimming
00:25:26
in water over 80 degrees.
00:25:27
And if you do, wear nose plugs.
00:25:29
It's simple as that.
00:25:40
NARRATOR: Many of Dr. G's cases involve
00:25:42
unpredictable circumstances that lead to untimely deaths.
00:25:47
But more often than not, she sees fatalities
00:25:49
that could have been prevented.
00:25:51
JAN GARAVAGLIA: He shouldn't have died.
00:25:53
It was his choices that he made that caused
00:25:56
him to die that day.
00:26:13
The new morgue has been under construction for months.
00:26:17
And today, we're checking in on its progress.
00:26:20
Wait till you see the morgue.
00:26:23
OK, we're in the new morgue.
00:26:26
They still have some final touches,
00:26:27
so workstations are in.
00:26:29
They're still putting in some cabinetry.
00:26:32
Lights are in.
00:26:33
We're excited about the lights.
00:26:35
Three coolers.
00:26:37
Our everyday workload was getting
00:26:39
to the point we didn't have enough room to keep
00:26:42
the bodies in the cooler.
00:26:44
We have a real special floor.
00:26:46
They put in.
00:26:47
The mother of all autopsy rooms.
00:26:49
See the kind of room?
00:26:52
Oh, that's nice.
00:26:54
You don't even have to push anything?
00:26:56
Oh, nice.
00:26:57
A lot of times after we do an autopsy, the rest of the staff
00:27:01
doesn't allow us to eat in the break room.
00:27:04
So we have an outside dining area,
00:27:06
so we can eat out here after doing
00:27:08
an autopsy, particularly at decomp,
00:27:10
and nobody will be bothered.
00:27:11
Well, believe it or not, the smell lingers.
00:27:19
Easily accessible.
00:27:20
The employees that are bad, they have to go in.
00:27:23
We've got one in this building and one in the other building.
00:27:26
They have to go in here and stand here for as long as Dr.
00:27:28
G has put them in timeout.
00:27:32
We got to get back to work, though.
00:27:33
Now we gotta get back to our old office.
00:27:44
NARRATOR: It's a sweltering summer
00:27:45
day in Kissimmee, Florida.
00:27:48
But despite the heat, 47-year-old John Sullen
00:27:51
and his roommate Charlie have decided
00:27:53
to spend the day outdoors, grilling,
00:27:57
drinking, and playing cards.
00:28:03
At around 9:00 PM, Charlie calls it a day and goes to bed--
00:28:07
Good night, man.
00:28:09
NARRATOR: --leaving John alone on the couch.
00:28:14
The next morning, the roommate sees him in the same position
00:28:17
as when he went to bed.
00:28:19
NARRATOR: Concerned, Charlie tries to wake him.
00:28:22
John.
00:28:23
John.
00:28:24
NARRATOR: But John is unresponsive.
00:28:28
JAN GARAVAGLIA: He immediately calls 911.
00:28:33
But he was dead when they checked in.
00:28:43
NARRATOR: The 47-year-old's unexpected passing
00:28:46
shocks his sister, Janice.
00:28:49
It really upset me a little bit because you know,
00:28:53
I loved my brother.
00:28:55
He was special to me.
00:28:58
NARRATOR: Now the family must put their trust in Dr. G
00:29:01
to see if she can explain why John was
00:29:03
taken from them so suddenly.
00:29:05
It's definitely something we need to answer for that family.
00:29:15
NARRATOR: It's 9:00 AM at the District 9 morgue,
00:29:18
and the workday is just beginning.
00:29:21
Good morning.
00:29:21
Good morning.
00:29:23
NARRATOR: But Dr. G can tell that it's going to be hectic.
00:29:27
JAN GARAVAGLIA: And then we just have a whole assortment
00:29:29
of things going on.
00:29:30
We have car accident going at a high rate of speed.
00:29:34
We have a man who was surfing on the back of a car.
00:29:39
NARRATOR: But the first case on the docket
00:29:41
is the unexplained death of John Sullen.
00:29:44
JAN GARAVAGLIA: So today, we have
00:29:45
a 47-year-old African-American man who's
00:29:48
basically dead on the couch.
00:29:53
NARRATOR: As her technicians prepare John's body
00:29:55
for autopsy, Dr. G pores over the events
00:29:58
leading up to his death.
00:30:00
And immediately, she spots a red flag.
00:30:03
The family said he'd been drinking.
00:30:05
He doesn't usually drink, and they thought
00:30:07
that very unusual behavior.
00:30:11
NARRATOR: And according to his roommate,
00:30:13
John wasn't just drinking casually.
00:30:16
When we hear somebody is drinking heavily,
00:30:18
you know, you worry about alcohol poisoning,
00:30:20
particularly in someone who's not used to alcohol.
00:30:23
NARRATOR: As she reads on, however,
00:30:26
Dr. G discovers that John had another vice.
00:30:28
Wow.
00:30:30
NARRATOR: One that also may have threatened his life.
00:30:32
JAN GARAVAGLIA: He does smoke about a pack
00:30:34
of cigarettes a day.
00:30:36
And smoking is a risk factor for stroke
00:30:39
and cardiovascular disease and is probably
00:30:42
the number one risk factor.
00:30:45
NARRATOR: She now wonders if smoking,
00:30:47
along with the binge drinking, could have killed
00:30:49
this seemingly healthy man.
00:30:53
But it isn't long before Dr. G comes across another alarming
00:30:57
revelation.
00:30:59
JAN GARAVAGLIA: He had his leg amputated about a year ago
00:31:02
because his toe was gangrenous.
00:31:07
NARRATOR: Gangrene occurs when a part of the body
00:31:10
is receiving insufficient blood supply
00:31:12
due to an injury, infection, or underlying
00:31:15
illness such as diabetes.
00:31:18
Left untreated, the tissue eventually begins to die.
00:31:21
And once you have dying tissue,
00:31:23
it's more apt to be infected.
00:31:26
NARRATOR: According to the medical report,
00:31:28
John had contracted an infection on his left foot
00:31:30
sometime in December of the previous year.
00:31:35
But amazingly, he ignored his symptoms until the gangrene
00:31:39
was already out of control.
00:31:41
His entire foot and ankle has become black,
00:31:45
so they had to do an emergency of below the knee amputation.
00:31:50
It was his life or his leg, and they had to take his leg.
00:31:58
NARRATOR: At the time, John's doctors attributed the gangrene
00:32:01
to atherosclerosis, a buildup of fatty plaque
00:32:04
in his blood vessels.
00:32:05
They felt he had severe atherosclerosis on the vessels
00:32:09
going to his legs.
00:32:12
If the vessel is narrowed, the blood can't get to it.
00:32:16
That oxygen can't get to the muscle.
00:32:19
And eventually, like this man, he can get death of the tissue.
00:32:26
NARRATOR: After the surgery, a pathologist did a full exam
00:32:29
on John's amputated leg to confirm the doctor's
00:32:31
theory about atherosclerosis.
00:32:34
But these results are missing from his medical records.
00:32:37
JAN GARAVAGLIA: I only got a portion of that medical record.
00:32:40
I clearly still need to see that pathology report.
00:32:44
What did his leg really look like?
00:32:46
Did he really have atherosclerosis in his leg?
00:32:51
NARRATOR: If it was atherosclerosis that caused
00:32:53
his gangrene, she wonders if it had blocked other blood
00:32:56
vessels in his body as well.
00:32:59
And the most common and deadly place for the disease to strike
00:33:03
is the heart.
00:33:04
You know, I need to look at his heart.
00:33:07
We just don't know what killed him.
00:33:09
And the family they just wanted to make sure we did an autopsy.
00:33:13
As you know, not everybody that comes through the morgue
00:33:16
gets an autopsy necessarily.
00:33:19
If you have significant medical history
00:33:22
or you're expected to die, we may not
00:33:24
do an autopsy once we confirm that you have no trauma.
00:33:28
Yeah, just kind of wipe the blood off.
00:33:29
But this family was very concerned with him.
00:33:36
I wanted to know what happened to my brother.
00:33:40
Because he was young, too young to die.
00:33:44
JAN GARAVAGLIA: I agreed he was too young.
00:33:46
We need to figure out what happened.
00:33:58
So with the external examination,
00:34:00
we're just going to look for any clues
00:34:02
that could give us information about what happened to him.
00:34:06
Just his chest.
00:34:11
NARRATOR: Dr. G begins the external exam
00:34:13
with a careful inspection of John's amputation stump.
00:34:16
Really, what you worry about is sometimes
00:34:19
they can get chronic poor wound healing.
00:34:23
But the amputated stump looked OK.
00:34:24
It didn't look infected, anything wrong with that.
00:34:28
Clearly, that's healed and he's moved on.
00:34:33
NARRATOR: Next, she scours John's head
00:34:35
for any swelling or suspicious injuries
00:34:38
JAN GARAVAGLIA: When you're drinking,
00:34:39
you know, trauma is a real possibility.
00:34:42
And you may not tell anybody that you stumbled
00:34:45
and fell and hit your head.
00:34:48
But I don't see any direct trauma.
00:34:52
NARRATOR: Still, the absence of external clues
00:34:55
only deepens the mystery.
00:34:59
And given John's medical history,
00:35:01
the possibilities are sobering.
00:35:04
You know, he clearly doesn't go to the doctor
00:35:06
unless it's a crisis.
00:35:08
He didn't do anything about his leg until it almost killed him.
00:35:11
He could be a ticking time bomb.
00:35:31
NARRATOR: Dr. G prepares to cut open the body of John Sullen.
00:35:34
No, thanks for worrying about me, Brian.
00:35:38
NARRATOR: The 47-year-old amputee
00:35:40
was found lifeless in his living room
00:35:42
after a night of heavy drinking.
00:35:46
His unexpected death has shaken the family
00:35:49
already wrought with tragedy.
00:35:51
I loved my brother, and I had just
00:35:55
a couple of years buried my mama and buried
00:35:58
another of my brother.
00:36:00
So when this happened with him it was just like, oh my god.
00:36:03
Thanks.
00:36:05
It's always hard for the family to have to wait.
00:36:09
We're going to just have to do the internal exam
00:36:10
to get the answer.
00:36:19
OK.
00:36:22
So I do my initial Y incision, and
00:36:24
before I look at any of the organs,
00:36:26
I need to take the toxicology.
00:36:28
Because we're so worried about possibly alcohol poisoning.
00:36:32
NARRATOR: Dr. G draws samples of John's blood and urine
00:36:36
to send to the lab for testing.
00:36:39
Then she moves on to the abdominal organs.
00:36:43
Still concerned that alcohol might
00:36:45
have played a role in his death, she starts with the liver.
00:36:48
Sometimes people can drink enough on a binge
00:36:50
that you get tremendous fatty liver.
00:36:53
So is it a large fatty liver associated
00:36:55
with his binge drinking?
00:36:57
And it wasn't.
00:37:03
NARRATOR: Dr. G continues to scour the rest of John's
00:37:05
abdominal organs, looking for anything that could
00:37:08
help explain his sudden death.
00:37:11
But after a thorough search, she comes up empty.
00:37:15
Overall, his abdominal organs looked relatively normal.
00:37:20
NARRATOR: Next, she turns her attention
00:37:22
to John's chest cavity.
00:37:28
And when she opens the chest plate,
00:37:30
she immediately sees the first sign of disease in his lungs.
00:37:35
When I look at his lungs, his lungs show some emphysema.
00:37:38
It goes along with the smoking.
00:37:41
NARRATOR: And that's not all.
00:37:45
When she removes the lungs, she finds a puzzling clue--
00:37:50
a small patch of fibrosis or scarring.
00:37:53
JAN GARAVAGLIA: It's nothing that would have killed him,
00:37:55
but I'm not quite sure what it's from.
00:37:58
So I'm going to take a biopsy of that,
00:38:01
look under the microscope.
00:38:02
Yeah, go ahead.
00:38:05
NARRATOR: Finally, she turns her attention to the heart.
00:38:11
The medical records suggest he had atherosclerosis in his leg.
00:38:17
And Dr. G wonders if he might also have a fatal buildup
00:38:20
of plaque in his heart vessels.
00:38:23
To find out, she begins dissecting
00:38:25
the coronary arteries--
00:38:27
JAN GARAVAGLIA: All right.
00:38:27
NARRATOR: --one by one.
00:38:31
JAN GARAVAGLIA: So the first thing I look at
00:38:33
is the left main coronary artery,
00:38:35
and I slice it down a few millimeters at a time.
00:38:40
It looks completely normal, not a bit of atherosclerosis.
00:38:46
I do his diagonal branches.
00:38:50
There's no atherosclerosis.
00:38:53
I do the right coronary artery.
00:38:55
No atherosclerosis.
00:38:57
Not a bump in the road.
00:38:59
And I was really shocked, actually.
00:39:01
He didn't have any.
00:39:03
Hm.
00:39:05
NARRATOR: But then she cuts into the left anterior descending
00:39:09
artery, and right away, she finds
00:39:13
what she's been looking for.
00:39:15
There is some yellow atherosclerosis
00:39:18
buildup of that plaque in an adjacent thrombus.
00:39:23
NARRATOR: The thrombus, or blood clot,
00:39:25
is large enough to have blocked the entire artery.
00:39:28
And that ultimately caused his heart
00:39:31
to have lack of blood going to the front of his heart.
00:39:36
That's a classic heart attack.
00:39:40
That was ultimately what killed him.
00:39:48
NARRATOR: It's the kind of discovery that would normally
00:39:50
bring the autopsy to a close.
00:39:53
But it isn't long before Dr. G notices
00:39:55
something else, something quite odd.
00:39:58
He got heart muscle damage in places that don't make sense.
00:40:03
NARRATOR: Damage to the heart muscle
00:40:05
can be seen after a heart attack,
00:40:07
but only where the blocked artery
00:40:09
deprives the tissue of blood.
00:40:12
In John's case, she can see muscle
00:40:14
damage in multiple locations.
00:40:16
And surprisingly, it's everywhere except in the area
00:40:20
supplied by the blocked artery.
00:40:22
There's only one coronary artery
00:40:24
I can find that has narrowing, and that's
00:40:26
the least damaged area.
00:40:29
He's got heart muscle damage in places not even supplied
00:40:32
by that coronary artery.
00:40:34
Why does he have all that heart muscle damage
00:40:37
with no other plaque?
00:40:40
NARRATOR: This extensive damage could have been the result
00:40:43
of a virus, disease, or even a genetic abnormality,
00:40:47
which means his sister, Janice, could also be at risk.
00:40:50
There's a lot of questions to be answered, some of which
00:40:54
has some definite implications for the family.
00:41:00
I don't really have the true answer.
00:41:03
And I'm hoping maybe my microscopic slides could tell
00:41:07
me what's going on with him.
00:41:29
NARRATOR: Dr. G has just learned that John Sullen died
00:41:32
from a heart attack and that it was caused
00:41:34
by a huge coronary thrombus, a blood clot in the artery that
00:41:38
leads to the heart.
00:41:40
But she's also found something extremely puzzling--
00:41:43
damage to the heart muscle in unexpected places.
00:41:47
The pattern of heart muscle damage
00:41:50
doesn't fit what I'm seeing in the coronary artery.
00:41:54
Some of this is not making sense.
00:41:58
NARRATOR: In the meantime, John's
00:42:00
grieving family is struggling to make sense of his sudden death.
00:42:03
Every day I think about my brother--
00:42:06
you know, every day.
00:42:07
I have a picture of him and me when we were younger.
00:42:10
And I look at it every day.
00:42:13
I really can't wrap it up for him until after the micros.
00:42:20
Hopefully the micros would give me the answer.
00:42:32
NARRATOR: Two weeks later, Dr. G receives the microscopic slides
00:42:36
of John's tissue samples.
00:42:40
Hoping to identify his mysterious condition,
00:42:43
she inspects his heart tissue at 400 times magnification.
00:42:47
It confirmed what I saw with my naked eye.
00:42:50
He had death of the heart muscle in various ages of healing.
00:42:56
NARRATOR: But then, she spots an incredible clue,
00:42:59
one she couldn't see at all during the autopsy.
00:43:01
So when I'm looking under the microscope of the heart,
00:43:05
I actually find something I'm not expecting.
00:43:08
What I saw was another thrombus in that heart muscle.
00:43:15
NARRATOR: But that's not all.
00:43:19
Looking next at his lung tissue, she's shocked to find
00:43:22
yet another clot.
00:43:24
I can actually see a blood clot, which
00:43:28
has reabsorbed and just left the remnants of the clot
00:43:31
in the pulmonary artery.
00:43:34
NARRATOR: This discovery is alarming
00:43:36
evidence that something terribly wrong
00:43:38
was going on inside John's body.
00:43:43
And when Dr. G finally received the pathology records
00:43:46
for John's amputated leg, all the pieces of the puzzle
00:43:50
fall into place.
00:43:52
JAN GARAVAGLIA: I was assuming that he
00:43:53
had a severe atherosclerosis on the leg.
00:43:56
But they did, like, a mini autopsy on his leg
00:43:59
after it was amputated.
00:44:01
And as it turns out, they didn't find any atherosclerosis.
00:44:05
NARRATOR: On the contrary, what they
00:44:08
found were several clots that were
00:44:09
preventing blood flow to the lower part of John's left leg.
00:44:14
As it turns out, the clots were the real cause
00:44:17
of John's gangrene and eventual amputation.
00:44:21
It's a critical clue and one that
00:44:23
finally reveals the truth behind John Sullen's mysterious death.
00:44:28
I think we've hit upon what the ultimate cause of death is.
00:44:44
NARRATOR: It's a sizzling summer afternoon,
00:44:47
and John Sullen, along with his roommate,
00:44:49
Charlie, is outside grilling and playing cards.
00:44:53
But today, John isn't quite himself.
00:44:56
He's drinking and that's very unusual for him.
00:44:59
NARRATOR: Still, as Dr. G determines
00:45:02
from the final tox report, he's hardly drowning in liquor.
00:45:05
He was drinking, but not all that much.
00:45:08
He was just at the legal limit of driving and intoxicated.
00:45:11
He had about a 0.08.
00:45:14
To kill you, you need at least around a 0.4.
00:45:18
So he wasn't anywhere near that.
00:45:22
He was drinking, and he was drinking heavily, but not
00:45:25
anywhere enough to kill you.
00:45:28
NARRATOR: Instead, there's a far greater threat to his life,
00:45:33
one that began long before his leg amputation.
00:45:36
He's probably got a hypercoagulable state.
00:45:39
His blood clots very easily.
00:45:44
That can be due to some genetic problems, where you're missing
00:45:49
some proteins in your blood and your blood
00:45:51
will clot more easily.
00:45:52
And that fits with the blood clot I'm finding in his heart,
00:45:58
you know, in his lung.
00:46:00
NARRATOR: This also explains the gangrene.
00:46:03
Additional blood clots in John's left leg
00:46:05
likely cut off the blood supply to his foot.
00:46:08
And just like the little heart muscle areas were dying,
00:46:12
the lower leg was dying.
00:46:15
NARRATOR: But doctors mistakenly concluded
00:46:17
that John's gangrene was caused by atherosclerosis
00:46:21
and that the amputation resolved his problem when,
00:46:24
in fact, deep inside his body, his blood
00:46:26
continued to form new clots.
00:46:29
Slowly, they begin to damage his heart and lungs.
00:46:32
I'm sure this fellow is not feeling well.
00:46:35
I'm sure he's ignoring a lot of his symptoms.
00:46:37
He might have even had chest pain,
00:46:39
and that's one theory why he started drinking, that he
00:46:42
was treating his own pain.
00:46:45
NARRATOR: But while alcohol may help mask John's discomfort,
00:46:48
nothing can stop the chain of events
00:46:50
taking place inside his body.
00:46:53
His heart was starting to give out
00:46:55
because there are multiple areas of heart muscle
00:47:00
missing because it had died.
00:47:03
NARRATOR: And on that same night,
00:47:05
he forms a blood clot that completely blocks
00:47:08
the opening of the one coronary artery
00:47:10
already narrowed by plaque.
00:47:13
Boy, that's unlucky.
00:47:14
You got one little narrowing by atherosclerosis,
00:47:16
and then you get the clot associated with it.
00:47:19
That clot occluded and blocked all blood
00:47:23
flow in a heart that's already failing, already irritable.
00:47:26
And that was the coup de grace and caused
00:47:29
him to go into an arrhythmia.
00:47:31
NARRATOR: His heart spasms, unable
00:47:33
to establish a regular rhythm.
00:47:37
Without fresh blood and oxygen, his vital organs
00:47:40
begin to shut down.
00:47:42
And the 47-year-old dies on his living room couch.
00:47:53
Dr. G's first call is to John's sister, Janice, who reacts
00:47:57
to the news with some relief.
00:47:59
Dr. G gave me closure because I would have never knew
00:48:05
what really happened with my brother
00:48:07
if she wouldn't have did that autopsy.
00:48:09
I would have never knew.
00:48:14
NARRATOR: She also provides the family
00:48:16
with some critical information that
00:48:18
could help prevent the same thing
00:48:20
from happening to one of them.
00:48:22
There also could be a genetic abnormality that they
00:48:25
might have trouble with.
00:48:26
So that's something for them to let their doctor know,
00:48:29
that their brother had a problem with multiple blood clots
00:48:33
and make sure that they're tested.
00:48:39
NARRATOR: Dr. G's only regret is that she couldn't
00:48:41
prevent John's death as well.
00:48:44
That's the old saying.
00:48:45
Pathologist knows everything but can do nothing.
00:48:48
I wish he'd had that diagnosed while he was still alive.
00:48:52
You know, you can give him medication
00:48:53
to keep his blood from clotting, but it's too late now.
