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[MUSIC PLAYING]
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NARRATOR: When a man is found dead outside a rundown motel,
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Dr. G fears the worst.
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So a man down, kind of a seedy part of town,
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this could very well be a homicide.
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NARRATOR: But during the autopsy,
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she discovers something so shocking she
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can hardly believe her eyes.
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What I found was one of the most remarkable things
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I'd ever seen.
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NARRATOR: Then a teenage boy is traumatized
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when he finds his father's lifeless body at the foot
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of their attic ladder.
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He's obviously devastated to find his dad dead.
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NARRATOR: And now, his grief stricken family
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is desperate to know what took his life so suddenly.
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Why him?
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Why that day?
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Why that moment?
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That's $1,000 question.
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[THEME MUSIC]
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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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As a rule, chief medical examiner Dr. Jan
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Garavaglia prefers to work with as few distractions as
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possible.
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I don't like a lot of people talking
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while I'm doing my autopsies.
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And a lot of people don't understand
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that, that, you know, you're actually concentrating
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when you're doing an autopsy.
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I'll have my gloves on.
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I'll have a scalpel in my hand.
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And I'm getting ready to autopsy,
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and a detective will ask, what do you think he died from?
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I'm like, hold your horses.
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I don't like to guess.
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I like to get to the answer.
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NARRATOR: And it will take a whole lot more than guesswork
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to solve the mystery in this next case.
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What I found during the autopsy
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was one of the most remarkable things I'd ever seen.
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NARRATOR: On a brisk winter morning,
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Hank Johnson arrives at his maintenance job
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at the Blue Sky Lodge.
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He had gotten to work around 6:00 in the morning.
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And he was making his rounds.
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NARRATOR: But as he's taking out the trash behind the motel,
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he comes upon a startling sight.
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A man is lying face up on the sidewalk.
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And as Hank moves in for a closer look,
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he gets the shock of his life.
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The man is clearly dead.
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Must've been scary.
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NARRATOR: Shaken, Hank immediately dials 911.
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Police soon arrive on the scene, followed closely by one of Dr.
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G's medical investigators.
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My investigator goes to the scene to be my eyes and ears.
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NARRATOR: And her foremost priority is to ID the body.
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And in this case, there was an identification
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with a photo that looked just like this fellow.
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NARRATOR: The mystery man now has a name--
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Victor Morales, a 52-year-old Hispanic male
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from St. Cloud, Florida.
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But outside of that, investigators
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have precious little to go on.
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His body is transported to the District 9 morgue,
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and now Dr. G and her team are determined to figure
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out what claimed his life.
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We've got a fellow down.
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We don't know anything about him.
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So we gotta look for clues.
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All right, let's see here.
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Let's see here.
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NARRATOR: She begins by reading through the investigator's
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report, searching for any insights
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into what could have led to his sudden death.
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We don't have much history.
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Nobody's telling us much about this fellow.
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NARRATOR: According to the few who knew him,
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Victor was a loner who lived in a nearby trailer park,
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until a few days earlier, when a fire destroyed his home.
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He just had his home burned down and all his possessions.
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So he is kind of forced to go into this hotel.
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But now he's dead.
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It sounds like terrible luck.
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NARRATOR: But while Victor's misfortune provides little
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in the way of clues, it isn't long before Dr. G
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gets her first promising lead.
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A hotel proprietor stated that he just
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checked in about two days ago and that he was kind
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of yellowish and kind of shaky.
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The proprietor really thought he looked ill,
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so certainly natural disease could have played a role.
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NARRATOR: Unfortunately, the vague description
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isn't a lot to go on.
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Victor could have been suffering from a myriad
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of ailments, from kidney failure to heart disease.
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But based on the circumstances, Dr. G
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can't help but wonder if the 52-year-old
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may have been wrestling with a dangerous addiction.
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I really thought he sounded like he
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might have been an alcoholic.
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There's many ways you can die from alcohol.
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And one always has to worry about drugs.
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NARRATOR: But there's an even more unsettling possibility--
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foul play.
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JAN GARAVAGLIA: What's really disturbing is my investigator
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said he's got a small abrasion at the top of his forehead
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near his hairline.
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So that's somewhat suspicious.
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A man down, kind of a seedy part of town--
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one always has to worry about foul play.
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The police are waiting to see if this
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looks suspicious for homicide.
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But we don't know what this is.
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This is truly a mystery at this point.
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It's just a wide open game.
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We won't know until we do the autopsy.
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All right, let's see.
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Oh, wow, he looks old.
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Overall, he looks a little older than 52 years old.
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He looks a little disheveled, and he looked ill.
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NARRATOR: Given that foul play is
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high on her list of suspects, Dr. G zeros in on the abrasion
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on Victor's head.
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He does have a little bit of head trauma.
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I don't know if somebody has hit him.
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I don't know what this abrasion is all about.
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NARRATOR: She won't know if the injury was fatal until she
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completes a full cranial exam.
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But as Dr. G's eyes move down Victor's body,
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she spots a clue that just may hold the secret
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to his untimely death.
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You see these?
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Oh, jeez.
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Gosh.
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Something is going on with him.
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It looks like it could very well be a homicide.
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NARRATOR: Dr. G has just discovered a telling clue
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on the body of 52-year-old Victor
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Morales, who was found dead on the sidewalk
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outside a rundown motel.
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He's got kind of scratch abrasions on his arm.
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NARRATOR: This, along with the abrasion on his forehead,
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has moved foul play up the list of suspects.
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The scratches on his arm may indicate
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somebody is grabbing him.
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So maybe there's an altercation going on.
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NARRATOR: But the only way to know for sure
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is to look inside Victor's body.
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And she'll start with the head.
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It could be foul play.
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It could have been accidental that he'd hit his head.
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But I need to see if we can really piece this together.
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Let's see what happens when we get inside.
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NARRATOR: Using an oscillating saw,
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morgue technician Brian Machulski opens the skull.
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So we go to the head really looking for trauma.
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But there is no evidence of bruising, no skull fractures.
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There's no hemorrhage over the brain.
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There is no evidence of trauma.
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All right, he's fine.
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So he's got no trauma to the head.
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That's what we're looking for.
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But there's still a possibility of broken ribs
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and maybe fractured a spleen or, you know, tore the liver.
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So being hit or falling is still in the mix.
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Clearly, I need to open the rest of the body to get my answer.
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OK.
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We do our typical Y incision from the shoulders
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down to the lower abdomen and open it up.
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I make sure there's no free fluid in that abdominal cavity.
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There's nothing in there.
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And there isn't any.
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Go ahead.
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I move the chest plate.
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Of course I'm looking for any rib fractures,
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and there is none.
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There's nothing there.
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We know that we're not dealing with trauma.
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NARRATOR: Dr. G can now safely rule out both foul play
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and an accidental follow.
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But this only deepens the mystery.
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If he wasn't the victim of an assault,
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how did he wind up in the lot behind the motel,
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and why all the scratches and abrasions?
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Her next step is to collect blood and urine
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samples for toxicology.
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JAN GARAVAGLIA: Of course we check if there's any alcohol.
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And I need to check for any type of drugs,
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whether it's prescription or illicit.
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It's important to take tox because that
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might be our answer.
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NARRATOR: With the samples drawn,
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Dr. G scans Victor's abdominal organs one by one,
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looking for any abnormalities.
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When I look in the abdomen, everything looks pretty good.
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He's looking pretty good on the inside.
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NARRATOR: But based on the circumstances surrounding
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Victor's death, there's one organ in particular
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that Dr. G must examine.
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When I hear that he's yellow and shaky,
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he could be dying from liver disease.
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But his liver, which I thought was going to be
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cirrhotic and show evidence of chronic alcohol abuse,
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really didn't.
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Let's see what's going on here.
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NARRATOR: No closer to his cause of death,
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Dr. G turns her attention to the organs
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in Victor's chest cavity.
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And she can see right away that something isn't right.
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Oh, something's wrong with his lungs.
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Normally, our lung should be nice and airy,
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kind of like a sponge.
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There's little tiny air air spaces.
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But when I look at his lung, the entire lower lobe
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of that right lung was firm.
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He clearly has a bacterial infection.
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And this has progressed to the entire lobe and almost
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solidified because so much pus is filling
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up those alveolar air spaces.
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He's got a low bar pneumonia.
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NARRATOR: But Dr. G can't tell with just her naked eye
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if the infection was severe enough to kill him.
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JAN GARAVAGLIA: It's hard to say.
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I will, of course, culture that, and I will, of course,
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look under the microscope.
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All right.
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But the next thing I want to look at
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is his heart, because you always worry
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about maybe a heart attack.
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NARRATOR: Carefully, Dr. G pierces
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the pericardial sac with her scalpel,
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exposing the heart inside.
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And right away, she makes a shocking discovery.
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Oh, look at that.
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When I open up this pericardial sac, I am absolutely floored.
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Wow.
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What I found was one of the most remarkable things
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I'd ever seen.
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Oh, look at that.
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NARRATOR: Dr. G has just stumbled
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across a tantalizing and unusual clue inside the heart sac
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of 52-year-old Victor Morales.
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It is the most remarkable pericardial sac
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I have ever seen.
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It looks as if somebody took a shag rug,
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lined the pericardial sac, and covered the heart.
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Oh my god.
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Look at that.
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He's got clearly a pericarditis, an inflammation
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of the sac lining the heart.
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Untreated bacterial pericarditis is 100% fatal,
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if this is what he has.
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But this pericarditis is unbelievable to the point
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where it's too unbelievable.
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So I'm a little worried about what's going on there.
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Is there truly just an infection,
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or is there something else going on?
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It can be a lot of natural diseases causing it,
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everything from rheumatic fever, some connective tissue
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diseases, or it could be from a TB or from a fungus.
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I have to take micros of it.
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NARRATOR: Dr. G collect samples of his heart
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to be made into slides.
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She hopes a magnified view of the tissue
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will help shed light on the bizarre finding.
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I need to look under the microscope.
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What is the etiology, the cause of all this?
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So I think what we're going to do is be prudent
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and [INAUDIBLE] until we get those micros back.
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NARRATOR: As the autopsy comes to a close,
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so does Dr. G's day.
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But although she leaves the morgue,
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her mind doesn't leave the case.
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MARK WALLACE: Dr. G brought up this case when we're
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driving home from work one day.
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She was excited about talking to me about what
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this might represent.
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It's always fun to talk about cases with Mark.
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He's a very wise fellow.
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He really brings out the best of you
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kind of discussing it and thinking of new angles.
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He just thought it was a great case.
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So we were interested to see what the micros would show
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and what the cultures would show.
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NARRATOR: For three weeks, Dr. G has
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patiently waited for the lab experts to work their magic.
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And today, the waiting game finally comes to an end.
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JAN GARAVAGLIA: The tox, actually, in and of itself,
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didn't show anything.
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You know, it was negative all across.
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NARRATOR: She can now officially rule out a drug
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or alcohol related death.
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Next, Dr. G slips the micros of Victor's heart
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and lungs underneath the lens.
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And what she discovers is telling.
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The lining of the pericardial sac and lining of the heart
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was definitely an acute infectious pericarditis.
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And when you look at his lungs, he clearly
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has a low bar pneumonia.
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NARRATOR: Two severe infections, one in the lungs
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and one in the heart, both caused by the strep bacteria.
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This confirms Dr. G's findings at autopsy.
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But when she zooms in on the bronchus, the main air
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tube inside the lungs, she spots something that she couldn't
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see with her naked eye.
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The bronchus inside the lungs show necrosis
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and some chronic inflammation.
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What is causing all this?
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NARRATOR: And at this point, Dr. G has only one place
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left to look--
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the viral culture report.
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And when I get my culture, that's the smoking gun.
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All the pieces fit together.
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And I love that when that happens.
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NARRATOR: Dr. G has just reviewed the lab results
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of 52-year-old Victor Morales.
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And after a three-week investigation,
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she's finally found the missing link
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to a strange and sudden death.
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When I get my cultures back, I have all my pieces together.
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And I clearly see the progression of what happened.
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NARRATOR: In the winter of 2009, Victor Morales
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checks into the Blue Sky Lodge after a devastating fire
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burns down his home.
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JAN GARAVAGLIA: He looked kind of yellow and kind of shaky
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when he checked into the hotel.
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The clerk thought he looked sick.
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He is sick.
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And he's dying.
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NARRATOR: Thanks to the culture of Victor's bronchus,
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Dr. G now knows the identity of this ruthless killer.
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The cultures came back positive for H1N1 influenza.
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NARRATOR: H1N1, also known as swine flu,
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is a strain of influenza first detected in the United States
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in April of 2009.
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In extreme cases, it can be life threatening.
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MARK WALLACE: It's thought that there
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was about 16 million Americans who
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got H1N1 over the last year.
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Out of that, about 12,000 died.
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This flu bug was different in that it didn't kill
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our typical demographic of the older person
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with a lot of chronic diseases.
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You tended to see it more in young people.
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We saw a lot of people who were obese having a lot of problems
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with it.
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We had pregnant women die with it.
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We had kids dying with it.
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And we even had, you know, people
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52 years old dying with it.
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NARRATOR: Dr. G suspects that Victor contracted H1N1
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about 10 days before he died.
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Whether someone sneezed on him or he touched the virus
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and then touched his mouth or nose or eyes,
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that virus took hold.
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He started feeling sick.
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He's feeling achy.
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He's got a headache.
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At this point, he could have gotten treatment,
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but he didn't.
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NARRATOR: Not long after Victor is infected,
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the virus invades his airways and attacks the lining
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of his bronchus, to the point where the tissue
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becomes irritated and dies.
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That lining is so inflamed, it can't do its job.
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And part of its job is to help remove bacteria,
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get it out of the lungs.
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NARRATOR: Eventually, the bacteria
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begins to spread from the bronchus into Victor's lungs,
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setting into motion a deadly chain of events.
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That set him up for a serious bacterial pneumonia,
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which developed in his right lower lung.
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JAN GARAVAGLIA: That infection, then,
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spreads to his pericardial sac, which sits adjacent to it.
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NARRATOR: The raging infection triggers a pericarditis
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so severe that the heart appears to be
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covered in a thick shag carpet.
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The pus starts developing these kind of fronds,
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and eventually, that bacteria goes into his blood.
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NARRATOR: And once the bacteria is in Victor's bloodstream,
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it isn't long before it sets off a life threatening
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condition called sepsis.
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It causes the blood pressure to drop,
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and eventually, he doesn't get blood to his brain, his heart.
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NARRATOR: And as he staggers outside,
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most likely to seek help, his heart finally gives out.
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And he collapsed and dies on the sidewalk.
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NARRATOR: Dr. G can now close the book
00:21:14
on the case of Victor Morales.
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But one question still remains.
00:21:19
How did he get the scratches and abrasions?
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JAN GARAVAGLIA: We may never know
00:21:23
why he had the scratches on his arm and the abrasions
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to his head.
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Oftentimes you don't know exactly what happened,
00:21:32
and you never will.
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But it's really interesting that we started out
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with a case that could have been homicide,
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an accident, a natural, and the culprit ends up to be H1N1.
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NARRATOR: Dr. G immediately reports her findings
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to the local authorities.
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When you find something like this,
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you contact the health department.
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The health department keeps track of all the people
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die from the flu.
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All those numbers that you hear on TV,
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all the statistics, all that information
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is gathered one case at a time.
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This man's death was preventable.
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He didn't have to die from the flu.
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He could have been treated along multiple stages of his illness.
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There is antiviral medication that this flu was sensitive to,
00:22:26
and his pneumonia would have been
00:22:28
treated with clear antibiotics.
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He probably spent the last week of his life miserable.
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This poor guy had no one.
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It's not good that people die alone.
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That's really the tragedy of this case.
00:23:06
NARRATOR: Dr. G is ultimately responsible for all cases that
00:23:09
come through the District 9 morgue.
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But she doesn't perform every autopsy herself.
00:23:14
[INAUDIBLE] he needs to be X-rayed.
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Some people think I'm the only one here.
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There's actually five of us.
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Well, if you'd get here on time--
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There's five physicians that work in this office.
00:23:25
NARRATOR: And the youngest physician on her staff
00:23:27
is Dr. Joshua Stephany, who first came
00:23:30
to the morgue in 2003, when he trained as a resident
00:23:34
under Dr. G.
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He really had an inquisitive mind.
00:23:38
He really liked the cases, and the smells didn't bother him.
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So I hired Josh immediately out of his fellowship
00:23:46
to work in our office.
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You know, Josh is still young.
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And there's still things that he hasn't seen.
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And he still is learning the day-to-day.
00:23:56
You know what you're going to have to do,
00:23:57
is take some micros of that.
00:23:59
Yeah.
00:24:00
[INAUDIBLE]
00:24:01
I value her input just from the experience level.
00:24:04
She's been doing this longer than I have.
00:24:05
She's seen a lot more than I have.
00:24:07
JAN GARAVAGLIA: I'm thankful for all the physicians
00:24:09
that work with me.
00:24:10
We have a really good team, and it's
00:24:12
nice to work with good people.
00:24:16
NARRATOR: Every morning at 8:00 AM, all five medical examiners
00:24:20
gather to discuss the day's cases.
00:24:22
JAN GARAVAGLIA: It is very important to have multiple eyes
00:24:25
and ears because one medical examiner could come up
00:24:28
with an idea and kind of shed a new light and a new way
00:24:32
of thinking about a case.
00:24:34
NARRATOR: At the end of each meeting,
00:24:35
the morgue workload is divvied up.
00:24:37
And the winner of that lottery was Dr. Stephany.
00:24:41
NARRATOR: And today, it looks like Dr.
00:24:43
Stephany has landed a particularly interesting case.
00:24:47
We all like a mystery.
00:24:49
It's no fun to get a present when
00:24:51
you know what's inside already.
00:25:01
NARRATOR: It's a Sunday morning in late June.
00:25:05
But for Dario Romano, a ninth grade teacher,
00:25:08
it isn't your typical lazy weekend.
00:25:12
He's knee deep in a home renovation project
00:25:15
that he's been working on for weeks.
00:25:17
Apparently, he was working up in the attic,
00:25:19
helping the family try to put an addition on to the attic.
00:25:23
NARRATOR: Nothing about the 45-year-old
00:25:24
seems out of the ordinary.
00:25:27
But around noon, Dario San Miguel is on his way
00:25:30
to the laundry room--
00:25:31
Dad?
00:25:32
NARRATOR: --when he stumbles onto a terrifying scene.
00:25:34
Dad!
00:25:36
He finds his father unresponsive at the bottom
00:25:38
of the ladder.
00:25:40
NARRATOR: In a panic, Miguel immediately dials 911.
00:25:44
And paramedics arrive on the scene within minutes.
00:25:48
He had no vitals, no heartbeat, no pulse.
00:25:53
He wasn't breathing.
00:25:54
NARRATOR: Emergency technicians performed CPR
00:25:57
on Dario for over half an hour.
00:26:00
But despite every effort to save his life,
00:26:03
the beloved father and husband dies right there at the foot
00:26:07
of his attic stairs.
00:26:10
They couldn't bring him back.
00:26:14
The family's very surprised, very shocked.
00:26:17
JAN GARAVAGLIA: It's really sad.
00:26:18
You know, the poor 15-year-old is obviously devastated
00:26:22
to find his dad dead.
00:26:23
NARRATOR: And now, it's up to Dr. Stephany
00:26:26
to solve the mystery of Dario's tragic death.
00:26:31
JAN GARAVAGLIA: But we don't know why he died.
00:26:33
But by the end of the day, we're hoping to know.
00:26:55
NARRATOR: Associate medical examiner Dr. Joshua Stephany
00:26:58
is preparing for the autopsy of Dario
00:27:00
Romano, whose family is still reeling
00:27:03
from their unexpected loss.
00:27:05
JAN GARAVAGLIA: I think the worst part is that the family
00:27:07
just has no clue why he died.
00:27:10
And we're hoping the autopsy gives us the answer.
00:27:12
JOSHUA STEPHANY: Trying see what's going on with this guy.
00:27:15
NARRATOR: Dr. Stephany begins by reading
00:27:17
through the detailed investigator's report.
00:27:20
We have a 45-year-old Hispanic male
00:27:21
found dead at the bottom of a ladder
00:27:24
that leads up to his attic.
00:27:25
I think trauma is a possibility on this fellow.
00:27:29
NARRATOR: And a fatal head injury
00:27:31
is at the top of his list.
00:27:33
He could have hit his head up in the attic,
00:27:35
or he could have fallen coming down the ladder.
00:27:39
If there is trauma, there could be a buildup of blood.
00:27:41
A buildup of blood affects you to the point
00:27:43
where you can pass out.
00:27:45
NARRATOR: But Dr. Stephany must also consider a number
00:27:47
of alternate scenarios.
00:27:50
It was a hot day at the end of June.
00:27:52
JOSHUA STEPHANY: That attic can get up to 120,
00:27:53
150 degrees no problem.
00:27:56
So heat stroke is a definite possibility.
00:28:00
Heat stroke is when your body temperature
00:28:03
goes up, usually above 105.
00:28:07
It's a serious condition.
00:28:09
But that one's going to be difficult to prove because we
00:28:12
don't have a temperature.
00:28:13
EMS didn't take a temperature.
00:28:16
NARRATOR: This means that in order to record heat stroke
00:28:19
as Dario's official cause of death,
00:28:21
Dr. Stephany will first have to rule everything else out.
00:28:26
And given the circumstances on the scene,
00:28:28
there's another theory he must consider.
00:28:31
We know he's working with the power tools up there.
00:28:33
So you're thinking, is there possible of electrocution?
00:28:37
JAN GARAVAGLIA: He'd been in that very hot attic,
00:28:40
so he's probably sweating profusely.
00:28:43
You know, that sweat is a very good conductor of electricity.
00:28:47
You can still move after you've been electrocuted.
00:28:50
So there is a chance that he started walking--
00:28:53
he got electrocuted, started walking down the ladder
00:28:55
and fell off.
00:28:56
That's a possibility.
00:29:00
NARRATOR: Next, Dr. Stephany leafs
00:29:01
through the 45-year-old's medical history,
00:29:04
and right away, he spots an important detail.
00:29:07
We have the history that he's got
00:29:09
a congenital cardiac anomaly.
00:29:12
NARRATOR: Dario was born with a defect of the aortic valve,
00:29:15
the opening that regulates blood flow
00:29:18
from the heart to the aorta.
00:29:20
Over time, it can lead to a dangerous condition
00:29:23
called aortic stenosis.
00:29:25
The aortic stenosis causes those valves to be stiff
00:29:29
and then narrowed, letting less and less blood
00:29:33
get through them.
00:29:34
And that's a huge strain on your heart.
00:29:37
But we were told he is being followed by a cardiologist.
00:29:41
And up until you start getting that narrowing,
00:29:45
there's not a really high chance you're going to die suddenly
00:29:49
and unexpectedly.
00:29:52
Well, right now, if there is, given those circumstances,
00:29:56
it's pretty much open ended.
00:29:57
It can be anything.
00:29:58
He's going to let the body speak to him.
00:30:09
Let's take a look what we've got here.
00:30:11
NARRATOR: Dr. Stephany begins with a meticulous examination
00:30:14
of the body, searching for any evidence of electrocution.
00:30:17
We often see just little burns where the electricity goes in.
00:30:21
They're kind of dry with raised white edges--
00:30:25
real classic for electrical burn.
00:30:30
NARRATOR: With a careful eye, he studies the hands
00:30:32
and other extremities, on the lookout
00:30:34
for any suspicious markings.
00:30:37
No burn marks, no small charring
00:30:40
or discolorations of the body.
00:30:42
NARRATOR: On first blush, death by electrocution
00:30:45
is looking less likely.
00:30:47
However, as with heat stroke, Dr. Stephany must rule it
00:30:51
out by diagnosis of exclusion.
00:30:54
But as he continues to scan the body for clues,
00:30:57
something else immediately grabs his attention.
00:31:00
Oh, look at this.
00:31:02
There are abrasions on the chest,
00:31:03
the lower back, the shins, the knees,
00:31:05
and on the upper extremities.
00:31:08
That could be from a fall, going down the ladder.
00:31:14
You get a clean picture of that one?
00:31:16
NARRATOR: Now, he'll have to dig deeper for answers.
00:31:19
And he knows just where to look first.
00:31:21
The number one traumatic injury for falling off a ladder
00:31:24
would be head trauma.
00:31:25
But you never know what you find in the head.
00:31:36
NARRATOR: With his scalpel in hand,
00:31:38
Dr. Stephany slides the blade across Dario's scalp.
00:31:41
We'll make an incision going from the back of one ear
00:31:44
to the back of the other ear.
00:31:46
Our theory is that he hit his head,
00:31:48
that he has maybe a subdural, blood
00:31:51
collecting over the brain.
00:31:54
NARRATOR: To gain access to the brain itself,
00:31:56
he cuts through the bone with an oscillating saw.
00:31:59
How do you breathe in this thing?
00:32:00
Everything's so foggy.
00:32:01
I know.
00:32:03
NARRATOR: Eyes peeled for any abnormalities, Dr. Stephany
00:32:06
inspects the surface of the organ inch by inch.
00:32:09
But I don't see any subdural blood.
00:32:11
I don't see any blood around the cerebral hemispheres.
00:32:14
Nothing here.
00:32:16
This looks fine.
00:32:18
He didn't have a typical injury we
00:32:20
see with falling off a ladder.
00:32:23
He didn't have head trauma.
00:32:25
The head was not the cause of his death.
00:32:26
JOSHUA STEPHANY: I'm not quite sure what's going on.
00:32:28
He's a mystery.
00:32:30
So we really don't know what's going on with this fellow.
00:32:34
I think it'll be interesting to see what the autopsy shows.
00:32:47
JOSHUA STEPHANY: We take the scalpel,
00:32:48
make the incision from both anterior shoulders,
00:32:51
meet at the mid chest, and then go down the mid-abdomen.
00:32:55
NARRATOR: Carefully, Dr. Stephany
00:32:56
peels back the deep layers of tissue to reveal
00:32:59
the inside of Dario's body.
00:33:02
And the instant the abdominal cavity is exposed,
00:33:05
he's completely taken aback.
00:33:07
That's not good.
00:33:08
This was quite shocking.
00:33:30
NARRATOR: Dr. Stephany has just made
00:33:32
a stunning discovery inside the body
00:33:34
of 45-year-old Dario Romano.
00:33:38
That's not good.
00:33:39
He's quite surprised at what he finds.
00:33:41
He's got some blood in the abdomen, so I don't know.
00:33:43
I see a large amount of blood in the cavity,
00:33:46
so I want to know what's going on.
00:33:51
First of all, I want to measure it to see how much is in there.
00:33:53
Let's let all this blood out.
00:33:54
We need to measure that.
00:33:55
We actually take a soup ladle and slowly ladle it out
00:34:00
like we're ladling out soup.
00:34:03
NARRATOR: And by the time he's done,
00:34:04
Dr. Stephany has measured out a staggering 1,700 milliliters.
00:34:10
That's a lot of blood.
00:34:11
That's over a third of his blood volume.
00:34:13
Now it's his job to figure out why has he got that blood.
00:34:17
Right now, I'm not really sure what the source of blood is.
00:34:20
Is it natural disease?
00:34:21
Did he rupture a spleen?
00:34:23
And what's going on in his chest?
00:34:26
Are there rib fractures involved here?
00:34:30
NARRATOR: With these thoughts in mind,
00:34:32
Dr. Stephany removes the chest plate
00:34:34
and takes initial stock of Dario's upper body cavity.
00:34:38
I don't see any evidence of fractures on the ribs.
00:34:41
I don't see any lacerations.
00:34:42
I don't see perforations.
00:34:43
I need to look at his heart.
00:34:46
NARRATOR: But given Dario's congenital abnormality,
00:34:49
Dr. Stephany is also eager to examine the heart.
00:34:52
So let's see.
00:34:54
NARRATOR: He cuts through the pericardial sac
00:34:55
to expose the organ inside and immediately
00:34:58
spots something alarming.
00:35:00
Oh, that's a big heart.
00:35:02
What's noteworthy right off the bat with his heart
00:35:05
is it's enlarged.
00:35:08
The heart weighs almost 600 grams.
00:35:10
That's a thick, big heart.
00:35:14
NARRATOR: And as Dr. Stephany inspects the organ more
00:35:16
closely, he's surprised to see that it's in worse shape
00:35:20
than he expected.
00:35:22
It's clear now that Dario had developed a severe case
00:35:26
of aortic stenosis.
00:35:28
JOSHUA STEPHANY: It doesn't look so good.
00:35:30
The valve is usually beautiful.
00:35:32
They're very thin and delicate, but this
00:35:34
is a gnarly looking valve.
00:35:36
It's all diseased and narrowed and stiff and calcified.
00:35:41
The heart, to push out same amount of blood
00:35:43
out through that narrow opening has to pump harder.
00:35:45
So because the heart's working harder,
00:35:47
the heart is a little thickened and a little larger.
00:35:51
JAN GARAVAGLIA: This is a very bad heart.
00:35:53
If not for the blood in his belly,
00:35:56
I would have said that is probably the cause of death.
00:35:59
But he needs to figure out what has happened
00:36:02
that's created 1,700 milliliters of free blood
00:36:06
in his abdominal cavity.
00:36:08
So I don't know where the blood is coming from.
00:36:11
So I want look in the abdominal cavity.
00:36:14
NARRATOR: One by one, Dr. Stephany
00:36:16
begins the arduous task of removing
00:36:18
and dissecting the abdominal organs,
00:36:21
starting with the GI tract.
00:36:23
We do a look around the organs,
00:36:25
but I don't see any perforations in the stomach, in the bowels,
00:36:30
in the intestines.
00:36:32
He doesn't find anything.
00:36:36
NARRATOR: Next, he removes the liver.
00:36:39
The surface of the liver looks intact.
00:36:41
It looks nice tan brown color.
00:36:43
Nothing remarkable.
00:36:45
NARRATOR: But as he cuts into the organ itself,
00:36:47
he finally strikes paydirt.
00:36:50
JOSHUA STEPHANY: Oh, there it is.
00:36:51
I see a nice big laceration of the internal surface
00:36:55
of the liver.
00:36:57
That tear is quite deep.
00:37:00
That's clearly where that blood is coming from.
00:37:06
NARRATOR: But ironically, this discovery
00:37:08
only deepens the mystery.
00:37:10
Well, to me, it was strange, you know.
00:37:12
It's a surprising finding.
00:37:14
It's unusual to have a lacerated liver not related
00:37:18
to an automobile accident and really high falls,
00:37:21
like off of buildings.
00:37:23
Why did he lacerate his liver?
00:37:26
That's the $1,000 question.
00:37:32
NARRATOR: As the autopsy comes to a close,
00:37:34
Dr. Stephany still has his work cut out for him.
00:37:38
What is the chain of events that
00:37:40
led to that cause of death?
00:37:41
NARRATOR: To figure that out, Dr. Stephany
00:37:43
will need to go back to square one,
00:37:46
reexamining all the evidence from the investigator's report
00:37:50
to the medical history to the internal and external exams.
00:37:54
In the morning, each of the doctors
00:37:55
shares what they found from the autopsy from the day before.
00:38:01
NARRATOR: And after a night of intense deliberation,
00:38:04
Dr. Stephany believes he can finally
00:38:07
explain to his colleagues exactly what led
00:38:09
to Dario Romano's tragic death.
00:38:18
It's a scorching hot Sunday in Winter Park, Florida,
00:38:22
and Dario Romano is up in his attic,
00:38:24
laboring over a home improvement project.
00:38:27
He was working, laying planks up
00:38:29
there, using some electrical equipment, sawing some boards.
00:38:35
It's hot.
00:38:36
It's the height of summer.
00:38:38
The attic temperature can get easily to 120, 150 degrees.
00:38:43
NARRATOR: As the temperature rises,
00:38:44
Dario's body becomes overwhelmed by the heat,
00:38:47
putting a dangerous strain on his already damaged heart.
00:38:51
JAN GARAVAGLIA: The heart is really working hard
00:38:54
to get the blood through that narrowed
00:38:57
opening at the aortic valve.
00:38:59
And when he's stressing himself in that attic,
00:39:02
in the heat, working, that's a lot for his heart to take.
00:39:08
NARRATOR: The organs soon goes into overdrive,
00:39:10
struggling to pump fresh blood and oxygen
00:39:13
through the 45-year-old's body.
00:39:15
That could make him dizzy.
00:39:16
It could make him woozy.
00:39:18
Which led him to lose balance, causing him to fall.
00:39:21
He must have hit his side.
00:39:24
He's got a nice abrasion on that right side.
00:39:26
NARRATOR: And given the odd manner in which Dario's body
00:39:29
goes down, what might have been a relatively harmless fall
00:39:33
turns into a catastrophic blow.
00:39:36
Unfortunately, you know, he hit just the right way
00:39:40
to lacerate that liver.
00:39:41
This gentleman must have fallen against something, must
00:39:44
have hit something with his abdomen to cause
00:39:45
that type of laceration.
00:39:48
JAN GARAVAGLIA: Dr. Stephany thinks he
00:39:49
lacerated it up in the attic.
00:39:51
My theory is that he clearly can't get that liver
00:39:54
laceration with a minor fall.
00:39:57
I don't think there's enough force
00:39:59
up in that attic that would have caused that laceration.
00:40:03
I think it occurred that when he was walking down that ladder
00:40:06
and he fell.
00:40:10
NARRATOR: But while Dr. G and Dr. Stephany
00:40:12
may disagree on the exact chain of events,
00:40:15
one thing is certain--
00:40:17
once the liver is lacerated, blood
00:40:19
begins gushing out of the wound and into the abdominal cavity
00:40:23
at an alarming rate.
00:40:25
He is losing blood flow to the organs
00:40:26
and losing blood flow to the heart.
00:40:28
He gets himself up, sits up against that ladder to rest.
00:40:32
He's just slowly losing consciousness.
00:40:35
NARRATOR: One by one, the 45-year-old's organs
00:40:37
begin shutting down.
00:40:39
And within seconds, he is dead.
00:40:42
JAN GARAVAGLIA: This is one of those cases
00:40:43
that you think is a sad accident.
00:40:47
NARRATOR: In the end, no one can argue
00:40:49
that the sequence of events leading to Dario Romano's
00:40:52
untimely death were unusual--
00:40:54
a hot day, a compromised heart, and a flukish fall.
00:40:58
But sadly, to Dr. G and her team,
00:41:01
it's not an unfamiliar story.
00:41:03
Why him?
00:41:05
Why that day?
00:41:06
Why that moment?
00:41:08
People always assume that it's one thing that kills you.
00:41:12
And ultimately, there's many factors that play a role that
00:41:18
end up causing people to die.
00:41:22
NARRATOR: Now, findings in hand, Dr. Stephany
00:41:24
reaches out to Dario's devastated widow, Gloria.
00:41:29
I relayed my cause and manner of death.
00:41:31
Let them know that there is nothing they could have done.
00:41:34
But I wanted to talk to her more about the aortic valve.
00:41:39
JAN GARAVAGLIA: Dr. Stephany put extra effort-- just
00:41:41
make sure she understood how serious
00:41:44
his aortic stenosis was in that there is an increased
00:41:49
chance her son had this.
00:41:51
Because there is a possibility that congenital abnormality
00:41:54
could be genetic.
00:41:56
You definitely want to have her get
00:41:58
the son to see a cardiologist.
00:42:00
So she was thankful.
00:42:05
Dr. Stephany handled this case great.
00:42:08
I mean, he kept an open mind.
00:42:11
He let the body tell him what happened.
00:42:13
And then he kind of sat back and thought about it
00:42:16
and put the pieces together.
00:42:18
A lot of people think we don't-- you know,
00:42:20
the people are dead.
00:42:21
How do we help people if all we're doing
00:42:23
is examining dead people and [INAUDIBLE] cause of death?
00:42:25
This is a good example of helping a living person,
00:42:28
helping a family.
