00:00:04
[MUSIC PLAYING]
00:00:18
NARRATOR: A healthy woman rapidly
00:00:20
succumbs to a virulent illness.
00:00:22
She gets antibiotics and ends up in the hospital.
00:00:24
A week after that, dies.
00:00:26
NARRATOR: Her body is covered with dozens
00:00:28
of raw, oozing sores.
00:00:30
DR. G: Well, I looked at the body, and I'm kind of, like,
00:00:32
taken aback.
00:00:33
She's got these vesicles all over her.
00:00:36
Oh, gosh.
00:00:37
NARRATOR: Can Dr. G identify the deadly disease
00:00:39
and find its source?
00:00:41
I have never seen a case like this,
00:00:43
and I know I will never see another case like this.
00:00:47
NARRATOR: And then a woman helps her husband
00:00:49
recover from what appears to be a routine epileptic seizure.
00:00:52
I said, are you sure you don't want me to call 9-1-1?
00:00:55
No, no.
00:00:56
No, no.
00:00:57
I'll be all right if you just let me sleep.
00:00:59
NARRATOR: But this time, he never wakes up.
00:01:01
DR. G: She felt horrible.
00:01:03
I knew that she was going to be dealing with some guilt right
00:01:05
from the start.
00:01:08
NARRATOR: Altered lives, baffling medical mysteries,
00:01:13
shocking revelations.
00:01:16
These are the everyday cases of Dr. G, medical examiner.
00:01:27
It's just after 8:00 AM at the District 9 morgue in Orlando,
00:01:31
Florida, and preparations for the day's work
00:01:33
are in full swing.
00:01:34
OK.
00:01:35
We need--
00:01:36
NARRATOR: When chief medical examiner
00:01:38
Jan Garavaglia arrives, she and her staff
00:01:40
size up the day's cases.
00:01:42
We've got three to x-ray.
00:01:45
NARRATOR: Dr. G's first autopsy will
00:01:47
be the case of a 34-year-old woman who died
00:01:50
a bizarre and unexpected death.
00:01:58
Claire Jackson was transferred to the District 9 morgue
00:02:00
last night after she died in the hospital
00:02:03
due to a sudden illness, which appears to have
00:02:05
caused massive liver failure.
00:02:08
We have this woman, and we've gotten her from the hospital.
00:02:10
And the doctors don't know why she died.
00:02:12
She's in fulminant liver failure.
00:02:15
It's massive death of your liver, and they don't know why.
00:02:20
NARRATOR: According to Dr. G's investigator's report,
00:02:23
the woman's ordeal began approximately one week earlier.
00:02:30
Claire Jackson is feeling sick.
00:02:32
She visits her doctor complaining
00:02:34
of a fever, diarrhea, nausea, and pain in her mouth.
00:02:39
Her physician suspects she may have a minor infection.
00:02:43
He prescribes an antibiotic and a painkiller
00:02:45
and sends her home to rest, but the treatment is ineffective.
00:02:51
A week after she gets the antibiotic,
00:02:53
she just gets sicker and sicker.
00:02:54
She goes to the hospital and they
00:02:56
thought she was septic, or, you know, bacteria in her blood.
00:03:00
NARRATOR: Suspecting that Claire has developed
00:03:02
an aggressive bacterial infection called septicemia,
00:03:05
doctors rushed to treat her with powerful antibiotics.
00:03:08
But Claire's condition quickly spirals out of control.
00:03:13
Within only hours, her vital organs, including her liver,
00:03:16
begin to fail, and she is put on life support.
00:03:21
Barely alive, she begins to develop a strange rash,
00:03:25
and by the next day, Claire is dead.
00:03:28
The hospital is baffled by the woman's swift decline.
00:03:32
Their suspicion?
00:03:33
She died from septicaemia, a massive and often catastrophic
00:03:37
bacterial infection in the bloodstream,
00:03:39
which caused her liver to fail.
00:03:42
So that's what I've got, and they don't know.
00:03:44
They don't have anything diagnosed,
00:03:45
really, in the hospital.
00:03:47
NARRATOR: For Dr. G, the death of Claire Jackson
00:03:50
is a mystery with no easy answers
00:03:52
and no clear hypothesis.
00:03:55
She begins immediately with the external examination.
00:04:02
On the exam table, Dr. G gets her first look
00:04:05
at Claire Jackson's body, but it's
00:04:08
not at all what she expected.
00:04:10
Well, I walk over to the body and I'm kind of, like,
00:04:12
taken back.
00:04:13
She's got these vesicles all over her, like-- like blisters
00:04:17
on her skin.
00:04:18
And I'm like, nobody told me about this.
00:04:20
I was shocked.
00:04:21
I mean, when I'm looking at the chart,
00:04:22
when I'm reviewing medical records,
00:04:24
they don't mention that.
00:04:25
They mentioned some kind of crusted thing on her forehead,
00:04:28
but she's got like 50 of them on her face,
00:04:30
on the backs of her arms, on her back.
00:04:38
NARRATOR: In her 20 years as a medical examiner,
00:04:40
Dr. G has rarely seen a body with such
00:04:43
an unusual affliction.
00:04:45
DR. G: She looked really sick.
00:04:47
I mean, when I looked at her, she looked really sick.
00:04:50
Her gums were all red.
00:04:52
She had lesions on the gums.
00:04:54
Her teeth were actually even falling out of the gums.
00:04:57
Oh, gosh.
00:04:59
She looked very, very bad.
00:05:01
NARRATOR: Dr. G has no explanation
00:05:03
for Claire's condition or what would cause it.
00:05:06
But to her, it certainly does not
00:05:08
look like a bacterial infection as the hospital thought.
00:05:13
However, she does learn from Claire's medical records
00:05:16
that the victim had her own theory
00:05:18
about her strange illness, a very unusual theory.
00:05:23
According to Claire, two weeks earlier she
00:05:25
was having a drink at a local bar
00:05:27
when she kissed a man she had recently met,
00:05:30
and then he bit her.
00:05:34
Claire believed that whatever made her sick,
00:05:36
she caught from the bite.
00:05:39
Ugh, you know?
00:05:40
Is it some kind of assault?
00:05:42
What did she die of?
00:05:44
NARRATOR: Death from a human bite
00:05:45
would be highly improbable, but at this point
00:05:48
Dr. G needs to pursue any lead she can find.
00:05:52
First, she carefully inspects Claire's mouth
00:05:54
for any signs of a bite mark.
00:06:00
Inside of her mouth looked horrible.
00:06:02
The mucosa was sloughing off.
00:06:04
She had these all sort of lesions.
00:06:06
Bad teeth.
00:06:07
NARRATOR: And yet, Dr. G finds no scarring
00:06:10
to corroborate Claire's claim.
00:06:11
And I'm looking, because I have a history of a bite,
00:06:14
and I didn't find it.
00:06:17
NARRATOR: With another theory apparently off the table,
00:06:20
the mystery only deepens.
00:06:27
But there was another potential culprit Dr. G can pursue.
00:06:31
Claire has a history of cervical cancer,
00:06:34
which required a hysterectomy and genital surgery.
00:06:37
DR. G: She's got a large abdominal scar going down
00:06:41
basically from her belly button down to her bone-- pubic bone.
00:06:44
And then we also have that she's got a history
00:06:46
that the cancer had recurred and was on the outside
00:06:50
of her genitalia.
00:06:51
They had to do vulvectomy, remove
00:06:53
some of the external genitalia.
00:06:55
NARRATOR: But until she examines the body internally,
00:06:58
Dr. G has no clear answers as to whether the cancer
00:07:01
was Claire's killer.
00:07:04
A supposed bite, unusual lesions on the skin, cancer.
00:07:10
At the close of the external exam,
00:07:12
the woman's case remains baffling.
00:07:14
DR. G: None of it was making sense.
00:07:16
What exactly is going on, I wasn't sure.
00:07:20
NARRATOR: However, Dr. G believes
00:07:21
she might have a viable, albeit tentative,
00:07:24
diagnosis as to the cause of her strange disorder.
00:07:28
Well, you know, I am looking--
00:07:30
I'm looking at her, and I'm thinking
00:07:33
could it-- it might be chicken pox.
00:07:35
It might have been chicken pox that killed her.
00:07:39
NARRATOR: Chicken pox, known clinically as the virus
00:07:42
varicella zoster, is typically thought
00:07:45
of as a benign childhood rite of passage
00:07:47
which causes a rash of itchy welts
00:07:50
and a fever lasting about a week.
00:07:52
But for reasons unclear the disease
00:07:55
can be exceptionally virulent and even deadly
00:07:58
for certain individuals.
00:08:00
Especially vulnerable, according to Dr. Mark Wallace,
00:08:03
are newborn babies and adults.
00:08:06
The older you are when you acquire
00:08:08
chickenpox by and large, the more severe it is.
00:08:11
Sometimes when neonates acquire it, babies that are born
00:08:15
to mothers with chickenpox, that can be quite severe,
00:08:17
but that's sort of an exception.
00:08:25
NARRATOR: Because chicken pox is easily spread by direct contact
00:08:29
or through the air from a sneeze or cough,
00:08:31
Dr. G knows that Claire could have
00:08:33
been infected just about anywhere and never known it.
00:08:37
One way she can test if Claire was infected with chickenpox
00:08:40
is to take samples of the pustules themselves,
00:08:43
and that's where she turns next.
00:08:45
I had to do some special procedures, because I wanted
00:08:48
to know what the infection was.
00:08:50
NARRATOR: Coming up, Dr. G inspects
00:08:52
slides from Claire's sores and discovers that her death seems
00:08:56
to defy medical possibility when "Dr. G, Medical Examiner"
00:09:00
continues.
00:09:02
[MUSIC PLAYING]
00:09:15
At the District 9 morgue in Orlando, Florida,
00:09:18
chief medical examiner Dr. Jan Garavaglia
00:09:21
is working on her first autopsy of the day,
00:09:24
the case of Claire Jackson.
00:09:26
Her next step is to collect a sample
00:09:29
from one of the many sores that covered
00:09:31
the woman's body to examine later under the microscope.
00:09:34
DR. G: I took one of her vesicles and I opened it.
00:09:37
I broke it open and scraped it so I could see the cells
00:09:41
that were inside that vesicle.
00:09:45
NARRATOR: The woman died yesterday in the hospital
00:09:47
after a rapid onset of a bizarre illness
00:09:49
that she believed was caused by a human bite during a kiss.
00:09:54
However, Dr. G found no evidence of a bite mark
00:09:57
in the external exam, and she suspects
00:09:59
instead that Claire's death may have been due to chickenpox.
00:10:04
She had an infection that was-- that was killing her.
00:10:06
It was pretty obvious by looking at her.
00:10:09
NARRATOR: But there's also the lingering
00:10:10
possibility that Claire died from a relapse
00:10:13
of cervical cancer.
00:10:15
Chicken pox or cancer?
00:10:17
It's a question that can only be answered by completing
00:10:20
the internal examination.
00:10:26
DR. G: OK, we ready?
00:10:29
You took a picture?
00:10:30
You did.
00:10:32
NARRATOR: Claire's body is opened
00:10:33
with a Y-incision from the shoulder blades
00:10:35
to the pubic bone.
00:10:37
Immediately, the extent of her illness is apparent.
00:10:40
Well, when you open her up, she just looks sick.
00:10:43
Sick on the inside, just like she looked sick on the outside.
00:10:47
NARRATOR: Dr. G draws toxicology samples
00:10:50
and then begins her search of Claire's body
00:10:52
cavity for any signs of recurring cancer.
00:10:56
As medical records indicated, Dr. G
00:10:58
find several of Claire's reproductive organs
00:11:00
previously removed as a result of the disease.
00:11:04
Internally, she has no uterus, tubes,
00:11:08
or ovaries, which goes along with her history
00:11:11
of cervical cancer.
00:11:16
NARRATOR: But she finds absolutely
00:11:18
no evidence of a relapse.
00:11:22
DR. G: There was no cancer.
00:11:27
NARRATOR: Dr. G is now confident that the woman's rapid death
00:11:30
was not due to a cancer relapse.
00:11:33
Could it have been from chicken pox?
00:11:35
OK.
00:11:36
So the right is 500--
00:11:37
NARRATOR: She isn't sure, but then she sees Claire's liver.
00:11:43
DR. G: Her liver was-- had kind of a pitted surface.
00:11:46
It was somewhat soft and round.
00:11:49
Her liver does not look good.
00:11:51
NARRATOR: It's obvious that Claire succumbed
00:11:53
to liver failure, just as the hospital
00:11:56
indicated in its records.
00:11:58
Dr. G now needs to find a link between Claire's liver
00:12:02
and chickenpox, but infections like chickenpox
00:12:07
can only be positively identified
00:12:09
through lab analysis.
00:12:10
Oh, right.
00:12:12
NARRATOR: Dr. G must take tissue samples of Claire's liver
00:12:15
and send those to the lab, along with the skin scrapings
00:12:18
from the vesicles, to have microscopic slides prepared.
00:12:22
DR. G: So we've got to put it all together.
00:12:24
We've got the vesicles.
00:12:25
We have the vesicles on her skin,
00:12:27
the vesicles in her mouth, the mucosa sloughing off.
00:12:31
We've got pretty much dead-looking liver.
00:12:35
And what does it all mean?
00:12:38
NARRATOR: She must wait several weeks to find out.
00:12:42
[MUSIC PLAYING]
00:12:49
I just have--
00:12:50
I have the one from today for the death certificate.
00:12:52
First thing I got back was I got the slides stained
00:12:57
of the vesicle that I scraped.
00:13:02
Yeah.
00:13:02
[INAUDIBLE]
00:13:11
And it's-- it's-- you see these kind of--
00:13:14
these cells almost kind of look like they fuse.
00:13:16
It's big cells, and then they have
00:13:18
a-- like a little glob of kind of pink purple stuff,
00:13:21
and that shouldn't be there.
00:13:22
Your cells shouldn't have these pink purple globs, and
00:13:26
the cell's kind of enlarged.
00:13:27
And they look like several of them together.
00:13:31
NARRATOR: Claire's liver samples and blood
00:13:32
cultures are abnormal as well, and they
00:13:35
all point to the same disease.
00:13:37
But it's not chicken pox.
00:13:39
It's something Dr. G never expected.
00:13:47
It had the characteristic findings for herpes.
00:13:52
NARRATOR: But the type of herpes Dr. G finds in Claire's body
00:13:55
is herpes simplex type 1, or oral herpes,
00:13:59
one of the most common viral infections in the world.
00:14:03
Unlike genital herpes, herpes simplex type 1
00:14:06
is not considered a sexually transmitted disease
00:14:09
because it is usually contracted through casual contact
00:14:12
in childhood.
00:14:13
Typically, the virus causes only localized cold sores
00:14:17
on the face, lips, and gums.
00:14:27
The idea that such a common virus, which usually remains
00:14:30
localized on the mouth, could have spread through Claire's
00:14:33
entire body and caused her death seems
00:14:36
almost impossible to believe.
00:14:38
DR. G: Herpes, systemic herpes infection?
00:14:41
That's-- you know, I'm thinking, that's got to be ridiculous.
00:14:43
I've never heard of, you know--
00:14:44
I mean, she's a healthy woman.
00:14:46
I don't-- I don't know why she would
00:14:48
get systemic herpes infection.
00:14:50
NARRATOR: It's impossible, and yet there it is on the slide.
00:14:54
For Dr. G, the unbelievable finding begs one question.
00:15:00
Why?
00:15:00
Why does she have herpes all through her body?
00:15:03
I mean, I'm like, I don't know.
00:15:05
NARRATOR: Coming up next, the hunt
00:15:07
for answers to Claire Jackson's stunning death
00:15:09
leads Dr. G to a shocking conclusion.
00:15:12
I really couldn't get a handle on why she
00:15:14
would be get systemic herpes.
00:15:17
NARRATOR: And later when an epileptic man dies
00:15:19
after a seizure, his wife is stunned
00:15:22
by what killed him and blames herself for his death.
00:15:25
If I'm such a smart nurse, why didn't I notice your symptoms?
00:15:29
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:15:37
[MUSIC PLAYING]
00:15:50
In the case of Claire Jackson, Dr. G
00:15:53
has two findings that seem to contradict medical science,
00:15:57
the death of a woman and absolute proof
00:16:00
that a massive herpes simplex 1 infection killed her.
00:16:04
Her herpes took off and went all over her body.
00:16:07
She has acute fulminant liver necrosis from the herpes.
00:16:13
NARRATOR: But now Dr. G might finally
00:16:15
have a logical explanation.
00:16:23
After consulting with her staff and other infectious disease
00:16:26
experts, Dr. G theorizes that herpes might have become
00:16:30
lethal in Claire because her immune system was
00:16:33
somehow significantly weakened.
00:16:35
To me, to--
00:16:37
one reason for her to have systemic herpes
00:16:40
would-- maybe she's immunosuppressed.
00:16:42
In the cases that I could find, the only people
00:16:45
who really get it systemically are
00:16:48
immunosuppressed people, people whose immune system
00:16:51
can't control this virus.
00:16:52
And I thought, well, what could have acutely caused
00:16:56
her becoming immunosuppressed?
00:16:57
Well, AIDS is one of them.
00:16:59
So immediately, I order an HIV to see if maybe she's immune--
00:17:03
has an immune problem.
00:17:07
NARRATOR: Dr. G asks the lab to recheck
00:17:09
samples of Claire's blood for HIV,
00:17:12
the virus that causes AIDS.
00:17:14
This could be the explanation she needs in the case.
00:17:18
HIV and AIDS could have inhibited Claire's ability
00:17:20
to fight off the infection, rendering
00:17:23
even the most benign viruses like herpes simplex 1
00:17:27
a potential killer.
00:17:35
But when Dr. G receives the results from the lab,
00:17:38
once again, she's taken aback.
00:17:41
DR. G: It was negative.
00:17:42
She wasn't-- she didn't have AIDS.
00:17:43
She didn't have the virus that would cause immunosuppression.
00:17:47
I cannot explain that.
00:17:49
I had experts that I contacted.
00:17:52
I cannot explain why, with her, it went all over her body.
00:17:56
I thought surely she had to be immunosuppressed.
00:17:59
I thought surely she must have AIDS, uh, something
00:18:03
that would cause immunosuppression.
00:18:04
And I don't have an answer on why it happened to her.
00:18:09
NARRATOR: Despite her lack of answers as to why,
00:18:11
she does make one shocking inference into how Claire
00:18:15
might have contracted herpes.
00:18:19
After reviewing the entire case, Dr. G
00:18:21
believes that Claire was right after all about the bite,
00:18:25
despite no evidence of scarring at autopsy.
00:18:28
We clearly has a history that something happened,
00:18:31
so it's hard to believe that that didn't play a role.
00:18:35
I just can't totally connect the dots
00:18:37
and totally blame him for this whole thing,
00:18:40
because it still doesn't make sense
00:18:41
why she got it systemically.
00:18:43
But it sure sounds about from the timeline
00:18:47
that she got that herpes from that bar and from that kiss
00:18:50
from Prince Charming.
00:18:53
NARRATOR: With her long awaited findings in hand,
00:18:56
Dr. G can finally speculate about what
00:18:58
happened to Claire Jackson during her last two weeks
00:19:01
alive.
00:19:09
Two weeks before her death, Claire Jackson
00:19:11
stops into a local bar, looking for a drink and some company.
00:19:16
She finds both.
00:19:17
But unbeknownst to Claire, her impromptu suitor is likely
00:19:21
a carrier of herpes simplex 1.
00:19:24
And tonight, the virus is active in his mouth.
00:19:29
DR. G: She kisses someone.
00:19:33
Probably this someone has a cold sore.
00:19:37
And during this kiss, we think that she was bitten either
00:19:41
on the lip or the tongue.
00:19:50
Herpes simplex type 1 is usually acquired from contact
00:19:52
with saliva, so it's certainly possible
00:19:55
that you might be exposed to more virus at one time
00:19:59
through a bite then--
00:20:00
then through just exposure to a sore or infected saliva.
00:20:08
NARRATOR: For unknown reasons, Claire's body
00:20:10
is unable to fight the usually benign virus
00:20:13
and it quickly spreads.
00:20:15
DR. G: I don't think anybody has a good answer
00:20:17
on why a healthy person could then get systemic herpes.
00:20:22
It just happens.
00:20:24
NARRATOR: By the time she visits her doctor approximately five
00:20:26
days later, she is nauseous, suffers from a fever,
00:20:30
and has diarrhea.
00:20:32
She also complains of pain in her mouth.
00:20:35
Suspecting a bacterial infection,
00:20:37
the doctor prescribes antibiotics,
00:20:39
but the treatment is ineffective in quelling herpes.
00:20:42
And then from there she gets sicker and sicker and sicker.
00:20:47
NARRATOR: Her decline is swift.
00:20:49
About two days after visiting her doctor,
00:20:51
Claire was rushed to the hospital, critically ill.
00:20:54
Her body teams with a systemic herpes infection.
00:21:00
Overrun with the rampant virus within only 22 hours,
00:21:03
her liver fails to function.
00:21:06
By then, Claire's body has erupted with hundreds
00:21:09
of herpes blisters.
00:21:12
And shortly thereafter, Claire dies.
00:21:18
The herpes went into her body and went into her liver
00:21:22
and actually killed her liver.
00:21:24
And she died from fulminant hepatic necrosis.
00:21:29
NARRATOR: Amazingly, there have been only 21 people
00:21:32
in the world not suffering from immunosuppression who are known
00:21:36
to have died from systemic herpes infections,
00:21:39
And Claire was one of those unlucky few.
00:21:43
I have never seen a case like this,
00:21:46
and I know I will never see another case like this.
00:21:49
It's just-- I'm never going to see it.
00:21:50
Systemic herpes infection in a normal woman is really rare.
00:21:56
It is frightening.
00:21:58
You know, I guess life is just full of uncertainties,
00:22:01
and sometimes bad things happen that you just can't explain.
00:22:10
NARRATOR: Coming up next, did epilepsy kill this man?
00:22:14
There was a small subset of people
00:22:17
who have these major seizures that
00:22:19
can die suddenly from them.
00:22:20
So what we've got here is a man who has a known
00:22:24
history of seizure disorder.
00:22:26
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:22:32
[MUSIC PLAYING]
00:22:49
Krishell is here looking--
00:22:51
looking pretty today.
00:22:53
And because Krishell decided to show up,
00:22:56
we have a pay statement for her.
00:22:57
Oh, thank you.
00:22:58
There you go.
00:22:59
She was looking rough yesterday,
00:23:00
but she looks good today.
00:23:02
Oh.
00:23:03
And she's doing this on camera, Krishell.
00:23:05
Oh, yeah.
00:23:05
That's right.
00:23:06
Dr. G was saying such nice things about us yesterday.
00:23:11
She was vicious.
00:23:12
I was not.
00:23:13
She put her head in the fan like she was one of those dogs,
00:23:16
sticking it out the window for air.
00:23:18
Yeah.
00:23:19
So that's nice.
00:23:20
Call me a dog.
00:23:27
NARRATOR: Dr. G's next case involves the death
00:23:30
of a 56-year-old man named Dale Ennis,
00:23:33
who has suffered from epileptic seizures since childhood.
00:23:36
OK.
00:23:38
NARRATOR: As her morgue assistant Krishell [INAUDIBLE]
00:23:40
prepares the body for examination,
00:23:42
Dr. G familiarizes herself with the case history.
00:23:46
So what we've got here is a man who is a known
00:23:50
history of seizure disorder.
00:23:52
The seizure disorder started when he was a little kid
00:23:54
after an episode of what they think
00:23:56
was meningitis encephalitis.
00:23:57
He would sleep for a long time afterwards [INAUDIBLE]..
00:24:00
NARRATOR: According to Dr. G's investigator's report,
00:24:02
yesterday afternoon Dale was discovered by his wife,
00:24:06
collapsed in the backyard.
00:24:08
PAULA: I went outside, and he was down on the ground.
00:24:10
And I could see that he'd had a seizure.
00:24:12
I shook him, and I said, are you all right?
00:24:14
And he goes, yeah, yeah.
00:24:15
I had a seizure.
00:24:16
Just let me lay here and sleep for a few minutes
00:24:18
and I'll get up.
00:24:19
And I said, are you sure you don't want me to call 9-1-1?
00:24:22
No, no. No, No.
00:24:24
I'll be all right.
00:24:25
Just let me sleep.
00:24:26
He's been quite firm with her not
00:24:28
to call EMS, not to transport him to the hospital.
00:24:31
He sleeps for about 20 minutes in his post ictal state,
00:24:35
you know, after the seizure, and then he's fine.
00:24:38
NARRATOR: Paula, a nurse, places a pillow
00:24:40
under Dale's head and an umbrella over him
00:24:43
to shield the sun.
00:24:45
Then she waits for her husband to wake as usual.
00:24:53
OK.
00:24:54
NARRATOR: But 20 minutes pass and Dale is still unconscious.
00:24:58
Well, you see, something horrible happens this time.
00:25:01
He doesn't wake up.
00:25:02
NARRATOR: Sensing something is wrong, Paula calls 9-1-1.
00:25:06
PAULA: The ambulance pulled in.
00:25:08
They came over, and she checked him.
00:25:10
And she goes, he doesn't have a pulse.
00:25:11
And I said, what do you mean he doesn't have a pulse?
00:25:14
I just checked him.
00:25:15
He had a pulse. - No pulse.
00:25:16
PAULA: And she said, well, he doesn't have one now.
00:25:18
Initially they feel a pulse, and then
00:25:20
he had some jerking movements.
00:25:22
And then he-- they lose the pulse and they start CPR.
00:25:26
NARRATOR: Dale is rushed to the hospital
00:25:27
in full cardiac arrest.
00:25:32
But only four minutes after his arrival, he is pronounced dead.
00:25:38
Um, it was just--
00:25:40
you just go into a state of shock.
00:25:42
You feel like somebody rips open your chest
00:25:44
and pulls out your heart and your lungs.
00:25:46
And your brain shuts down.
00:25:51
NARRATOR: According to medical records,
00:25:52
Dale had no major health problems, only mild high blood
00:25:56
pressure and epilepsy.
00:25:59
And at this point, it's his brain disorder
00:26:01
that concerns Dr. G the most.
00:26:06
Epilepsy is a malady where, for unknown reasons,
00:26:09
nerves in the brain signal abnormally
00:26:11
and trigger recurrent seizures.
00:26:14
DR. GARY PEARL: Epilepsy is a state where a person has
00:26:17
enhanced electrical activity.
00:26:19
This electrical activity may then
00:26:21
spread through other areas of the brain
00:26:24
and cause the manifestations of the seizure.
00:26:27
NARRATOR: But while epilepsy is generally
00:26:29
considered a manageable disorder,
00:26:31
for some it can and does kill.
00:26:35
The deadly but mysterious phenomenon
00:26:37
is known as SUDEP, or Sudden Unexpected Death in Epilepsy.
00:26:43
DR. GARY PEARL: SUDEP is a diagnosis of exclusion.
00:26:45
You have an individual who has a history of seizures who
00:26:49
is found dead, most often at home, and no cause of death
00:26:53
is found.
00:26:54
So all we have is a history of seizures and no findings
00:26:58
to explain the death.
00:27:06
So it looked like it was going to be pretty straightforward.
00:27:09
I wouldn't find anything, and he was going to be a sudden death
00:27:12
associated with seizure.
00:27:16
NARRATOR: But if SUDEP is Dale's killer,
00:27:18
it would leave his widow Paula with a tremendous burden.
00:27:22
According to investigator Bill Stratton, who spoke with Paula
00:27:26
at the hospital, she feels partially responsible
00:27:29
for her husband's death.
00:27:30
When I first met with her, she seemed very upset by his death.
00:27:35
But she also was concerned that she
00:27:37
hadn't called 9-1-1 earlier.
00:27:40
It was clear from what my investigators got from the wife
00:27:44
is that she felt horrible because she
00:27:46
followed his directions and didn't call EMS.
00:27:49
NARRATOR: Could Paula have saved her husband's life
00:27:51
by acting sooner?
00:27:53
Only an autopsy can tell.
00:28:01
DR. G: So basically at autopsy, the first thing I look at him
00:28:05
is how he came in.
00:28:06
He's got-- he's got some little minor trauma to him
00:28:09
that we could see right away.
00:28:10
He's got a little abrasion on his nose, some little abrasions
00:28:13
on his forehand.
00:28:14
And if you feel, you could see that he's got a small abrasion
00:28:18
on the back of his scalp.
00:28:20
He's got a little [INAUDIBLE] a little abrasion up there.
00:28:25
NARRATOR: On his scalp Dr. G also
00:28:27
finds evidence of the seriousness of Dale's epilepsy.
00:28:30
There was a large scar near his right temple
00:28:33
from brain surgery 20 years earlier.
00:28:35
He's got this craniotomy scar.
00:28:38
His seizures were so bad at one point 20 years ago
00:28:42
that he actually went into a major hospital
00:28:45
to get part of his brain taken out.
00:28:48
NARRATOR: Most people with epilepsy
00:28:50
can control their symptoms with medication.
00:28:53
But for some, like Dale Ennis, drugs alone are ineffective.
00:28:58
Brain surgery, the removal of the irregular and localized
00:29:01
parts of the brain responsible for seizures,
00:29:04
is sometimes an effective albeit risky alternative.
00:29:08
After Dale's surgery he was free of seizures for many years
00:29:12
until just several months before his death.
00:29:15
PAULA: He loved it.
00:29:16
He was thrilled.
00:29:17
He could go back to work.
00:29:18
He could drive again.
00:29:20
He was able to just live like a normal person.
00:29:25
NARRATOR: For Dr. G, the autopsy so far
00:29:28
is straightforward, exactly what is
00:29:30
anticipated in a case of SUDEP.
00:29:33
But the internal exam will not be so routine.
00:29:37
Coming up next, Dr. G opens Dale Ennis's body
00:29:41
and discovers that despite what his medical records state,
00:29:45
epilepsy was not his only medical problem.
00:29:48
I said, I have no idea what you're talking about.
00:29:50
He's never made any complaints about this.
00:29:52
NARRATOR: The unexpected findings
00:29:54
and their consequences when "Dr. G, Medical Examiner" continues.
00:30:01
[MUSIC PLAYING]
00:30:21
Dr. G is now ready to open Dale Ennis's body.
00:30:26
An epileptic since childhood, Dale
00:30:28
died without warning yesterday afternoon after a seizure.
00:30:32
Dr. G believes that Dale might have succumbed
00:30:35
to a fatal but little known phenomenon associated
00:30:38
with the disease, Sudden Unexpected Death in Epilepsy,
00:30:42
or SUDEP.
00:30:44
And his widow, Paula, wonders if calling 9-1-1 sooner
00:30:48
would have saved his life.
00:30:50
PAULA: I was just basically in a wait mode.
00:30:54
I couldn't lay still.
00:30:55
I couldn't think.
00:30:57
I just wandered the house and cried.
00:31:04
NARRATOR: Once Dale's chest cavity is opened,
00:31:07
Dr. G gets her first look at his internal organs.
00:31:13
And then the chief medical examiner comes
00:31:15
face to face with a bombshell.
00:31:17
Look at the heart.
00:31:18
He's got a-- he's got a big heart.
00:31:22
Right off when we weigh his heart,
00:31:24
we see there's something wrong.
00:31:25
He's got an enlarged heart.
00:31:28
Normal heart should-- for him shouldn't be over 400.
00:31:31
His is 550 grams.
00:31:33
So his heart was enlarged, 550 grams.
00:31:37
And then I look at the coronary arteries,
00:31:38
and he has very significant narrowing
00:31:41
to the coronary arteries that they didn't know about.
00:31:44
His left anterior descending is at least 90% narrowed.
00:31:48
His first diagonal is at least 90% narrowed.
00:31:51
Dilated there's not much left where
00:31:53
the blood is supposed to be.
00:31:56
NARRATOR: Dale's heart has severe atherosclerosis,
00:31:59
or clogged arteries, and it is also enlarged from the effects
00:32:02
of chronic high blood pressure.
00:32:04
That heart could have killed him easily from an arrhythmia.
00:32:10
NARRATOR: The finding of heart disease
00:32:11
seems to contradict Dr. G's original hypothesis.
00:32:16
However, some physicians theorize
00:32:18
that the heart might actually be a contributing
00:32:20
factor in SUDEP deaths.
00:32:22
DR. G: We don't really know the true mechanism
00:32:25
of why these seizures kill.
00:32:28
And one theory is that it affects your heart,
00:32:31
and it's possibly the electrical component
00:32:34
of the heart with the seizure kind of short circuits also.
00:32:38
So if you already have a bad heart on top of that,
00:32:42
that certainly could play into it.
00:32:44
Appendix present.
00:32:45
NARRATOR: Her tentative conclusion?
00:32:47
Dale Ennis died from two causes of death.
00:32:51
You can't really separate.
00:32:52
It'll be sudden death associated with seizure or epilepsy
00:32:56
with hypertensive and atherosclerotic
00:32:59
cardiovascular disease.
00:33:03
NARRATOR: It is a finding that comes
00:33:05
as a shock to Paula, who had no knowledge that her husband had
00:33:08
heart disease.
00:33:09
I'm like, you're kidding me.
00:33:11
I said, he has never had any complaints.
00:33:15
NARRATOR: But before closing the case,
00:33:17
there's one more organ that Dr. G must examine, the brain.
00:33:23
Will there be any hidden surprises there?
00:33:25
OK.
00:33:26
I'm coming.
00:33:27
NARRATOR: Coming up next, the unpredictable case
00:33:30
of Dale Ennis takes yet another left turn.
00:33:32
DR. G: Well, I reflect the scalp and something
00:33:35
kind of popped out right away.
00:33:36
I'm like, what?
00:33:38
I was beyond surprised.
00:33:40
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:33:46
[MUSIC PLAYING]
00:33:58
[INTERPOSING VOICES]
00:34:00
NARRATOR: At the outset, the death of 56-year-old Dale Ennis
00:34:03
seemed straightforward, a case of sudden death
00:34:07
during an epileptic seizure.
00:34:10
But during the internal exam, Dr. G
00:34:12
has discovered that Dale suffered
00:34:14
from advanced heart disease.
00:34:16
And she now believes that both his heart and the epilepsy
00:34:19
contributed to his death.
00:34:21
DR. G: I mean, at this point I'm feeling fairly confident.
00:34:26
But we still have to look at the head, and there's always--
00:34:28
you know.
00:34:29
You never know until you finish the head.
00:34:35
Ew.
00:34:37
I reflect the scalp and something
00:34:39
kind of popped out right away.
00:34:41
I knew going in that he'd already
00:34:43
had a craniotomy to get part of his brain taken out
00:34:47
where the seizure focus was.
00:34:49
And, you know, they have to take out a little bony window,
00:34:53
and then they cut out the brain and then
00:34:55
put the bony window back and the bone heals very nicely.
00:34:58
It's remodeled.
00:34:59
I mean, your bone will reabsorb.
00:35:01
And then the little area that they cut, it grows back
00:35:07
and there's union.
00:35:08
But in his case, something was amiss.
00:35:11
It never grew back together.
00:35:13
There's a huge non-union, particularly
00:35:16
in the area of temporal lobe--
00:35:18
temporal bone kind of going on the inferior lower
00:35:20
aspect, pretty big area.
00:35:22
[INAUDIBLE] his part.
00:35:27
It's about almost an inch and a half, I'd say.
00:35:30
NARRATOR: In other words, Dale's surgery 20 years ago
00:35:34
left him with an actual opening in the temporal region
00:35:37
of his skull, an extremely unusual and potentially
00:35:40
dangerous condition.
00:35:42
DR. G: You could have easily put a--
00:35:43
a quarter in that space.
00:35:45
It was actually very pliable.
00:35:47
You could just press on that temporal bone,
00:35:50
and it would move back and forth.
00:35:52
NARRATOR: Moreover, Dr. G discovers that the abrasion
00:35:55
on the back of Dale's head, which was first
00:35:57
noted in the external exam, is much deeper
00:36:00
than she originally thought.
00:36:02
Now I didn't know what significance that had,
00:36:06
so I just noted it and then proceeded
00:36:10
in having my technician remove the calvarium, the skull cap.
00:36:15
And then I go and remove the brain.
00:36:19
[INAUDIBLE]
00:36:30
Oh.
00:36:33
Lo and behold, we see a surprise.
00:36:36
NARRATOR: There was abnormal bleeding in Dale's brain,
00:36:39
very close to the non-fused portion of his skull.
00:36:43
He's got--
00:36:44
Well, you know, it should be nice and white.
00:36:45
You notice it's awfully bloody?
00:36:47
NARRATOR: For Dr. G, the diagnosis
00:36:50
is immediately apparent.
00:36:51
He's got a subdural hematoma, and that's not what
00:36:56
we usually see with a seizure.
00:36:58
He does have a subdural.
00:37:03
NARRATOR: A subdural hematoma is a bleed
00:37:05
that occurs in the tiny blood vessels
00:37:07
between the brain and the dura, the protective sheath that
00:37:10
covers the brain.
00:37:12
Such bleeding can be life threatening
00:37:14
as the pooling blood compresses the brain within the skull.
00:37:19
And it's almost always caused by trauma, not seizures.
00:37:25
In an instant, the real cause of Dale Ennis's death is clear.
00:37:30
He did not die from epilepsy or advanced heart disease.
00:37:34
He died from a head injury.
00:37:36
He actually died from the subdural.
00:37:41
PAULA: She said that the vessels in his brain
00:37:43
were just very friable.
00:37:45
You know how old cloth falls apart in your hands?
00:37:47
His vessels were just falling apart in her hands.
00:37:50
I was beyond surprised.
00:37:52
I had to pick my jaw up and put it back on my face
00:37:54
where it fell off.
00:37:56
And then I called his family to let them know,
00:37:59
and they were surprised.
00:38:03
NARRATOR: The question is, how did this trauma occur?
00:38:07
Dr. G removes the brain to get a closer look.
00:38:11
And what she discovers will add yet
00:38:13
another unbelievable revelation to an already complicated case.
00:38:20
When we took the brain out, what
00:38:21
was interesting is he'd had a previous subdural hematoma.
00:38:25
Look at that.
00:38:26
And this previous subdural hematoma
00:38:28
looked a couple weeks old, definitely less than a month.
00:38:31
And that was in the area where there
00:38:33
was non-union of the bone.
00:38:38
NARRATOR: And at the dissecting table,
00:38:39
Doctor G discovers another abnormality.
00:38:43
DR. G: Lo and behold, the brain had trauma, too,
00:38:45
some contusions or bruising.
00:38:47
We've got contusions on the tip of the temporal lobe,
00:38:50
some inferior frontal.
00:38:52
He fell on the right-- also he had a little bit of trauma
00:38:54
which appeared to be a contusion in the area
00:38:57
of the pons or the brain stem, which is a bad area.
00:39:02
NARRATOR: A history of epilepsy, advanced heart disease,
00:39:07
two subdural hematomas and evidence
00:39:10
of critical brain trauma, a skull that never fully
00:39:13
healed from brain surgery.
00:39:16
The autopsy of Dale Ennis has been anything
00:39:18
but straightforward, and has uncovered
00:39:21
complex forensic evidence.
00:39:23
But Dr. G believes she now knows exactly how Dale Ennis died.
00:39:29
The intricate findings point to an unusual chain of events,
00:39:33
and it's a conclusion that Dale's widow, Paula,
00:39:36
will find difficult to fathom.
00:39:44
Based on findings at autopsy, Dr. G
00:39:47
knows that several weeks before his death, Dale
00:39:50
must have suffered some minor trauma to the right side
00:39:53
of his head, the side that had been weakened by brain
00:39:55
surgery 20 years earlier.
00:39:57
DR. G: How he got it, I don't know if we'll ever know,
00:39:59
but it caused a subdural.
00:40:01
And because of this weakness of the bone,
00:40:04
it somehow caused the little blood
00:40:06
vessels that go between the dura and the surface
00:40:08
of the brain to tear.
00:40:10
NARRATOR: Dale is apparently unaware
00:40:12
that he sustained a minor subdural hematoma,
00:40:15
and in the following weeks the delicate torn blood vessels
00:40:18
in his brain begin to heal.
00:40:21
Subdural hematoma aren't always killers.
00:40:24
A lot of people, particularly older people
00:40:26
because their brains shrink, can have small subdural from some--
00:40:32
from minor trauma that they didn't know they had.
00:40:35
NARRATOR: Then yesterday, Dale suffers an epileptic seizure
00:40:39
and collapses in his backyard.
00:40:44
He strikes the back of his head on the ground with force,
00:40:47
resulting in a contusion to the back of his skull and critical
00:40:50
trauma to the brain stem.
00:40:53
The jarring fall also jostles the weak portion of his skull,
00:40:57
shearing delicate blood vessels under the dura,
00:41:00
including those healing from his previous subdural.
00:41:03
Problem is with these old subdurals,
00:41:05
they get at a vulnerable stage when they're starting to heal
00:41:09
and can easily be damaged with more minor trauma.
00:41:13
NARRATOR: Soon the bleeding begins to irritate
00:41:16
and compress Dale's brain.
00:41:18
When his wife Paula checks on him,
00:41:20
she believes he's recovering from a seizure as usual.
00:41:25
Actually, he's dying of massive head trauma.
00:41:30
DR. G: Most likely his brain is starting to swell.
00:41:32
His brain is irritated from that subdural.
00:41:35
So there is just a lot of little findings in his brain
00:41:40
that it basically gets short circuited.
00:41:42
There's trauma there, and he dies.
00:41:45
[AMBULANCE SIRENS WAILING]
00:41:57
NARRATOR: Based on her findings, Dr. G
00:41:59
draws one final conclusion.
00:42:02
Dale's injuries were not survivable, even if his wife
00:42:06
had called 9-1-1 sooner.
00:42:09
A lot of different twists, but I'll call the wife
00:42:11
and tell her.
00:42:13
I don't think--
00:42:13
I think-- you know, tell her there's really
00:42:15
not much she could have done.
00:42:17
I will always try to look and see, you know,
00:42:20
would it have mattered?
00:42:21
Do-- could I get some information to tell
00:42:23
her that said, you know what?
00:42:25
You're-- you know, there's nothing you could
00:42:26
have done for him or-- it does.
00:42:28
I mean, it affects me, and I-- it's a one small way
00:42:31
I can help the living.
00:42:32
You always want to say, was there
00:42:34
some way that I could have figured
00:42:36
out to change this course?
00:42:38
And you come to realize at a point in time,
00:42:40
you couldn't have.
00:42:41
[MUSIC PLAYING]
00:42:42
(SINGING) You are the pillow on which I rest my tired head.
00:42:46
My alarm is set, but you're the rising
00:42:50
sun that woke me up instead.
00:42:52
You're the peaceful sleep I never want to end.
00:42:59
If you're not mine to hold.
00:43:03
Honey, love you.
00:43:05
I miss you.
00:43:07
I'm sorry you're not here, but I can understand that you're
00:43:10
a lot happier up there.
00:43:11
So there is nothing in this world
00:43:13
that I would do to make you come back down here.
00:43:17
And I let you go.
00:43:37
MAN (WHISPERS): Atlas.
