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[SUSPENSEFUL MUSIC]
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[THEME MUSIC]
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NARRATOR: A strange man staggers up to a woman's front door,
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dazed and bloody.
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He just stared, and then he walked away.
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NARRATOR: Hours later, a passerby
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finds him in the woods dead.
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JAN GARAVAGLIA: And I looked, and I-- woo, that looks bad.
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I mean, what is going on here?
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NARRATOR: And then, a seemingly healthy mother of two
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dies without warning.
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JAN GARAVAGLIA: The kids are devastated.
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The husband is devastated.
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She's now in my morgue, and we don't know why she died.
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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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[THEME MUSIC]
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[MUSIC PLAYING]
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NARRATOR: It's 8:00 AM at the District 9 Orange/Osceola
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County Medical Examiner's Office,
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but Dr. Jan Garavaglia is already hard at work.
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Oh, did my investigators have it?
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He does have an enlarged heart.
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Yeah, the cause of death is pending.
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No.
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Might be, you know, weeks and sometimes, you know, months.
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I've got families calling, wanting answers.
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I don't know why some of the micros are late.
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I'm going to have to go to cut more tissue.
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You know, there's people to call.
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Just thinking about what else I could do.
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And multiply that by numerous cases.
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New ones coming in every day.
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NARRATOR: Today's newest body arrives
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under suspicious circumstances, even by morgue standards.
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And although Dr. G is extremely busy,
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this case demands her immediate attention.
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Wow.
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NARRATOR: It's almost noon, and Deer Park,
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Florida resident Debbie Balcombe is
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busy fixing lunch when she hears a knock at the front door.
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She assumes it's just one of the neighbors dropping
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by for a visit, but what she sees on her front stoop
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comes as a complete shock--
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a disoriented, disheveled, and bleeding young man.
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Must have been scary, because he had blood on his shirt.
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It looks like he's been beaten up.
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He just stared at her, and then he walked away.
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NARRATOR: Shaken by the encounter,
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Debbie quickly locks the door.
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But neither she nor anyone else in the apartment complex
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crosses paths with the man again.
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In fact, he seems to disappear entirely until a few hours
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later when recently retired Jim Weisberg goes
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out for his afternoon walk.
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As he passes through the woods beside Debbie's home,
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he gets the shock of his life.
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The body of a man on the ground, dead.
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Jim calls 911, and within minutes
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the police arrive on the scene.
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JAN GARAVAGLIA: It's unclear what's going on here.
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The detectives are very suspicious that there's
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foul play.
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NARRATOR: The homicide unit's first step
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is to locate the man's wallet.
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His name is Gregory Flynn, and a background check reveals
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another more curious fact.
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JAN GARAVAGLIA: He doesn't live anywhere in these houses.
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He doesn't live in the apartment complex.
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NARRATOR: And a few minutes later,
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police make another discovery.
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JAN GARAVAGLIA: The investigators looked around.
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They found his-- what appears to be his car
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in a ditch in this wooded area.
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This wooded area separates these houses
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from an apartment complex.
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NARRATOR: Looking for possible witnesses
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to Gregory Flynn's death, detectives begin
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knocking on apartment doors.
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JAN GARAVAGLIA: Canvassing the area,
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they found out that he was seen driving
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about four hours earlier.
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NARRATOR: And it isn't long before the detectives
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find Debbie Balcombe.
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She views Greg Flynn's body and identifies him as the man who
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came to her door hours earlier.
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Meanwhile Medical Investigator Jack Cuccia of the District 9
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morgue arrives on the scene.
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He takes photographs of the body for Dr. G
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and prepares it for transport to the morgue.
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But the detectives need more information.
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At that point, they really didn't
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know what they were dealing with until we
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were able to see if there was any traumatic injury to him.
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NARRATOR: The detectives want permission
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to examine Greg's body for chest and face wounds on the scene.
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JACK CUCCIA: The law enforcement agencies, they do not
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have the authority to examine the body,
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remove the clothing, without making contact
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with the medical examiner because we don't want to lose
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any trace evidence or disturb the wound in any way
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until the doctor has seen that firsthand.
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NARRATOR: Jack Cuccia calls Dr. G.
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Dr. G?
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NARRATOR: He explains the situation
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and asks for permission to inspect the body.
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OK, Dr. G. Thank you.
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And I said, fine, you know, examine him at the scene.
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NARRATOR: Turning over the body, they reveal quite a sight.
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Greg Flynn's right eye looks swollen,
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and his face is bloody.
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There's also a large amount of blood on his shirt.
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So I said, just go ahead and bring him in.
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We'll X-ray him and look for the wounds.
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NARRATOR: Once Greg Flynn's body is on its way to the morgue,
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detectives make contact with his ex-wife, Rosanna.
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Hello?
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JAN GARAVAGLIA: According to his ex-wife,
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he didn't suffer from any major diseases
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or chronic health problems.
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NARRATOR: Next an officer calls Greg Flynn's brother, Sean.
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And as soon as they inform him of Greg's death,
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Sean levels a stunning accusation.
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The brother believes that the ex-wife had
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something to do with his death.
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NARRATOR: The detectives don't know
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if Sean is right about Greg's ex-wife,
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but they do suspect foul play.
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Detectives are highly suspicious that this
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was a homicide.
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They're really waiting for me to give them an answer.
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NARRATOR: But Dr. G has questions of her own
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about his death.
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JAN GARAVAGLIA: Why was he acting so strange?
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Why did he go up to that apartment and just stare?
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It's just very odd.
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NARRATOR: Dr. G wonders if someone ran him off the road.
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The car had only minor damage, but it's
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possible that Greg sustained injuries in the crash.
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JAN GARAVAGLIA: Did he have a head injury?
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Maybe he hit something when he stopped suddenly.
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NARRATOR: It's possible that the crash was an accident.
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But at this stage, one thing is clear--
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all clues point to murder.
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JAN GARAVAGLIA: Knife wound, gunshot wound,
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blows to the head, and that's what
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we're really looking for right now
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in the external examination.
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[MUSIC PLAYING]
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NARRATOR: The first thing Dr. G notices about Greg Flynn
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is how well dressed he is, but Greg's button down Oxford shirt
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is heavily stained with blood.
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Oh, Lord.
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The one pattern was odd.
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It was on front of his shirt only
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and at the ends of his sleeves.
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The other odd thing is that his clothes were also wet.
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There is a small wet creek in those woods, but how did
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he get wet?
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NARRATOR: But the strangest thing about Greg Flynn
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isn't his clothes.
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It's his skin.
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It's slipping off.
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He's already starting to show signs of early decomposition.
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That's very odd.
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NARRATOR: Greg's been dead less than 10 hours.
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But when it comes to the stages of death,
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he's way ahead of the curve.
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Skin slippage normally doesn't appear
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until 48 hours post-mortem.
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JAN GARAVAGLIA: When we see somebody decomposing that
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quickly, we really worry that maybe he
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had an infection or an elevated body temperature
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prior to death.
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NARRATOR: But that wouldn't explain
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the blood soaking Greg Flynn's shirtfront
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or his battered face.
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He's got a huge bruise over here.
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It looks bad.
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He's got dried blood.
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He's got this kind of big, swollen eyelid
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with a lot of, like, little abrasions.
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NARRATOR: He looks like he's been in a fight,
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and this makes Dr. G even more suspicious
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of possible foul play.
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But as she looks closer, Dr. G recognizes what did this
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to him, and it wasn't human.
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When you look closely, you see small rodent scratches
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and excoriations.
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NARRATOR: But on Greg's face, the damage done by the animal
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activity is mainly superficial.
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And I still can't explain this blood on his shirt.
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NARRATOR: Dr. G suspects it might
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have come from a nosebleed or mouth wound.
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So she carefully checks both potential sources.
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There's really no blood in his nose,
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and I don't see a blood in his mouth.
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I don't know where that blood is coming from.
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NARRATOR: As Dr. G moves down the body,
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looking for a major wound, she notices
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dozens of tiny cuts criss-crossing
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Greg's forearms and hands.
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He really was scratched up quite badly.
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NARRATOR: Was Greg running away from someone?
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And if so, who?
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And where did the blood soaking his shirt come from?
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The answers to these questions may lie under his clothes.
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JAN GARAVAGLIA: A little 22 can kill you,
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and my investigator may not see that, particularly
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if there is a lot of blood.
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May have a small stab wound.
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At this point, it can be anything.
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[MUSIC PLAYING]
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[SUSPENSEFUL MUSIC]
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NARRATOR: During the external exam of Gregory Flynn's body,
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Dr. G found scratches that suggest
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he may have been running from someone before he died.
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Greg's brother believes he was murdered,
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and now Dr. G is looking for the source of the blood
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soaking Greg's shirt.
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JAN GARAVAGLIA: And I'm taking his clothes off,
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and I'm examining inch by inch.
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Where could this blood be coming from?
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NARRATOR: She searches the entire body
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for a small bullet or knife wound,
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but what she finds surprises her.
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I don't see any wounds that are
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accounting for all that blood.
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At this point, I don't know how he died.
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It's very odd.
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I'm hoping I find something internally.
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All righty?
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MAN: All righty.
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NARRATOR: Dr. G opens Greg Flynn's chest with a y incision
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and begins searching for evidence of trauma.
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JAN GARAVAGLIA: I'm looking for evidence of contusion
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to his chest, maybe internal trauma to the organs.
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NARRATOR: As a first step, she removes Greg's chest plate
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looking for free blood and other signs of injury,
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but she doesn't find anything of significance
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in the abdominal or chest cavity.
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The source of all that blood is becoming
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more mysterious by the moment.
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All Dr. G can do now is continue searching for clues
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within his internal organs.
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[MUSIC PLAYING]
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SINGER: Clinging to the trees.
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NARRATOR: Next, she extracts the heart
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and prepares to dissect it.
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But right away, she notices a striking abnormality.
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He had a significant narrowing to his right coronary artery.
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It was at least an 80% narrowing.
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Odd for someone at a relatively young age.
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NARRATOR: This narrowing could have caused a heart attack,
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which could explain why Greg drove his car into a ditch--
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but not his behavior afterwards.
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JAN GARAVAGLIA: I would not expect
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him to be acting odd like that, just because he's
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got the heart disease.
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He still has enough energy to go running through the woods.
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I wouldn't really expect him to be doing
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that with a coronary event.
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So it's not making sense.
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NARRATOR: Other than signs of decomposition, the rest
00:14:09
of Greg's heart looks normal.
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Dr. G's next stop is the lungs, and what she sees
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here is disturbing.
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JAN GARAVAGLIA: You can also see that they
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were starting to decompose.
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NARRATOR: In addition to Greg's lungs,
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his other organs are clearly beginning to decay.
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JAN GARAVAGLIA: His spleen is soft and friable.
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His bowels are starting to turn green.
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These are all early signs of decomp.
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NARRATOR: Greg's accelerated decomposition
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is extremely unusual.
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It could be a sign that he was sick with a severe infection
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right before he died.
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People who are infected and have high fevers
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can start having early decomposition.
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NARRATOR: To confirm an infection,
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Dr. G takes blood samples to be tested
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for the presence of bacteria.
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And as standard practice, Greg's blood
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will also be screened for drugs and alcohol
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at a toxicology lab.
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By the end of the internal exam, Dr. G still has
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no idea how Greg Flynn died.
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The chest and abdomen just didn't tell us too much.
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NARRATOR: And as she readies her scalpel for the cranial exam,
00:15:30
she's hoping the brain and skull will yield the clues
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she's been looking for.
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I am hoping that the brain gives me the answer.
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[SUSPENSEFUL MUSIC]
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NARRATOR: Dr. G and the Orlando homicide unit
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both believe that 34-year-old Gregory
00:16:02
Flynn may have been murdered.
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There's blood on his shirt.
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He's faced down in kind of a dark area in the dirt.
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NARRATOR: So far, she's found no evidence of foul play,
00:16:18
but she's yet to examine Greg's skull and brain.
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Head trauma could indicate that Greg
00:16:27
was the victim of a fatal assault.
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Dr. G will also look for signs of natural disease.
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JAN GARAVAGLIA: Maybe he's got a ruptured aneurysm or stroke,
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something else going on that caused him to kind
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of act odd and lose control.
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I don't know.
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NARRATOR: Dr. G reflects Gregory's scalp,
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looking for any sign of a fracture or wound.
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Going on in here, no impact site,
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no wound, no small gunshot wound that I missed, nothing.
00:17:10
NARRATOR: But she can't entirely rule out trauma yet.
00:17:14
A blow to the head could fatally injure the brain
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without fracturing the skull.
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There's no skull fracture, but that doesn't mean there's
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no bleeding in the brain.
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NARRATOR: Next, morgue technician
00:17:27
Brian Machulski cuts through the skull with an oscillating saw.
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And Dr. G performs a thorough examination of the brain
00:17:36
itself.
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I don't see any blood.
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The brain looked good.
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I was disappointed.
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I was hoping for something.
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There is no trauma anywhere on his body.
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I'm sorry we have to rule out trauma.
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I mean, we have a lot of things it isn't.
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We just don't have what it is.
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NARRATOR: By the end of the autopsy,
00:18:02
big questions still remain.
00:18:04
There is no drama, but he's got blood all over him.
00:18:08
I'm still suspicious that it's from his nose.
00:18:11
I just don't see any residual blood in his nostrils.
00:18:15
I told the detectives if it's homicide,
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I don't know what kind of homicide
00:18:20
it is besides a poisoning, because there
00:18:23
is no trauma there.
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NARRATOR: The police accept Dr. G's initial findings,
00:18:28
but Greg's brother, Sean, finds it more difficult.
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I am getting multiple phone calls from his brother.
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He is sure his ex-wife murdered him.
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NARRATOR: Sean now thinks Greg's ex-wife, Rosanna,
00:18:41
must have poisoned him.
00:18:44
This could explain why he ran his car into the ditch
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and stumbled around in a state of delirium in the hours
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before his death.
00:18:53
But the only way Dr. G can prove it was murder
00:18:56
is with the results of microscopic and toxicology
00:18:59
tests.
00:19:00
[MUSIC PLAYING]
00:19:05
NARRATOR: It takes two weeks to get Greg Flynn's processed
00:19:09
tissue samples back from microscopic evaluation,
00:19:12
but only moments to find a significant abnormality
00:19:16
in his heart tissue.
00:19:18
He's got a lot more fibrosis in his heart than I'd expect.
00:19:22
When you look at cells and a normal heart,
00:19:24
you see the pink muscle cell.
00:19:27
But with him, instead of nice pink cells,
00:19:30
we see scar tissue replacing those cells.
00:19:33
NARRATOR: The fibrosis or scar tissue
00:19:37
tells Dr. G that Greg's heart has been damaged
00:19:40
over a long period of time, though she doesn't think it
00:19:44
could have killed him suddenly.
00:19:46
Seeing it gives her a crucial clue.
00:19:49
She now thinks she knows how Greg Flynn died,
00:19:52
but she can't prove it without the results of the toxicology.
00:19:56
[SUSPENSEFUL MUSIC]
00:20:02
NARRATOR: Back in her office, Dr. G
00:20:04
digs into the lab reports--
00:20:07
and it isn't long before they confirm her suspicions.
00:20:12
It turns out that the theory that Greg was poisoned
00:20:15
was partially correct.
00:20:17
JAN GARAVAGLIA: He was poisoned, all right.
00:20:20
He poisoned himself.
00:20:22
He was high on cocaine.
00:20:25
Extremely high on cocaine.
00:20:28
NARRATOR: Cocaine overdoses are hard to prove because drug
00:20:31
levels fall after death.
00:20:35
But even though his blood sample was taken 10 hours
00:20:38
after his death, Greg Flynn's blood
00:20:40
still had an extremely high level of cocaine.
00:20:47
Now the entire chain of events is beginning to make sense.
00:20:52
The side effects caused by cocaine use
00:20:55
can explain many of the curious details
00:20:57
of Greg Flynn's final hours.
00:21:00
JAN GARAVAGLIA: Sometimes we see excited delirium
00:21:02
with excited, kind of bizarre behavior, which
00:21:05
looked like he was having.
00:21:08
It's a marker that he's having a bad reaction to the cocaine,
00:21:12
and you can get this elevated body temperature.
00:21:16
NARRATOR: Dying with an abnormally high body
00:21:19
temperature causes accelerated decomposition.
00:21:22
This explains why Dr. G observed advanced decay
00:21:26
in Greg Flynn's body.
00:21:28
And cocaine even answers the question about the blood
00:21:32
on Greg's shirt.
00:21:33
JAN GARAVAGLIA: Cocaine is a stimulant,
00:21:36
making the heart beat faster, making
00:21:39
your blood pressure go up.
00:21:41
The bloody nose was probably associated with the high blood
00:21:44
pressure from the cocaine.
00:21:49
NARRATOR: Dr. G now believes prolonged use of cocaine
00:21:53
probably caused the fibrosis and coronary artery
00:21:56
disease she found in his heart.
00:21:59
And I think he's probably a chronic cocaine user.
00:22:03
NARRATOR: But what ultimately killed
00:22:05
him was a straightforward narcotic
00:22:07
overdose, most likely triggering a fatal seizure
00:22:11
or heart attack.
00:22:12
When the blood pressure goes up,
00:22:14
the heart beats harder, the coronaries constrict.
00:22:19
The terminal of it is usually the heart arrhythmia.
00:22:22
NARRATOR: An arrhythmia with the heart's normal rhythm
00:22:25
is disrupted can often result in a heart attack.
00:22:31
And although this is a common effect of cocaine overdose,
00:22:34
Gregory could have also succumbed
00:22:36
to a fatal brain seizure.
00:22:38
Just like it can disrupt the electrical component
00:22:42
of your heart, it disrupts the electrical aspect
00:22:45
of your brain and precipitate seizures,
00:22:47
and you can die that way, also.
00:22:50
There are many ways that cocaine can kill you.
00:22:53
NARRATOR: But all it takes is one.
00:22:57
Dr. G can now piece together the bizarre series of clues
00:23:01
and describe step by step the last moments
00:23:05
of Gregory Flynn's life.
00:23:06
[SUSPENSEFUL MUSIC]
00:23:12
[MUSIC PLAYING]
00:23:13
NARRATOR: On a cool September night,
00:23:15
chronic cocaine abuser Gregory Flynn
00:23:18
goes on yet another binge, snorting cocaine for hours,
00:23:23
but this time is different.
00:23:29
By the next morning, he's awake and high.
00:23:33
And although he's a frequent user, he begins to feel ill.
00:23:37
The cocaine was starting to affect his brain,
00:23:41
and his blood pressure was going up.
00:23:44
NARRATOR: Greg is disoriented, and his heart is pounding.
00:23:48
His high blood pressure most likely
00:23:50
triggers a severe nosebleed as he's driving,
00:23:53
so he steers his car into the parking
00:23:55
lot of an apartment complex.
00:23:57
He makes a u-turn, his car goes into a ditch,
00:24:04
then gets out of the car.
00:24:06
NARRATOR: By now, Greg's face is covered
00:24:08
in blood from the nosebleed.
00:24:10
Looking for help, he knocks on Debbie
00:24:12
Balcombe's apartment door.
00:24:16
At this point the cocaine is beginning
00:24:18
to affect his thinking process, possibly inducing delirium
00:24:22
and paranoia, and his body temperature
00:24:25
is getting dangerously high.
00:24:27
He's getting disoriented, confused.
00:24:30
NARRATOR: Unable to speak, Greg panics and runs into the patch
00:24:34
of woods bordering the complex.
00:24:38
At some point, he likely uses his shirt
00:24:40
to stop his nosebleed, soaking up the blood.
00:24:45
He probably jumps into a nearby creek in an attempt
00:24:48
to cool off, which gets his clothing wet
00:24:51
and also clears his nostrils of blood.
00:24:56
Delirious, Greg races on through the woods, hitting branches
00:25:00
and razor-sharp grass along the way, which scratched his arms.
00:25:05
And then he collapses.
00:25:08
He collapses either from the seizure
00:25:10
or from the heart arrhythmia, and then dies in that field.
00:25:19
[MUSIC PLAYING]
00:25:20
NARRATOR: Dr. G immediately contacts the investigators
00:25:23
to report her findings.
00:25:25
Hi, this is Dr. Garavaglia from the Medical
00:25:26
Examiner's Office.
00:25:27
NARRATOR: She then calls Greg's brother, Sean,
00:25:30
and breaks the news.
00:25:32
He, at first, refused to believe it.
00:25:35
But I think over time, he's accepting it.
00:25:39
NARRATOR: Sean's brother, Gregory,
00:25:41
kept his addiction well-hidden from everyone in life.
00:25:45
But in death, nothing can hide from Dr. G.
00:25:54
Greg Flynn's death is a sad irony.
00:25:57
Although it originally seemed tangled in mystery, in the end,
00:26:01
it was tragically predictable.
00:26:03
It's just another one of our drug deaths down here.
00:26:06
It's epidemic.
00:26:07
It's epidemic.
00:26:13
NARRATOR: Some days for Dr. G, it
00:26:16
seems like every death is an accident
00:26:18
that could have been avoided.
00:26:21
But her next case stands out in the morgue
00:26:23
as a truly unforeseen tragedy.
00:26:26
JAN GARAVAGLIA: It is devastating
00:26:27
that those two children are left without a mom.
00:26:32
[SUSPENSEFUL MUSIC]
00:26:45
NARRATOR: For Dr. G, juggling multiple cases at once
00:26:49
is just part of the job.
00:26:51
But when it comes time to perform an autopsy,
00:26:54
it's critical that she focus solely on the task at hand.
00:26:58
The autopsy itself is beautiful
00:27:00
because although I have hundreds of cases upstairs
00:27:03
that I have to think about, when I'm doing the autopsy
00:27:05
I'm just doing one, and I'm only thinking about that one case,
00:27:09
and nothing else in the world matters.
00:27:12
NARRATOR: But for Dr. G, cases aren't an escape.
00:27:15
They're a challenge.
00:27:17
He should have some scars around his face, too.
00:27:20
Yeah, see it?
00:27:21
I always prefer cases that are more of a challenge.
00:27:24
I love unusual cases.
00:27:25
You know, I get enough heart attacks down here
00:27:27
that I don't need another one.
00:27:29
When a really unusual case comes in, those are really the best.
00:27:34
NARRATOR: And her latest case definitely
00:27:36
qualifies as unusual.
00:27:38
This morning, we have a 42-year-old woman that just
00:27:42
had abdominoplasty surgery.
00:27:44
She's got two kids.
00:27:45
She's married, and she dies suddenly.
00:27:47
Two days after the procedure.
00:27:49
[MUSIC PLAYING]
00:27:52
NARRATOR: Michelle Rohn's tragic story actually started
00:27:55
three years earlier, shortly after the birth
00:27:58
of her first child.
00:28:01
It was then that her battle with obesity began.
00:28:06
By the time she had her second, the stay-at-home mom
00:28:09
was over 200 pounds.
00:28:13
At that point, Michelle decided she'd had enough.
00:28:16
[UPBEAT MUSIC]
00:28:19
She committed to a strict diet and exercise regimen,
00:28:22
and lost more than 50 pounds.
00:28:26
She felt great, except when she looked in the mirror.
00:28:31
If someone's been overweight or obese for a long time
00:28:35
and then they lose weight, then the skin will
00:28:38
hang over in various areas.
00:28:42
The most common place is the lower belly.
00:28:45
NARRATOR: Michelle is clearly unhappy with the excess skin
00:28:48
around her middle.
00:28:50
And after talking it over with her husband, Kevin,
00:28:53
she decides to go ahead and schedule
00:28:55
an abdominoplasty, or tummy tuck.
00:28:58
This is to remove some of that skin,
00:29:02
tighten, those abdominal muscles,
00:29:03
remove some of that excess fat.
00:29:07
200,000 people will lose a tremendous amount of weight
00:29:11
over this next year, and probably 75%
00:29:14
will seek a plastic surgeon to help them contour their body
00:29:18
because of this excess skin.
00:29:22
This is clearly an elective procedure for her,
00:29:25
partly doing it to please her husband, partly
00:29:27
doing it to please herself.
00:29:30
NARRATOR: By all accounts, the operation
00:29:32
goes according to plan.
00:29:35
And after three hours in surgery,
00:29:37
the procedure is pronounced a success.
00:29:41
The next day, her doctors send her home with a prescription
00:29:44
for painkillers.
00:29:47
But despite the powerful medication,
00:29:49
the pain becomes so intense that Michelle is unable to get
00:29:53
out of bed for 24 hours.
00:29:56
Still, it seems like a relatively routine
00:29:59
recovery from major surgery.
00:30:01
Nothing unusual, until 3:00 AM the following morning.
00:30:07
She goes and takes some medication,
00:30:10
and as she's going back to bed, she collapsed suddenly.
00:30:15
NARRATOR: Kevin scrambles out of bed
00:30:17
and attempts to revive her--
00:30:19
Michelle!
00:30:20
NARRATOR: But to his horror, he realizes
00:30:22
that she stopped breathing.
00:30:24
Frantic, he dials 911.
00:30:26
My wife had surgery.
00:30:28
NARRATOR: Paramedics arrive within minutes.
00:30:30
They rush her to the emergency room, where doctors work
00:30:35
on her for almost a full hour.
00:30:38
And they tried to resuscitate her, but she was dead.
00:30:41
They never could revive her.
00:30:45
At this point, her husband and family is devastated.
00:30:48
They can barely even talk, and I'm sure they
00:30:52
just want to know why she died.
00:30:53
Just like, you know, any of us would.
00:30:56
NARRATOR: It's now up to Dr. G to provide Michelle's
00:30:59
family with some answers.
00:31:02
Given the circumstances of her death,
00:31:04
she suspects that complications from the surgery
00:31:07
could have killed Michelle.
00:31:10
Wow.
00:31:12
NARRATOR: 10% to 20% of patients develop
00:31:15
complications during or after cosmetic surgery.
00:31:20
Most are not serious, but abdominoplasty
00:31:23
is one of the most invasive cosmetic procedures.
00:31:27
Abdominoplasty is not an operation
00:31:32
that should be taken lightly.
00:31:33
What you're doing is you're making a large incision
00:31:36
across your lower abdomen.
00:31:38
You're removing part of your skin.
00:31:41
CHRISTINE REN-FIELDING: Essentially, the underlying
00:31:43
fat plus the skin is removed.
00:31:46
Sometimes the muscle underneath is
00:31:48
then tightened by an extra stitch,
00:31:50
almost like a baseball stitch, sort
00:31:51
of corsetting you together.
00:31:53
And then the skin is sewn together.
00:31:56
NARRATOR: And the list of potentially adverse outcomes
00:31:59
is long.
00:32:01
For one, Michelle could have contracted
00:32:03
a fatal infection either during surgery or while recovering.
00:32:08
The CDC estimates probably about
00:32:11
88,000 to 90,000 deaths from hospital-acquired
00:32:14
infections each year.
00:32:17
Whenver you open the skin with surgery,
00:32:18
you are decreasing your skin barrier from infection
00:32:23
and increasing your risk of infection.
00:32:26
NARRATOR: Another possibility is that Michelle
00:32:28
developed blood clots in her legs
00:32:30
at some point during her recovery.
00:32:33
They conform after long periods of immobility,
00:32:37
then travel through the blood vessels to the heart, lungs,
00:32:41
and brain, cutting off blood supply with deadly results.
00:32:47
But because Michelle underwent liposuction,
00:32:49
she's also at risk for fatal fat emboli,
00:32:53
a problem specific to the procedure.
00:32:56
JAN GARAVAGLIA: The liposuction, you're breaking up the fat when
00:33:00
they're trying to suck it out.
00:33:02
Then you can cause damage to some of the small veins.
00:33:07
These fat molecules and globules get into your vascular system,
00:33:12
and then could go to any organ.
00:33:14
NARRATOR: And with the fat emboli displacing blood supply,
00:33:17
the body cannot absorb the oxygen it needs to survive.
00:33:23
However, there's a chance that the culprit
00:33:25
had been developing undetected in Michelle's body for years.
00:33:30
Could just be natural disease, and that the surgery
00:33:32
had nothing to do with it.
00:33:34
NARRATOR: Although Michelle was no longer obese,
00:33:37
her past weight gain could have triggered heart problems.
00:33:41
If someone is obese or overweight,
00:33:45
their heart has to pump much harder
00:33:48
to carry that extra weight, and that can affect its health.
00:33:53
NARRATOR: Dr. G also can't ignore
00:33:56
another potential scenario--
00:33:59
Michelle may have overdosed on her powerful pain medication.
00:34:02
JAN GARAVAGLIA: She's given some potent narcotics,
00:34:05
and possibly, she's taken too much.
00:34:09
NARRATOR: And there's one even more tragic possibility.
00:34:13
If Michelle did overdose on painkillers,
00:34:16
it may not have been an accident.
00:34:19
JAN GARAVAGLIA: There is clearly a syndrome of depression
00:34:23
after these body-contouring surgeries.
00:34:26
After the surgery, you're in pain.
00:34:29
Things are looking bad down there.
00:34:31
You kind of get this depressive effect because stress hormones
00:34:34
go down.
00:34:35
NARRATOR: Could Michelle have succumbed
00:34:37
to a post-surgical depression and taken her own life?
00:34:41
Michelle's family is desperate for answers.
00:34:44
But with no immediate clues, only a full autopsy
00:34:48
can solve the mystery of her sudden death.
00:34:50
There's a lot of possibilities here.
00:34:53
It'll be interesting to see what we find.
00:34:55
[SUSPENSEFUL MUSIC]
00:35:02
OK.
00:35:03
We're just gonna go.
00:35:07
NARRATOR: The first thing Dr. G notices
00:35:10
as she begins the external exam is how hard doctors
00:35:13
worked to save Michelle's life.
00:35:16
They have lines in both arms.
00:35:18
They have a line in her neck, and they tried very,
00:35:20
very hard to resuscitate her.
00:35:23
NARRATOR: It's a sad reminder of what a tremendous loss
00:35:26
this was for Michelle's family.
00:35:29
She's got two kids, four and two,
00:35:32
which is just devastating to die and leave two children.
00:35:39
NARRATOR: But she has no time to dwell on the tragedy.
00:35:43
As Dr. G begins examining Michelle's skin,
00:35:46
she keeps an eye out for small, reddish,
00:35:49
purple dots called petechiae.
00:35:52
They occur when fat clots travel through the bloodstream
00:35:55
and congest the small capillaries
00:35:57
near the skin surface.
00:36:00
Petechiae could indicate the presence
00:36:02
of deadly fat emboli, one of Dr. G's leading suspects.
00:36:07
I don't see any of the petechiae,
00:36:09
but that doesn't mean she doesn't have fat emboli.
00:36:11
It's still a possibility.
00:36:13
NARRATOR: The only way to rule out fat emboli for sure
00:36:16
is to examine tissue samples of Michelle's heart, lungs,
00:36:20
and brain under the microscope.
00:36:24
Another thing that Dr. G is hoping
00:36:26
to find in the external exam is evidence of blood clots.
00:36:31
These often form in the legs, causing one leg to swell
00:36:35
up larger than the other.
00:36:37
Brian, could you lift the leg up for me when I measure?
00:36:41
Her legs don't look asymmetric.
00:36:43
There's no pulmonary embolism that has obviously developed
00:36:48
in her lower extremities.
00:36:50
NARRATOR: In fact, as she works her way up the entire body,
00:36:54
Dr. G doesn't see any red flags at all.
00:36:58
She looks like she's lost weight recently.
00:37:01
But overall, she looks pretty good.
00:37:03
The only thing that really doesn't look good
00:37:05
is that incision across her abdomen.
00:37:07
Whoa, whoa, whoa.
00:37:10
That looks painful
00:37:13
NARRATOR: Dr. G carefully examines
00:37:15
the 18-inch incision for telltale signs of infection.
00:37:19
Now, the one thing, though, when you look at the scar
00:37:22
is that it doesn't look infected.
00:37:24
NARRATOR: There's also no swelling under the wound.
00:37:28
Blood or serum can clot there, but I don't see any hematoma
00:37:31
or large amount of blood.
00:37:34
NARRATOR: Still, Michelle's surgical site looks extremely
00:37:37
painful, and this moves one of Dr. G's initial theories
00:37:42
to the forefront.
00:37:44
Just by looking at it, I'm thinking,
00:37:46
oh, she must have overdosed on medication.
00:37:51
[SUSPENSEFUL MUSIC]
00:38:05
NARRATOR: Although Dr. G now suspects that Michelle Rohn may
00:38:08
have overdosed on painkillers following a tummy tuck
00:38:12
operation, she still hasn't ruled
00:38:14
out other causes of death, such as an infection
00:38:17
or a botched surgery.
00:38:19
I won't know for sure until I open that incision up.
00:38:23
[MUSIC PLAYING]
00:38:30
NARRATOR: Because of Michelle's recent surgery,
00:38:33
Dr. G does not begin the internal exam
00:38:36
with a typical y incision.
00:38:38
In this case, I actually open up the incision--
00:38:42
the 18-inch incision, it goes around her lower abdomen,
00:38:45
because I want to see what that one looks like.
00:38:49
NARRATOR: Dr. G carefully cuts through Michelle's stitches
00:38:52
and reflects the skin.
00:38:54
It looked painful.
00:38:57
Where are those things coming from?
00:38:59
But it didn't look infectious.
00:39:03
All right.
00:39:07
NARRATOR: Finding nothing suspicious at the surgery site,
00:39:11
Dr. G uses her scalpel to make a y incision, opening up
00:39:15
the torso from each of Michelle's shoulders
00:39:17
through her chest, all the way to the pelvic bone.
00:39:23
First, she'll check the organs for any sign
00:39:26
of accidental injury from the surgery.
00:39:27
[MUSIC PLAYING]
00:39:33
JAN GARAVAGLIA: Her liver looks normal.
00:39:35
Her spleen looks normal.
00:39:36
There's no free blood, no pus in her abdominal cavity.
00:39:41
There's no perforation in her bowel.
00:39:44
NARRATOR: With no evidence of infection
00:39:47
or surgical injury to Michelle's organs,
00:39:49
it's looking like the surgery itself had absolutely
00:39:52
nothing to do with her death.
00:39:55
You know, I'm still wondering, maybe she took an overdose.
00:39:58
NARRATOR: An overdose of painkillers
00:40:00
could have been accidental--
00:40:03
or not.
00:40:04
Some patients have been known to suffer psychologically
00:40:07
after plastic surgery.
00:40:09
There's some serious depression that can occur
00:40:12
post body contouring surgery.
00:40:14
They were feeling good before surgery.
00:40:16
They're feeling terrible after surgery.
00:40:18
They have these horrible scars.
00:40:19
They're in a lot of pain.
00:40:21
And they second-guess their decision.
00:40:27
NARRATOR: Dr. G slices open Michelle's stomach, looking
00:40:30
for evidence of an overdose.
00:40:33
There's really nothing in her stomach.
00:40:37
I don't see any pills or pill fragments, or a bunch of pills
00:40:41
that I would expect with an overdose.
00:40:44
NARRATOR: But there's only one way to tell for sure,
00:40:48
and that's by drawing blood from Michelle's
00:40:50
body for toxicology testing.
00:40:54
JAN GARAVAGLIA: So if this autopsy is negative at the end,
00:40:58
I'm hoping that toxicology ends up positive.
00:41:01
NARRATOR: But toxicology aside, there's
00:41:04
still critical work to be done.
00:41:07
Dr. G must push on with the autopsy.
00:41:10
Michelle's body has yet to reveal what killed her,
00:41:13
and the possibilities are dwindling.
00:41:16
Maybe it's just some natural disease process.
00:41:18
Maybe she's got a bad heart.
00:41:20
Maybe she's got something else going
00:41:22
on that we don't know about.
00:41:24
NARRATOR: In the meantime, Michelle's husband
00:41:26
and two young children anxiously wait for any information
00:41:30
that may help them begin to come to terms with this tragic loss.
00:41:35
I just hope we find a cause of death.
00:41:36
There's nothing worse than a middle-aged woman
00:41:39
that dies suddenly with no cause of death.
00:41:43
[SUSPENSEFUL MUSIC]
00:41:58
NARRATOR: So far, Dr. G hasn't found any evidence
00:42:01
to suggest that 42-year-old Michelle Rohn died
00:42:05
from her recent tummy tuck.
00:42:08
But Michelle's sudden collapse does
00:42:10
point to a likely culprit--
00:42:12
the painkillers she took minutes before.
00:42:15
We see prescription drug, narcotic overdoses
00:42:19
all the time in this office.
00:42:21
Some of them are intentional.
00:42:23
Some of them are unintentional.
00:42:25
NARRATOR: But it will take weeks to get the toxicology
00:42:27
results back from the lab.
00:42:31
In the meantime, Dr. G continues the autopsy,
00:42:34
looking for any clue as to what might have caused
00:42:37
Michelle to die so suddenly.
00:42:40
Based on the circumstances of her death,
00:42:42
I'm going to really still look for natural disease.
00:42:44
I'll look at her heart.
00:42:45
That's really going to be where the money
00:42:47
is for dying suddenly.
00:42:49
NARRATOR: Dr. G opens Michelle's rib cage and removes the heart.
00:42:56
She then meticulously dissects every chamber
00:42:59
and artery in the organ.
00:43:02
JAN GARAVAGLIA: There's no evidence
00:43:05
of scar tissue, any evidence of longstanding high blood
00:43:08
pressure.
00:43:12
Hair looks good.
00:43:14
NARRATOR: Next, Dr. G turns her attention to Michelle's lungs.
00:43:19
At first glance they look healthy, judging
00:43:22
by their size and color.
00:43:24
You can't just look at the external aspect of a lung
00:43:27
and figure out what went on.
00:43:29
You gotta take it out and cut it.
00:43:31
NARRATOR: Carefully, she lifts the lungs up and uses
00:43:34
her scalpel to detach them.
00:43:39
She then begins dissecting the delicate tissue,
00:43:42
and at that moment, she sees something horribly wrong.
00:43:47
She's got bilateral pulmonary thromboemboli.
00:43:54
Blood clots that formed and are occluding
00:43:59
the main pulmonary arteries.
00:44:02
The lung can't get anymore blood from the heart,
00:44:05
and it's incompatible with life.
00:44:07
This is what killed her.
00:44:09
NARRATOR: But Dr. G's work isn't over yet.
00:44:12
Even though I have the cause of death,
00:44:14
I am curious what caused it.
00:44:18
I need to know, where did she get
00:44:20
these bilateral pulmonary emboli?
00:44:22
You know, inquiring minds still want to know.
00:44:25
NARRATOR: The prime suspect, Michelle's legs, where blood
00:44:29
clots are most likely to form.
00:44:32
So we dissect the legs, and they
00:44:36
don't have any residual clot in those legs.
00:44:40
No, I can't see.
00:44:41
It's just all blood here.
00:44:42
I don't see any clots.
00:44:46
NARRATOR: Determined to locate the source,
00:44:48
Dr. G slowly moves upward on Michelle's body--
00:44:52
and soon finds her culprit.
00:44:55
But not in the usual spot.
00:44:58
I find some residual clots still in her pelvic vessels.
00:45:03
NARRATOR: Although blood clots usually form in the legs,
00:45:07
in Michelle's body they formed in her pelvic area,
00:45:10
then broke free and traveled through her bloodstream
00:45:14
before lodging in the lungs' pulmonary arteries.
00:45:17
A blood clot forming in the pelvic vein
00:45:20
is more dangerous than a blood clot forming in the calf vein.
00:45:25
The reason being is that the vein in the pelvis
00:45:28
is much larger than the vein in the calf.
00:45:30
So when a blood clot breaks off, if it breaks off
00:45:33
from the pelvis, it's a larger blood clot,
00:45:35
and then can be much more fatal.
00:45:39
NARRATOR: This is the smoking gun she's been looking for.
00:45:43
And finally, Dr. G can explain exactly how Michelle Rohn's
00:45:47
tummy tuck turned tragic.
00:45:50
[MUSIC PLAYING]
00:45:59
NARRATOR: After an uneventful abdominoplasty and liposuction,
00:46:03
42-year-old mom Michelle Rohn is recovering at home.
00:46:08
She's bed-bound and in pain.
00:46:12
Still, on the outside, everything appears normal.
00:46:18
But inside her body, it's a completely different story.
00:46:22
The tissue destruction from the surgery and liposuction
00:46:25
causes blood to clot more readily,
00:46:28
and her immobility during recovery
00:46:30
makes it more sluggish.
00:46:32
JAN GARAVAGLIA: And that can lead to pulmonary emboli
00:46:34
forming in the pelvic region.
00:46:36
NARRATOR: At around 3:30 AM, Michelle's pain wakes her up.
00:46:41
She crawls out of bed and makes her way
00:46:43
to the bathroom for another dose of painkillers.
00:46:47
But unbeknownst to her, the movement's likely
00:46:51
caused several blood clots to break
00:46:53
free from her pelvic region.
00:46:54
JAN GARAVAGLIA: They go through her vascular system
00:46:57
and flog up the pulmonary arteries going to the lung.
00:47:00
NARRATOR: As Michelle tries to get back into bed,
00:47:04
her body, deprived of oxygen, suddenly begins to fail.
00:47:10
She collapses, and within minutes, she's dead.
00:47:19
That's one of the few things that you're
00:47:21
walking, talking one minute, and you're dead on the floor
00:47:25
the next.
00:47:26
NARRATOR: Michelle's sudden death
00:47:28
has left her grieving husband, Kevin, desperate for answers.
00:47:33
Now Dr. G calls him with her findings.
00:47:37
This is Dr. Garavaglia at the Medical Examiner's Office.
00:47:41
Yes.
00:47:43
He just got the cause of death and hardly said a word.
00:47:47
He certainly didn't want to talk to anybody about it.
00:47:50
Oh, I would imagine that there was some tremendous guilt.
00:47:53
NARRATOR: It's unlikely that Kevin Rohn ever
00:47:55
thought his wife could die from the consequences
00:47:58
of such a common procedure.
00:48:00
The dangers for cosmetic surgery are minor,
00:48:03
but they're real.
00:48:05
Having pulmonary emboli, the complication of that
00:48:08
is little less than 1%.
00:48:10
About a 0.08%, but it's real.
00:48:13
If she doesn't have anything that is going to put her
00:48:16
at increased risk for the surgery,
00:48:19
she's one of those unfortunate people
00:48:22
that had a bad complication.
00:48:25
NARRATOR: For Dr. G, Michele's death
00:48:28
is a powerful cautionary tale when it comes
00:48:31
to elective plastic surgery.
00:48:33
As long as you know the risks and the complications,
00:48:37
and it's still worth it for you, you know, go for it.
00:48:40
And especially if it makes you feel better.
00:48:44
But the people she devastated the most with it
00:48:46
are her children.
00:48:48
You can't ever substitute for mommy.
00:48:50
[MUSIC PLAYING]
00:48:52
SINGER: I miss you, I miss you.
00:48:56
I love you, la la, bah, bah, bah.
00:49:01
And the smell of your--
00:49:04
[MUSIC PLAYING]
00:49:06
MALE SPEAKER: Atlas.
