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[DRAMATIC MUSIC]
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NARRATOR: An elderly man dies after mysteriously falling
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from a high-speed train.
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JAN GARAVAGLIA: He kind of disappeared off the train,
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and nobody saw him.
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At least, nobody's saying they saw it.
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NARRATOR: Did he simply fall or is there
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a darker side to this story?
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JOYCE OLSEN: Right away, we were thinking
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that someone did it someone.
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Someone pushed him off.
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NARRATOR: And then, a young woman
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collapses during a romantic dinner with her husband.
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JAN GARAVAGLIA: Basically, she's brain dead by the time
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she gets to the hospital.
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NARRATOR: Now, her distraught husband
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needs to know if a deadly habit finally took its toll.
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She does like to use drugs, particularly cocaine.
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NARRATOR: Or is something else to blame?
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We don't know.
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I mean, there are a lot of odd things that could occur.
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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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You don't have to live inside Dr. G's jurisdiction
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to end up on her autopsy table.
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You just need to die there.
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And all too often a traveler ends their journey prematurely
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with a visit to the morgue.
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If you've died in the jurisdiction that I cover for,
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we're going to need to find out why you died.
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We don't care where you came from.
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If you've died in our jurisdiction,
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we're going to do that.
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NARRATOR: Such is the case of Victor Gust, who passed away
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while traveling through San Antonio,
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Texas during Dr. G's tenure at the Bear County
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Medical Examiner's Office.
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As Dr. G reads through the case file,
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she's surprised to learn that 76-year-old Victor
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Gust was a resident of Wisconsin,
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over 1,300 miles away.
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Oh, boy.
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Well, we don't get too many people
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from Milwaukee, Wisconsin.
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NARRATOR: To those who knew him, Victor
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was the life of every party.
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JUDY YANTIS: He was a bit of a clown,
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and my mom always referred to him
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as the jokester of the family.
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JOYCE OLSEN: Well, as far as I remember
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from back in the younger days that he
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had a good sense of humor.
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I just remember that we had fun.
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We had a lot good times.
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NARRATOR: Afraid to fly, Victor was traveling through Texas
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by train on his way to his sister's
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funeral in Phoenix, Arizona.
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But when the train arrived at the Phoenix station,
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Victor didn't get off.
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JUDY YANTIS: My sister and I went down to the train station.
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We waited and waited and waited.
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The train came in, people got off,
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and we'd be looking, going you know, is that him?
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Is that him?
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We were telling ourselves that maybe he fell asleep.
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NARRATOR: Conductors searched through the cars for Victor,
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but he's nowhere to be found.
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JOYCE OLSEN: We all were thinking
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that maybe he got off somewhere and didn't
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get back on that train.
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We just had no idea what to think.
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NARRATOR: Two hours later, Joyce gets a call from police.
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They found her uncle Victor, but he's 900 miles away
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just outside of San Antonio and lying
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unconscious beside the train tracks.
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They find him alive but pretty much unconscious.
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He can't really talk.
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They helicopter him to a hospital
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that is in my jurisdiction.
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NARRATOR: Victor remains in critical condition in a San
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Antonio hospital for two weeks.
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But he never regains consciousness.
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JAN GARAVAGLIA: He was very ill in the hospital,
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on a ventilator.
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They eventually had to put a tracheostomy tube in.
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His respiratory state got worse and worse,
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and he eventually died.
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NARRATOR: For Victor's family, the loss is bitter.
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His death was an especially sad time, because like I say,
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we had just lost my mother.
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We were all just shook up by the whole thing.
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JUDY YANTIS: Then for this to happen, it just was--
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just one thing after another was just compiled.
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NARRATOR: What happened to Victor Gust on that train,
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traveling through San Antonio at 6 AM?
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There's no witnesses.
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They don't know how he got off that train.
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So it's kind of a mystery.
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NARRATOR: The first scenario Dr. G considers is suicide.
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His sister was the only immediate family
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Victor had left.
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And the long trip to her funeral may have
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simply been too much to handle.
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JAN GARAVAGLIA: He's very upset, and maybe he
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feels what's the point?
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He doesn't want to face that funeral,
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and he commits suicide.
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I've had more impulsive suicides that I've autopsied.
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NARRATOR: Another possibility is that Victor could have simply
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suffered a fatal accident.
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JAN GARAVAGLIA: He could have accidentally just tripped
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and fallen off the train.
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NARRATOR: Finally, Dr. G considers
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the most disturbing scenario, that Victor was
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pushed from the speeding train.
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Well, I'm always worried about foul play.
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NARRATOR: And in this case, there might be good reason.
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According to several train passengers,
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Victor had been behaving oddly during the trip.
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He was acting very bizarrely, supposedly making
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people irritated on this train.
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He stole a pair of shoes from a little girl.
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He took somebody's pillow, and people
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were getting agitated at him.
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NARRATOR: Perhaps Victor did something that pushed
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a fellow passenger too far.
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I would hope that this is not the scenario, but I don't know.
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NARRATOR: It's this possibility that have police and Victor's
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family most concerned.
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JUDY YANTIS: Right away, we thought that someone
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pushed him off or something.
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Why, you know, would someone fall off the train?
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JAN GARAVAGLIA: He kind of disappeared off
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the train and nobody saw it, or at least
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nobody's saying they saw it.
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NARRATOR: As a first step, Dr. G begins documenting Victor's
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injuries from the fall, hoping they might reveal
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clues as to what happened.
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She finds abrasions on his hands and ears.
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That is odd. Look at that.
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I have two of those on--
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NARRATOR: And superficial puncture wounds
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to his arms and elbows, all consistent with a fall
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from a moving train.
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Oh, this should be interesting.
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NARRATOR: But it's Victor's head that seems to have
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sustained the most damage.
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JAN GARAVAGLIA: The lacerations extend through the scalp
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and go down to the bone.
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So there are very significant lacerations.
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I'm going to get a chart for his head.
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NARRATOR: Victor's head trauma might have been severe enough
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to kill him, but Dr. G won't know for sure until she
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performs the internal exam.
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But we've got to see what's on inside the brain.
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NARRATOR: If that is the cause of death, however,
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it may be impossible to say for sure what or who caused him
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to fall from the moving train.
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Certainly, I would love it if somebody pushes him
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and I see handprints.
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But I'm sorry, it's not that easy.
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It doesn't work like that in the real world.
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NARRATOR: Coming up next, Dr. G makes
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a shocking discovery about what happened
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to Victor after his fall.
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There's a lot of pus in there.
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It's clear.
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You can see it with your eye.
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NARRATOR: When "Dr. G Medical Examiner" continues.
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[DRAMATIC MUSIC]
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Dr. G reflects the scalp of 76-year-old Victor Gust.
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While traveling by rail from Wisconsin to Arizona,
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Victor somehow fell from the train
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and died two weeks later in the hospital.
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Dr. G is almost certain Victor died as a result of the fall.
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But the question is, what caused that fall in the first place?
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JOYCE OLSEN: Someone must have done something bad,
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you know, pushed him off or threw him off.
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I would hope that's not the case.
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But I have also had more senseless
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murders that I've autopsied.
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So what is it?
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I don't know.
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NARRATOR: As Dr. G gets her first look
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at the surface of Victor's skull,
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she is surprised by what she doesn't find.
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I don't see any skull fractures
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at the top of his skull to the bottom of his skull.
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NARRATOR: Her assistant then uses the oscillating
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saw to open his cranium.
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Here, Dr. G does find trauma, a subdural hematoma
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or bleed in the brain.
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Oftentimes, with trauma, we see blood collecting
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between the dura and the brain.
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And the dura is that tough covering over the brain.
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And the blood collects fast enough or enough,
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it can press on the brain and really cause trouble.
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NARRATOR: But when Dr. G carefully
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examines the collection of blood on Victor's brain,
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she determines that the hematoma is minor.
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With his, he's got just a little bit--
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just a little bit of blood there.
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It's layered out.
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It's what we call non-space-occupying.
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I wouldn't think that that was enough to kill him.
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NARRATOR: This is a surprising finding
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that could take the case in a completely different direction.
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Dr. G's initial suspicion that Victor
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died from head trauma sustained in the fall is not the case.
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In fact, the injury may not even have
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been severe enough to render him unconscious
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or required a stay in the hospital.
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I don't know what his problem is yet.
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NARRATOR: But that fall might still
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have caused other fatal internal injuries,
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and that's what she'll search for next.
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Dr. G opens Victor's torso with the standard Y incision.
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JAN GARAVAGLIA: I look in the chest, I look in the abdomen,
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but I don't see any trauma.
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I don't see any broken ribs.
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I don't see anything major as far as traumas concerned
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in his chest or abdomen.
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NARRATOR: Incredible as it seems,
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76-year-old Victor fell from a train going 80 miles per hour,
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and he sustained no significant internal injuries.
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Whatever killed Victor Gust, it wasn't his fall from the train.
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OK.
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But I gotta clean my hands.
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NARRATOR: With this shocking discovery,
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Dr. G is back to square one.
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All she can do now is push on with the internal exam,
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removing and dissecting each vital organ in turn,
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hoping for a clue.
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And it's not long before she finds one.
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Oh, my gosh.
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That left lung is just full of fluid.
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His lungs look terrible.
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They were full of fluid.
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NARRATOR: But it's not just fluid buildup she sees.
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There's a lot of pus in there.
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It's clear.
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You can see it with your eye.
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Yes.
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They're very congested.
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They've got some edema too them.
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NARRATOR: This tells Dr. G that Victor
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has contracted pneumonia, a significant bacterial infection
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in his lungs.
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It's very common to get pneumonias
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and infections in your long when you're on a respirator.
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Patients on ventilators are at high risk for bronchial or lung
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infections, because the breathing tube bypasses
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the normal defenses of the respiratory tract
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and can even harbor bacteria.
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Up to 25% of patients placed on a ventilator
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for more than two days develop ventilator-associated
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pneumonia.
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Up to 50% of them die as a result. After his fall
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from the train, Victor was on a ventilator
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for nearly two weeks.
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When you have a breathing tube down into your airway,
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you can get colonized with a lot of different bacteria.
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NARRATOR: Dr. G believes this infection wasn't just severe,
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she believes it's what ultimately killed Victor Gust.
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JAN GARAVAGLIA: I can clearly see that he died
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from unable to be oxygenating.
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He just cannot exchange oxygen anymore from the air,
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from the respirator.
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The lungs are too badly damaged.
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NARRATOR: In many autopsies, this discovery would be
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the final piece to the puzzle.
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But not in the case of Victor Gust.
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It's clear he died from an infection
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he contracted from a respirator in the hospital.
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But for Dr. G, what led him to be on that respirator
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is the real culprit, the true cause of death.
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JAN GARAVAGLIA: I mean, that's clearly the end result.
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But what is it that started this?
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He clearly didn't have lung damage
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when he was on the train.
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I mean, this is just all a result
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of whatever happened to him.
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NARRATOR: Coming up next, Dr. G zeros in on a killer.
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But will it be enough to close the case on Victor Gust?
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So how am I going to figure that out?
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I don't know.
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NARRATOR: When "Dr. G, Medical Examiner" continues.
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[DRAMATIC MUSIC]
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Dr. G is pulling out Victor's organs one by one
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and dissecting them.
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76-year-old Victor Gust was hospitalized
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two weeks ago after falling off a moving train.
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Dr. G has since discovered that Victor
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died of pneumonia he contracted while on a ventilator.
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Although this is his cause of death,
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Dr. G isn't satisfied, because to her,
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whatever caused Victor to be in the hospital
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in the first place, an accident, an assault,
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or a natural disease, is what really killed him.
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JAN GARAVAGLIA: The bottom line is, what happened to him?
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NARRATOR: Dr. G's next stop is the heart.
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And here, she soon finds a clue in Victor's coronary artery.
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He's got bad coronary arteries.
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NARRATOR: It contains a dangerous buildup
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of plaque, a condition known as coronary artery disease.
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He has some coronary artery disease,
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but what's really troubling is that he's got a thrombus.
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In one of the coronary arteries, in one of the vessels
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that supplies blood and oxygen to the heart,
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he's got a thrombus.
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It looks like there was a little clot.
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NARRATOR: A thrombus or blood clot is clearly obstructing
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Victor's coronary artery.
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JAN GARAVAGLIA: The blood flow then can't
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get through that thrombus.
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It's blocking it.
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It's damming it so no blood can get in.
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NARRATOR: The blockage of the artery
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deprives the heart of blood and oxygen,
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ultimately causing injury to the muscle itself.
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JAN GARAVAGLIA: When I look at the muscle, it's yellow,
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it's soft, it's necrotic, because the muscle
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fiber actually is dying.
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That's what the yellow is.
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It's just disintegrating and dying.
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It's a huge heart attack.
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NARRATOR: Could this heart attack
00:16:09
have set off the chain of events that led
00:16:11
to the death of Victor Gust?
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Or did Victor simply suffer the heart attack during his two
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weeks in the hospital?
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To find out, Dr. G will have to try to determine exactly
00:16:23
when the heart attack occurred.
00:16:30
To help establish a frame frame, she'll
00:16:32
need to dissect the heart and examine it up close.
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JAN GARAVAGLIA: When you have a heart attack,
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it changes from just pallor or paleness from lack of blood
00:16:42
to then some hemorrhage and then you can get some softening
00:16:46
and get some yellow, because the muscle fiber actually is dying.
00:16:51
And so his is at the stage where it's really, really necrotic.
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The muscle is just as soft as can be.
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NARRATOR: Based on her examination of the heart,
00:17:02
she calculates that the heart attack struck about two weeks
00:17:05
earlier, around the time Victor was traveling on the train
00:17:09
and before he was admitted to the hospital.
00:17:12
But she can't narrow the time frame any further.
00:17:16
And that means that there is one question that she'll
00:17:18
never be able to answer.
00:17:21
JAN GARAVAGLIA: Did he pass out from the heart attack
00:17:24
and fall off the train or was it the whole stress
00:17:27
of either being pushed or accidentally
00:17:30
falling off the train?
00:17:31
Now, when you have stress, your blood pressure goes up,
00:17:37
and that certainly could have ruptured that plaque
00:17:40
and caused the thrombus.
00:17:42
Here's the problem with this--
00:17:44
I can't date it within seconds or even within hours
00:17:48
at this point.
00:17:49
Which came first?
00:17:50
The chicken or the egg?
00:17:52
I cannot tell from just looking at that heart.
00:17:56
NARRATOR: By the end of the autopsy,
00:17:58
Dr. G is certain that Victor Gust had a major heart attack,
00:18:02
which then caused him to be on a respirator
00:18:05
and contract pneumonia.
00:18:07
But she'll never know what triggered it.
00:18:09
Unfortunately, it's one of those few cases
00:18:13
that you don't know.
00:18:15
So we're never going to get an answer on this.
00:18:18
NARRATOR: When she reports her findings,
00:18:20
Dr. G presents the scenario that seems
00:18:22
most likely, even though she knows
00:18:25
it's not the only possibility.
00:18:31
[TRAIN WHISTLE]
00:18:34
76-year-old Victor Gust is on a train
00:18:36
bound for Phoenix, Arizona.
00:18:39
According to fellow passengers, Victor
00:18:41
begins acting strangely during the second day of his journey.
00:18:45
JAN GARAVAGLIA: He's irritating people on that train,
00:18:47
stealing shoes, stealing pillows.
00:18:50
People are starting to get irritated at him.
00:18:52
NARRATOR: To Dr. G, this might be the first sign that he's
00:18:55
having a major heart attack.
00:18:58
Lack of oxygen going to his brain
00:19:00
because of the heart attack, it could
00:19:03
cause him to act funny from the heart just not pumping well.
00:19:07
NARRATOR: Not completely in his right mind,
00:19:10
perhaps Victor opens a door or ventures between cars.
00:19:14
He's had a heart attack.
00:19:15
His heart isn't pumping very well.
00:19:17
He's acting somewhat bizarrely.
00:19:20
He's probably getting some shortness of breath.
00:19:24
He goes out to get some oxygen. He collapses
00:19:30
and tumbles off the train.
00:19:33
NARRATOR: His head strikes the ground,
00:19:35
and a small hematoma begins to form,
00:19:38
but it is not life-threatening.
00:19:41
As the train clacks away down the tracks,
00:19:44
Victor's heart attack puts him into a state of unconsciousness
00:19:47
that he will never return from.
00:19:50
He's hospitalized, placed on a ventilator, and as a result,
00:19:54
contracts pneumonia.
00:19:56
Slowly and slowly, his lungs get worse and worse and worse,
00:19:59
and he died.
00:20:09
NARRATOR: For Dr. G, it's a poignant scenario,
00:20:12
but it's not the only possibility.
00:20:15
The heart attack could have simply
00:20:16
been the result of a fall from a fast-moving train.
00:20:20
JAN GARAVAGLIA: It could have happened after he'd fallen off
00:20:23
the train and just the stress of falling off,
00:20:26
that heart attack could have occurred.
00:20:29
NARRATOR: Victor's fate is something that forensic science
00:20:32
can never know.
00:20:35
He either jumped off that train,
00:20:37
he either fell off that train, or he
00:20:39
was pushed off that train.
00:20:40
So it's one of those very unsatisfying
00:20:43
movies where they do three different endings,
00:20:46
and you pick.
00:20:47
I hate those.
00:20:49
NARRATOR: The lack of certainty also troubles Victor's family.
00:20:53
JUDY YANTIS: The fact that we may never know what happened
00:20:55
to him really bothers me.
00:20:58
It does.
00:20:59
It still bothers me.
00:21:00
And I'm sure it probably always will.
00:21:05
JOYCE OLSEN: I would hate to think that another person
00:21:06
actually did this to him.
00:21:09
I wish I could have given the exact answer to the family.
00:21:12
I feel bad about that.
00:21:13
I always do.
00:21:15
But I got as many answers as I could from that body.
00:21:18
I don't have a preponderance of evidence here.
00:21:21
So I'm going to have to leave this one as undetermined.
00:21:29
NARRATOR: Coming up next, a young woman
00:21:31
suddenly collapses and dies in the middle of a restaurant.
00:21:35
JAN GARAVAGLIA: People see her fall to the floor
00:21:37
and have a seizure.
00:21:38
NARRATOR: Did a dangerous habit ravage
00:21:40
this healthy woman's body?
00:21:42
JAN GARAVAGLIA: She's known to use cocaine.
00:21:44
She's known to use ecstasy.
00:21:45
She is known to drink on a daily basis.
00:21:48
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:21:52
[DRAMATIC MUSIC]
00:22:07
As chief medical examiner of the District 9 Morgue in Florida,
00:22:11
Dr. Jan Garavaglia's job is to open and examine dead bodies
00:22:15
as soon as possible.
00:22:17
Oh, my goodness, though.
00:22:19
NARRATOR: Unless the decedent is an organ donor.
00:22:22
Somebody has already peeked in.
00:22:24
But that's OK.
00:22:25
We'll deal with that.
00:22:26
NARRATOR: Today, an organ recovery agency
00:22:29
wants to remove the liver of a local 26-year-old woman,
00:22:33
if Dr. G approves.
00:22:35
They do have to get our OK.
00:22:38
It certainly makes things a little bit harder
00:22:40
to find sometimes.
00:22:43
NARRATOR: According to the agency representative,
00:22:45
the donor died in the hospital after a sudden collapse
00:22:49
and three days in a coma.
00:22:51
JAN GARAVAGLIA: We can work around it.
00:22:53
These are lifesaving measures, and I'm certainly not going
00:22:56
to refuse an organ just because it would
00:22:59
make my job a little easier.
00:23:01
NARRATOR: Ultimately, she allows the procedure to move forward.
00:23:05
So they went ahead and then procured
00:23:07
the liver, transplanted that.
00:23:09
And then we got the body.
00:23:16
NARRATOR: The next morning, Dr. G finds the donor, Jesse Davis,
00:23:20
in the day's lineup.
00:23:21
Hi mom.
00:23:22
Hi dad.
00:23:23
NARRATOR: An aspiring cookbook writer, Jesse had a passion
00:23:26
for playing with recipes.
00:23:28
But according to the investigator's report,
00:23:31
her dreams were cut short three days earlier
00:23:35
while enjoying a meal at a favorite local diner.
00:23:38
JAN GARAVAGLIA: She was having dinner
00:23:39
with her husband late at night, kind of early in the morning.
00:23:43
And while she's eating, she falls
00:23:47
to the floor, starts seizing.
00:23:49
NARRATOR: Her husband, Aaron, springs into action.
00:23:52
Starts CPR.
00:23:53
They call 9-1-1.
00:23:54
They're able to get her heart going,
00:23:56
but basically she's brain dead by the time
00:23:59
she gets to the hospital.
00:24:01
[SIREN]
00:24:02
NARRATOR: Doctors immediately put Jesse on a respirator
00:24:05
and begin searching for a way to save her.
00:24:09
Desperate, Aaron tells them everything he can.
00:24:12
JAN GARAVAGLIA: She doesn't have a history of seizures.
00:24:14
She's got a family history of heart disease,
00:24:17
but it's a little bit vague.
00:24:19
And the husband didn't really know that much about it.
00:24:22
NARRATOR: He also reveals that his wife
00:24:24
has a history of drug abuse.
00:24:26
JAN GARAVAGLIA: She does like to use
00:24:27
drugs, particularly cocaine.
00:24:29
NARRATOR: But when the hospital runs a urine test,
00:24:32
it comes up negative for all illegal substances.
00:24:37
A CAT scan of her brain and a chest X-ray
00:24:40
also reveal nothing.
00:24:42
And they never could figure out why, what happened to her.
00:24:46
NARRATOR: With nowhere else to turn,
00:24:48
doctors must finally tell Aaron, there's no hope for recovery.
00:24:54
Three days later, he agrees to take Jesse off the respirator,
00:24:59
and she dies.
00:25:03
Now it's up to Dr. G to answer the question
00:25:06
ER doctors could not.
00:25:09
What caused her to suddenly collapse
00:25:11
and then start seizing?
00:25:13
NARRATOR: Based on the information thus far,
00:25:15
she believes that whatever caused the seizure is likely
00:25:19
the killer.
00:25:21
JAN GARAVAGLIA: When people present with a seizure,
00:25:23
they don't usually die from it.
00:25:24
And it's usually from something else.
00:25:27
NARRATOR: Unprecedented seizures are a symptom,
00:25:29
signaling that the brain has been suddenly deprived of blood
00:25:33
and oxygen. But numerous ailments, including
00:25:37
strokes, heart attacks, and an overdose
00:25:40
can trigger this condition.
00:25:43
Dr. G can only speculate as to what
00:25:46
was behind Jesse's seizure.
00:25:49
JAN GARAVAGLIA: Could be drugs, could be her heart,
00:25:51
or it could be something we don't know.
00:25:52
I mean, there are a lot of odd things that could occur.
00:25:56
Bottom line, is we don't know why she just all of a sudden
00:26:00
collapsed at the restaurant.
00:26:01
So that's what we're going to have to figure out.
00:26:08
OK.
00:26:09
We'll start.
00:26:10
NARRATOR: As Dr. G begins Jesse's external exam,
00:26:14
one glaring wound provides a glimpse of her journey
00:26:17
to the morgue.
00:26:19
JAN GARAVAGLIA: She's got the large incision
00:26:20
from the post-mortem organ retrieval.
00:26:23
NARRATOR: She also takes note of Jesse's
00:26:25
white antiembolic stockings.
00:26:28
JAN GARAVAGLIA: These are stockings
00:26:29
they put on to compress the legs so blood
00:26:33
clots don't readily form.
00:26:35
NARRATOR: Clots are the result of abnormally coagulating
00:26:38
blood in the veins.
00:26:40
Blood clots can be life-threatening
00:26:42
if they travel through the vascular system to the lungs.
00:26:47
She removes the stockings and sees no anomalies on the skin
00:26:52
beneath.
00:26:53
In fact, she finds nothing inexplicable
00:26:56
anywhere on the body until she inspects the arms.
00:27:01
She has needle puncture marks.
00:27:04
She's got a lot of them.
00:27:06
NARRATOR: These could be from the intravenous feeding
00:27:09
she received while on the respirator.
00:27:11
Were these needle puncture marks from the hospital?
00:27:15
NARRATOR: But Dr. G also considers
00:27:17
Jesse's history of drug abuse.
00:27:20
Perhaps she'd injected a stimulant such as cocaine
00:27:24
and died of an overdose.
00:27:26
Certainly, cocaine can precipitate a seizure.
00:27:29
NARRATOR: The hospital drug screen did
00:27:31
test negative for narcotics.
00:27:34
But Dr. G knows from experience that these tests
00:27:37
are not always foolproof.
00:27:39
JAN GARAVAGLIA: With the urine drug screen,
00:27:41
sometimes it won't pick up if you've
00:27:43
used the drug very quickly, before it gets a chance
00:27:47
to build up in the urine.
00:27:49
NARRATOR: The only way to prove whether she
00:27:51
seized from an overdose is a comprehensive blood screen.
00:27:55
JAN GARAVAGLIA: What we'll do is we'll get the initial blood
00:27:57
from the ER-- they said they'd save some of that--
00:27:59
and go ahead and test it ourselves.
00:28:02
NARRATOR: But the lab work will take weeks.
00:28:05
For now, Dr. G must proceed with the internal exam,
00:28:09
hunting for any evidence the ER staff might have missed.
00:28:14
We're not going to know until we get inside.
00:28:16
NARRATOR: First, she looks for signs of a stroke.
00:28:19
This ailment would have deprived a small part
00:28:22
of Jesse's brain of oxygen and could explain the seizure.
00:28:26
So we're going to go ahead and start with the head,
00:28:28
and then I'll do the chest.
00:28:30
NARRATOR: But even before she reflects the scalp,
00:28:33
Dr. G knows a major challenge lies beneath.
00:28:37
A brain that grew soft while Jesse
00:28:39
was kept alive on a respirator, long after the organ
00:28:43
itself was dead.
00:28:44
JAN GARAVAGLIA: We call these respirator brains.
00:28:47
If they're long enough on that respirator,
00:28:49
it'll be almost semi-liquid.
00:28:56
NARRATOR: Coming up next, Dr. G struggles
00:28:59
with a tricky maneuver.
00:29:00
It's difficult to get this brain out.
00:29:02
I'm going to pulverize it.
00:29:04
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:29:09
[DRAMATIC MUSIC]
00:29:21
Dr. G removes Jesse Davis's calvarium,
00:29:24
or the top of her skull, looking for signs
00:29:27
of a stroke or other disease.
00:29:30
Three days ago, while eating dinner,
00:29:33
the 26-year-old suffered a seizure
00:29:35
and never regained consciousness.
00:29:38
JAN GARAVAGLIA: Has a sudden arrest, unknown etiology,
00:29:40
unknown cause.
00:29:42
NARRATOR: With no diagnosis, her death is shrouded in mystery.
00:29:46
And Dr. G has little information with which to solve it.
00:29:50
We have no real history that she's got a family history.
00:29:53
She'd been in foster care, and I'm not so sure how
00:29:56
much she knew about her family.
00:29:58
NARRATOR: Jesse's husband fears that drug
00:30:00
addiction, which she tried so hard to conquer, is to blame.
00:30:06
Now it's in Dr. G's hands to determine
00:30:09
the true cause of death and bring a measure of peace
00:30:12
to her grieving husband.
00:30:21
Dr. G attempts to extract the brain,
00:30:24
but it's a risky operation.
00:30:27
Well, this is really difficult to get this brain out.
00:30:30
She's been three days on a respirator brain dead,
00:30:33
and the brain has gotten very soft.
00:30:36
It's starting to break down.
00:30:37
I'm going to pulverize it.
00:30:39
NARRATOR: It takes a very steady hand.
00:30:42
But after a few tense moments, she's
00:30:44
able to pull it out intact.
00:30:47
I got it.
00:30:50
NARRATOR: Now, she must dissect it as best she can,
00:30:53
searching for any signs of a stroke.
00:30:57
This is interesting.
00:31:00
NARRATOR: But after a thorough search,
00:31:02
she finds no abnormalities whatsoever.
00:31:06
JAN GARAVAGLIA: And I didn't see anything in that brain
00:31:08
that was unusual or that would have precipitated her death.
00:31:12
NARRATOR: So far, Jesse's killer is proving to be elusive.
00:31:17
Now, she's hoping to track it down in the internal exam.
00:31:26
Dr. G performs the usual Y incision.
00:31:29
Then she quickly homes in on a major organ,
00:31:33
whose failure could easily trigger a seizure, the heart.
00:31:37
She's got a family history of heart disease.
00:31:40
Most likely, that has something to do with atherosclerosis.
00:31:44
NARRATOR: Atherosclerosis, or the narrowing and hardening
00:31:47
of the arteries, is one of the leading
00:31:49
causes of heart attacks.
00:31:53
JAN GARAVAGLIA: 26 is pretty young,
00:31:55
but I've seen it before in young people of that age.
00:31:58
So it is a possibility, particularly
00:32:01
if you use cocaine.
00:32:04
NARRATOR: She methodically dissects the organ, searching
00:32:07
for any visible abnormalities.
00:32:09
I'm looking at the thickness of the wall
00:32:11
of the heart muscle.
00:32:13
I certainly will look at the coronary arteries.
00:32:17
NARRATOR: But it doesn't take long
00:32:18
to determine that Jesse's heart, like her brain,
00:32:22
was perfectly healthy.
00:32:24
I don't really see anything that
00:32:25
would indicate a chronic heart history from her family.
00:32:30
I don't see a lot of the chronic changes
00:32:32
that I see with cocaine.
00:32:34
That doesn't mean she would not have gotten it in the future.
00:32:37
But at 26, she did not have any heart disease.
00:32:42
NARRATOR: With that possibility ruled out,
00:32:44
Dr. G seems further than ever from determining
00:32:47
what cut down Jesse Davis in the prime of her life.
00:32:51
We've got the big two down, the brain and the heart,
00:32:53
so we're running a little bit low on options.
00:32:56
NARRATOR: Now, she turns to the last major organ
00:32:59
that could trigger a sudden lack of oxygen
00:33:01
and a seizure, the lungs.
00:33:06
And as soon as she picks them up, she detects a problem.
00:33:10
They're kind of heavy and boggy,
00:33:11
and I can see some hemorrhage on the surface.
00:33:14
NARRATOR: Quickly, she digs deeper,
00:33:17
and it isn't long before her scalpel hits the jackpot.
00:33:20
She's got these blood clots.
00:33:22
They look like little nubbins coming out of the blood
00:33:26
vessels, kind of a dark purple, and you
00:33:30
can see kind of whitish strands through them.
00:33:34
NARRATOR: These are multiple pulmonary thromboemboli,
00:33:38
blood clots in the lungs.
00:33:41
It's an alarmingly common condition
00:33:43
that strikes at least 650,000 Americans a year, most of whom
00:33:48
are elderly or immobilized after surgery.
00:33:52
Typically, the clots originate in the legs
00:33:55
or pelvis, when the patient's blood
00:33:57
starts coagulating too much.
00:34:00
The cells that are in charge of clotting
00:34:03
in the blood, the platelets, start tacking onto each other
00:34:07
and accumulating, and eventually they
00:34:09
form a large, soft, gooey mass.
00:34:14
NARRATOR: Then, when it breaks loose,
00:34:16
it travels through the cardiovascular system
00:34:19
until it gets stuck in the lungs.
00:34:24
Well, what happens if you get a blood clot in the smaller
00:34:27
vessels of the lungs is the blood to get oxygen
00:34:30
from the lungs can't get in.
00:34:33
NARRATOR: The diminished access to oxygen
00:34:35
can cause shortness of breath, anxiety, and chest pain.
00:34:39
That is, if the patient has any symptoms at all.
00:34:43
OMAR KAYALEH: Most of emboli can be asymptomatic.
00:34:47
And not all of them are necessarily very evident,
00:34:49
even in the tests that we do.
00:34:52
NARRATOR: This explains why doctors
00:34:53
were unaware of Jesse's emboli.
00:34:56
JAN GARAVAGLIA: X-rays don't show blood clots very well.
00:34:58
You're just not going to see them.
00:35:00
NARRATOR: But in autopsy, Dr. G is
00:35:03
able to see dozens with her naked eye,
00:35:06
peppered throughout the lungs.
00:35:08
JAN GARAVAGLIA: If you get enough of these
00:35:10
or if you get big enough ones, it
00:35:12
causes you to collapse from lack of oxygen.
00:35:17
So everything really fits with her.
00:35:19
NARRATOR: The profuse clots trump
00:35:21
all other possible causes of the seizure,
00:35:24
including a drug overdose.
00:35:26
JAN GARAVAGLIA: Clearly, the sheer number of them
00:35:29
is the reason why she collapsed and seized
00:35:32
and why her brain wasn't getting enough oxygen.
00:35:35
And this is why she died.
00:35:39
NARRATOR: Dr. G now has a definite cause of death.
00:35:43
But the discovery raises a new, baffling question.
00:35:47
JAN GARAVAGLIA: A big piece of the puzzle that's missing
00:35:49
is why this young woman would have thromboemboli.
00:35:54
NARRATOR: Unlike the classic victim,
00:35:56
Jesse was an active young woman.
00:35:59
And from the way the clots have attached to the lungs,
00:36:02
Dr. G can tell they developed before her fatal collapse.
00:36:07
This clearly predates her being just in the hospital.
00:36:11
So we really don't have anything that would put her at risk.
00:36:16
NARRATOR: To fully explain her untimely death,
00:36:18
Dr. G must leave no stone unturned until she brings
00:36:23
the true culprit to light.
00:36:31
Coming up next, dead-ends and negative findings
00:36:35
plague the case.
00:36:37
JAN GARAVAGLIA: She's not obese, doesn't
00:36:38
have cancer that we know of.
00:36:41
NARRATOR: When "Dr. G, Medical Examiner" continues.
00:36:46
[DRAMATIC MUSIC]
00:37:00
Another physical autopsy comes to a close.
00:37:05
Three days ago, Jesse Davis seized and collapsed
00:37:09
in front of her husband.
00:37:12
Dr. G discovered deadly clots in her lungs.
00:37:15
But why this young woman fell victim remains inexplicable.
00:37:20
Why would a 26-year-old have a risk factor for clotting?
00:37:24
NARRATOR: Now, she must look for the answers back at square one.
00:37:32
As a next step, Dr. G reopens Jesse's original case file.
00:37:37
She pours through all the data, weighing
00:37:40
each against every known cause of blood clots.
00:37:43
She's not obese, which is a risk factor.
00:37:46
She doesn't have cancer, which is a risk factor.
00:37:49
She doesn't have a history of immobility
00:37:53
prior to this hospitalization, like being
00:37:55
on a long airplane flight.
00:37:57
That's a risk factor.
00:37:59
NARRATOR: Dr. G also wonders if genetics played a role,
00:38:03
but as a foster child, Jesse's family
00:38:06
history is tragically slim.
00:38:11
Finally, she's left with only one option.
00:38:14
Go back to the man who knew Jesse better than anyone.
00:38:19
JAN GARAVAGLIA: We may not have all of her history.
00:38:22
Maybe we'll come up once I talk to the husband
00:38:25
why she would have these multiple
00:38:28
pulmonary thromboemboli.
00:38:32
Hi, this is Dr. Garavaglia at the medical examiner's office.
00:38:35
NARRATOR: At first, it's appearing as if Aaron has
00:38:38
no new information to offer.
00:38:41
But then, he reveals two seemingly trivial facts,
00:38:45
with enormous implications.
00:38:48
She's recently started birth control pill, and she smokes.
00:38:54
NARRATOR: For Dr. G, this new information
00:38:57
breaks the case wide open.
00:38:59
There is an association, although small,
00:39:03
between birth control pills and developing blood clots.
00:39:07
NARRATOR: Normally, the human body
00:39:09
maintains a delicate balance between chemicals that promote
00:39:13
clotting to heal wounds and chemicals that prevent
00:39:16
thrombosis or unwanted clots.
00:39:20
JAN GARAVAGLIA: So the body has this beautiful balance,
00:39:23
and it has a way to regulate this internally.
00:39:26
NARRATOR: But in less than 1% of women, for reasons yet unclear,
00:39:31
the hormones in oral contraceptives
00:39:33
upset the chemical interaction.
00:39:36
And smoking makes the problem worse
00:39:39
by constricting blood vessels and causing easy blockage.
00:39:43
OMAR KAYALEH: If you're on oral contraceptives, and you smoke,
00:39:46
you are at increased risk of developing clots.
00:39:51
NARRATOR: In Jesse's case, the odds
00:39:53
may have been stacked against her,
00:39:55
if she was genetically prone to clots and never knew it.
00:40:00
JAN GARAVAGLIA: She developed them so quickly after taking
00:40:02
the birth control pills.
00:40:03
So I really suspect that she has a hereditary predisposition
00:40:09
for thrombosis.
00:40:10
And, in fact, probably about 23% of women who get birth control
00:40:16
pills, who then develop these thrombi,
00:40:18
have this predisposition.
00:40:20
It's probably even much higher.
00:40:24
NARRATOR: Unfortunately, there's no way for Dr. G
00:40:26
to prove that the pills directly caused the blood clots.
00:40:30
JAN GARAVAGLIA: We don't usually test
00:40:32
for these hereditary thrombotic diseases,
00:40:34
and there is nothing I can do to somehow correlate it
00:40:38
with the birth control pills.
00:40:40
It's just that you put the pieces of the puzzle together.
00:40:43
NARRATOR: The pulmonary emboli, the oral contraceptives,
00:40:47
the cigarettes, and the obscure family history.
00:40:51
Now, with accumulative evidence, Dr. G
00:40:54
is confident she can say exactly what happened to Jesse Davis
00:40:59
on the night of her untimely death.
00:41:07
At 26 years old, Jesse's life is in grave danger.
00:41:12
But it's not from her cocaine addiction or her family
00:41:15
history of heart disease.
00:41:18
It's from her new birth control pills.
00:41:21
JAN GARAVAGLIA: Probably when she starts taking these pills,
00:41:24
the increased estrogen kind of throws off
00:41:26
that delicate balance your body has
00:41:29
to dissolve the little blood clots that normally
00:41:33
form in our bloodstream.
00:41:35
NARRATOR: Soon, clots begin to develop
00:41:37
all over her pelvic vessels, and some begin a precarious journey
00:41:42
through her body.
00:41:43
JAN GARAVAGLIA: Several of these are
00:41:44
starting to break off and shower her lungs,
00:41:48
both sides, all lobes.
00:41:51
NARRATOR: Unfortunately, like most who develop clots,
00:41:54
she has no symptoms from these smaller ones,
00:41:58
until one night when a large one finally breaks loose.
00:42:02
JAN GARAVAGLIA: Once that blood clot breaks off,
00:42:04
it travels very quickly, seconds, into your heart
00:42:08
and then into your lung.
00:42:09
NARRATOR: The embolus lodges firmly in one of her lungs,
00:42:12
completely blocking the blood flow.
00:42:15
JAN GARAVAGLIA: And it just puts her over the edge.
00:42:19
She passes out and starts to seize.
00:42:24
NARRATOR: No amount of CPR can fully resuscitate her.
00:42:27
JAN GARAVAGLIA: They're never really
00:42:29
able to bring her brain back, which had already
00:42:31
died from lack of oxygen.
00:42:33
NARRATOR: Three days later, without ever
00:42:35
comprehending her fate, Jesse dies in her husband's arms.
00:42:43
While Dr. G can't say whether Jesse could have entirely
00:42:46
prevented the clots, there's no question that quitting smoking
00:42:50
would have helped her odds.
00:42:52
OMAR KAYALEH: Nobody really needs
00:42:54
to be smoking, quite frankly.
00:42:55
But for those who do smoke, they need to realize that they are
00:42:58
at risk for developing clots.
00:42:59
NARRATOR: And her genetic predisposition
00:43:01
may have come to light with a blood test,
00:43:04
if only she'd known more about her family.
00:43:07
JAN GARAVAGLIA: Unless she had the family history,
00:43:09
they probably wouldn't test you for it.
00:43:12
It's a very small fraction of people that have it.
00:43:15
Otherwise, the pills should be very, very safe,
00:43:18
and it shouldn't be a problem.
00:43:21
She was just one of the unfortunate
00:43:22
ones that developed the clots.
00:43:25
I guess you could say it's just the luck of the draw.
00:43:28
Some people are just unfortunate.
