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[SOMBER MUSIC]
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NARRATOR: A devoted sister dies young after suffering
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bizarre symptoms.
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She developed severe itching.
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NARRATOR: And Doctor G's odds of solving the case
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prove astronomically slim.
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It's probably one in a million.
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NARRATOR: Then a mother's death shatters her family.
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I miss everything about her.
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NARRATOR: But in autopsy, Dr. G uncovers answers her family
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may not want to hear.
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She's got some chronic pain.
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And she also has depression.
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I have to worry whether it's a suicide.
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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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You want to pick the pillow you're going to bring?
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My older son Alex is going to college.
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That's OK?
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All right.
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Did you see the dorm rooms when you were there?
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Yeah.
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Do they have more closet space or drawer space?
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What else?
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I think the hardest is when Eric and I are together,
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my younger son, and we're going to sit around and miss Alex.
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It's going to be touch.
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All right, say bye to your sugar gliders.
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Alex has had these since second grade.
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ALEX: Since seventh grade.
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JAN GARAVAGLIA: He's given me nothing but happiness.
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He's a great kid.
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Thank you.
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(SOBBING) I'm going to miss you.
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You too.
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I think [INAUDIBLE].
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All right.
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Now I gotta go somewhere where I never cry.
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So in this case, we have a 36-year-old black female
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that's kind of an interesting story on how she got to us.
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NARRATOR: According to the investigator's report,
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it all began the previous morning
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in the home of Leah Conrad.
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Leah lived with her younger brother Shane.
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Saving every penny from her job at a local toy store,
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she was putting him through night school.
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Typically, Leah's at work by the time Shane gets up.
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But on this morning, he's surprised to find her
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on the couch.
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Leah?
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NARRATOR: She's barely awake and incoherent.
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JAN GARAVAGLIA: She's getting slurred speech.
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Her lips kind of turned blue.
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The brother even thought maybe she was
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having some seizure activity.
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Huh?
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NARRATOR: Then Shane notices an empty box
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and a half-empty bottle of over-the-counter drugs.
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JAN GARAVAGLIA: He gets her into the car.
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They beeline it to the emergency room.
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[TIRES SCREECHING]
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But by the time they arrive, Leah
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seems to be doing a lot better.
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She was walking, talking.
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Normal level of consciousness.
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NARRATOR: She tells the ER doctors
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she woke up that morning feeling flushed,
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nauseous, and itchy all over.
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Figuring it was an allergic reaction,
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she took some diphenhydramine, an
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over-the-counter antihistamine.
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But the itch persisted, so she took more and more.
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You know that old adage.
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If one doesn't do it, let's try 10 more.
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Well, that's not good with medicine.
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NARRATOR: Concerned and a bit puzzled,
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the ER doctors insist on running a few tests.
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No, they obviously took her seriously
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with the diphenhydramine.
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You never know exactly how much she took.
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They're kind of working her up on,
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maybe it's an overdose, trying to figure
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out what's wrong with her.
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NARRATOR: As they wait in the ER for the results,
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Leah appears to be rapidly improving.
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She looked like she was doing great.
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NARRATOR: Until suddenly, she falls unconscious.
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The next thing they know, she starts to seize.
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She goes into cardiac arrest.
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Can I get some help here please?
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NARRATOR: The ER staff scrambles to revive her.
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I need a defrib!
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NARRATOR: But tragically, they can't.
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JAN GARAVAGLIA: And she dies.
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And they have no clue what's wrong with her.
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NARRATOR: Leah's brother can't believe she's gone.
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And he desperately needs someone to explain what
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happened to his big sister.
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That someone is Dr. G. But like the hospital staff,
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she faces a perplexing set of circumstances.
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There's a lot of considerations in this case.
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Certainly, the one thing I'm worried about
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is, could she have died from the diphenhydramine overdose?
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NARRATOR: In addition to its antihistamine properties,
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diphenhydramine is a strong sedative that can cause
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drowsiness even in small doses.
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With the large amount Leah said she took,
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the drug could have depressed her vital functions
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to a dangerous level, low enough to stop her breathing.
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Just a frank overdose where you actually cause
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respiratory depression and die.
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So we'll have to see how that plays a role in her death.
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NARRATOR: But then Dr. G finds something even more disturbing
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and Leah's medical history.
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Oh, boy.
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She had systemic lupus erythematosus,
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commonly known as lupus.
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Systemic lupus is one of the autoimmune diseases.
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That means basically your body is making
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antibodies against yourself.
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So somehow, your body almost-- just as
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if you were going to react to a foreign substance in your body,
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your body starts reacting to your own body.
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NARRATOR: The illness can affect almost any organ at any time.
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Each lupus patient has their own flavor of disease.
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100 patients with lupus have 100 different disease
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manifestations.
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NARRATOR: Many symptoms are benign
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and occur during active periods known as flare-ups.
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It is a common unknown entity of that disease that you have
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flare-ups and then kind of remissions
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and then flare-ups again.
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Sometimes, people flare up during the normal course
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of their menstrual cycle, just with the hormonal fluctuation.
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NARRATOR: But patients can also develop
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serious complications, like hypertension and heart disease.
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Certainly, there is a myriad of things
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that you can die from with lupus.
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NARRATOR: Dr. G also notes that, between the occasional visits
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to her specialist, Leah was taking prescription
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drugs for her lupus.
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Ironically, that treatment may have posed
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another threat to her life.
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And she's, lo and behold, on some very potent medicine.
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That can have some side effects.
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NARRATOR: In particular, one of her drugs
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prednisone, an immunosuppressant,
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has been known to cause stomach ulcers.
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An undiagnosed ulcer may have eroded
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the lining in her stomach, erupting in
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a fatal gastrointestinal bleed.
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That's a possibility, something
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maybe they didn't recognize right
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away in the emergency room.
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It's something I certainly want to look for.
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NARRATOR: But Dr. G doesn't know how
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any of these possible causes of death
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could fit with Leah's bizarre set of symptoms.
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It seems pretty sketchy.
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We've got the overdose.
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We've got the drug she's on.
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NARRATOR: And then there's the itching.
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You always worry when you have this really
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weird symptomatology that maybe you're
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not going to get an answer.
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All right, let's see.
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All right.
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NARRATOR: The first task at hand is for Dr. G
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to see how severe Leah's lupus was.
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She begins by checking for the most classic visible signs.
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The butterfly rash and the malar rash right on the cheeks.
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We look for a kind of a discoid rash, patches of red
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with a scaly kind of surface on it.
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NARRATOR: But surprisingly, Leah has
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none of these skin conditions.
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She actually looked pretty good, except for, you know,
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the resuscitation.
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NARRATOR: Dr. G then looks closer,
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searching through other external marks of lupus--
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swollen joints, ulcers in the nose and mouth, even hair loss.
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She finds none.
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She has a nice, thick head of hair.
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NARRATOR: The negative findings suggest
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Leah's lupus was very mild, or at least
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under complete control.
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I don't even have any indication she has lupus,
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except for the fact we have it in our history,
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and it appears she's on meds that are consistent with lupus.
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With modern medicine, most people
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live for a very long time with lupus.
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Maybe her lupus has nothing to do with her death.
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NARRATOR: But if complications from lupus
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didn't kill this 36-year-old woman in the prime of her life,
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what did?
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I have to chart, you know.
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Yeah, go ahead.
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But after you do that, I'll do the ribs.
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OK.
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NARRATOR: In the final stroke of the Y incision,
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Dr. G cuts into Leah Conrad's abdomen
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on a hunt for her cause of death.
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One possibility is that Leah's lupus medication
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caused severe ulcers, killing her
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with a gastrointestinal bleed.
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If so, the GI tract would be filled with hemorrhage.
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Carefully, she reflects the skin and subcutaneous fat.
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And with one look, it's clear.
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Leah had no fatal blood loss whatsoever.
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So I'm pretty much ruling out a gastrointestinal hemorrhage.
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NARRATOR: No signs of lupus and no signs the medication
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for it caused her demise.
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Dr. G must now consider the other drug
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in Leah's history, the diphenhydramine she
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took to ease her itchy skin.
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It might be an overdose.
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[INAUDIBLE] first.
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NARRATOR: With the help of her morgue technician,
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Dr. G removes Leah's major organs
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and isolates the stomach.
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Because I wonder, you know, maybe she's
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got a lot of pills in the stomach
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and it's going to be a slam dunk.
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NARRATOR: But when she cuts open the organ, all she finds
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is the natural lining of mucus.
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Nothing really to write home about.
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NARRATOR: Unfortunately, whatever
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Leah ingested before her death has already been absorbed.
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And Dr. G will only be able to find out exactly how
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much different diphenhydramine was in her system
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through toxicology tests.
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For now, it's time to shift gears.
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JAN GARAVAGLIA: OK, let's see.
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If you have-- you know, I'm going
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to take a lot of tissue, Arden.
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NARRATOR: Perhaps a natural disease could explain Leah's
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symptoms, if not her death.
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But with every organ she examines,
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Leah appears as healthy internally
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as she did externally.
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JAN GARAVAGLIA: All the organs look pretty good.
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Her liver doesn't show signs of liver failure.
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Her gallbladder looks fine.
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I don't see anything that'll give me a hint so far.
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Yeah, that's it.
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NARRATOR: In the meantime, Leah's brother
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is waiting for answers as to how his seemingly
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healthy 36-year-old sister could die so suddenly.
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But Dr. G is no closer to identifying her cause of death.
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She now has only one internal organ
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left to dissect, the heart.
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And it doesn't look promising.
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She's never complained of heart disease.
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She doesn't drink.
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She doesn't smoke.
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She leads a clean, healthy life.
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So I'm not thinking that it's probably her heart.
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NARRATOR: First, she examines its exterior.
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I look at the epicardial surface,
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the surface of the heart.
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That looks normal.
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NARRATOR: Yet there's something slightly odd.
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It's somewhat rounded and dilated.
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NARRATOR: She cuts in for a better look.
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I start with the left main coronary artery and just
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dissect it out every few millimeters
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and do a cross-section of that coronary artery.
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NARRATOR: And there, in these cross-sections,
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Dr. G discovers that Leah's heart is riddled with disease.
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She has 80% narrowing of her left main coronary artery.
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She has 95% narrowing of her left anterior descending
00:14:09
coronary artery, the coronary artery that supplies
00:14:11
the front of the heart.
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NARRATOR: In fact, her vessels have been completely overrun
00:14:17
by arteries atherosclerotic plaque, layers of cholesterol,
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and other waxy materials that obscure blood flow
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and often trigger a heart attack.
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[AMBULENCE SIREN]
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The condition afflicts more than 4.6
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million Americans every year and kills one patient every hour.
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Most are older than 65.
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But Dr. G believes there's a good reason
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why Leah had such severe atherosclerosis
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at almost half that age.
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People with lupus have an earlier onset
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of corneal artery disease.
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So it looks like maybe she's got just
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a run of the mill heart attack.
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NARRATOR: At last, it seems Dr. G has
00:15:03
found Leah's cause of death.
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But then she detects something very strange.
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Oh, boy.
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NARRATOR: Something else that could have killed Leah.
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This is separate from the atherosclerosis.
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NARRATOR: It's on the lining of the arch
00:15:18
of the aorta, where the body's biggest blood vessels diverge.
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She's got a thrombus attached to the aorta,
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tightly attached to the wall, 3/4 of an inch in length
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and about a half an inch in width.
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It comes out maybe about a fourth of an inch.
00:15:37
NARRATOR: Thrombi, or blood clots,
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most often form in the body's smaller blood vessels
00:15:43
for reasons ranging from trauma to genetics.
00:15:46
But Leah's thrombus grew in her aorta, a large central vessel.
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This is highly unusual.
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And it could have been deadly if pieces of it
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traveled to her brain and cut off the flow of blood.
00:16:02
She's had two episodes where people
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say she had some mental status changes and maybe seizing.
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MAN: Can I get some help here?
00:16:10
I mean, it is a possibility she's
00:16:12
throwing these little clots that break off and go to the brain.
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NARRATOR: A minute ago, Dr. G had no possible cause of death.
00:16:23
Now, she has one too many.
00:16:25
It is always worrisome when I do an autopsy
00:16:28
and I don't find anything.
00:16:30
It's also worrisome that I'm not putting
00:16:31
it together when I have several things that could kill her.
00:16:35
Sometimes, actually, I wish I could save something
00:16:38
I found on one person and, you know, give it to somebody
00:16:41
that I can't figure out.
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Because you know, if somebody already
00:16:44
has three reasons to die, they don't really need all three.
00:16:47
This guy needs one.
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But unfortunately, I can't do this.
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And I have to kind of figure out what really went on.
00:16:55
NARRATOR: Unfortunately, none of the theories
00:16:58
would explain Leah's strangest symptom.
00:17:01
We've got her pure pruritis or diffused itching.
00:17:04
NARRATOR: Still, Dr. G must explore every option.
00:17:08
Determined to unlock this mystery,
00:17:10
she extracts Leah's brain for inspection.
00:17:13
The search will be difficult.
00:17:16
The problem is, it's going to be a needle in a haystack
00:17:19
for me to find one of those little thrombi that
00:17:23
flicked off.
00:17:25
NARRATOR: Ultimately, Dr. G finishes the internal exam
00:17:29
with a wealth of evidence and nothing that ties it together.
00:17:33
I don't have the smoking gun yet that tells me why she died.
00:17:38
NARRATOR: To untangle this perplexing death,
00:17:41
Dr. G must now rely on the two forensic tools
00:17:44
left in her arsenal--
00:17:46
toxicology and the microscope.
00:17:49
JAN GARAVAGLIA: I'm still worried
00:17:50
about the diphenhydramine overdose.
00:17:52
So I'll be interested to see what her level is.
00:17:56
NARRATOR: Somewhere in Leah's blood and tissue
00:17:59
is the key to closure for her grieving
00:18:01
brother, if Dr. G can find it.
00:18:20
And I was going to say--
00:18:21
I was going to say-- you remember that--
00:18:23
There's no peanuts!
00:18:24
No!
00:18:25
My lunch staple!
00:18:27
All right, I'm going to run across the street.
00:18:30
Yeah.
00:18:32
NARRATOR: A quick bite and it's time
00:18:34
to buckle down with Leah's tissue
00:18:36
slides and toxicology report.
00:18:40
Immediately, she checks the report
00:18:42
to see if Leah had overdosed on the diphenhydramine
00:18:45
she took too ease her itch.
00:18:48
The numbers tell a disturbing tale.
00:18:52
Her diphenhydramine level was very high,
00:18:56
past even the level that we see where you would take it
00:19:01
for a hypnotic to go to sleep.
00:19:04
NARRATOR: But surprisingly, the dosage
00:19:06
is still far from deadly.
00:19:09
You don't really start getting lethal
00:19:11
until you start seeing seven or eight milligrams per liter.
00:19:14
Hers was closer to maybe a one or two milligrams per liter.
00:19:20
She clearly doesn't have enough that would kill her.
00:19:24
NARRATOR: But the high levels do explain the state
00:19:26
her brother found her in--
00:19:28
lethargic and slurring her speech.
00:19:31
And she really didn't have anything else
00:19:33
of significance in her blood.
00:19:36
So I think we've ruled out an overdose on this case.
00:19:40
NARRATOR: This leaves her with one more shot at deciphering
00:19:43
Leah's sudden death.
00:19:45
I really, at this point, can't wait until I look
00:19:48
at this under the microscope.
00:19:50
What is going on with this woman that
00:19:52
would really explain and unify all of her symptoms
00:19:56
and my findings?
00:20:08
NARRATOR: Dr. G slides the first tissue sample under the lens.
00:20:13
Now, the thing that I was most fascinated with
00:20:16
was, why is there a thrombus on her aorta?
00:20:20
And so that's where I'm going to.
00:20:22
NARRATOR: At 400 times magnification,
00:20:24
she can discern the cell structure of the vessel wall.
00:20:28
Slowly, she turns the dial.
00:20:30
And what comes into focus takes her completely aback.
00:20:37
She's got inflammation-- like white cells and breakdown
00:20:41
products of the white cells--
00:20:42
all through the aorta.
00:20:45
NARRATOR: The invasion has visibly damaged
00:20:47
the vessel's delicate tissue.
00:20:49
And the body is reacting to that
00:20:52
and putting a clot over it.
00:20:53
NARRATOR: This is a sign of vasculitis, a condition
00:20:57
in which white blood cells attack and inflame blood
00:21:00
vessels all over the body.
00:21:02
The affliction is a rare complication of lupus.
00:21:07
Externally, Dr. G had found no symptoms of lupus.
00:21:11
But clearly, Leah's immune system had gone haywire,
00:21:15
and her medication was not enough to stop it.
00:21:19
What's happened is, this immune complex--
00:21:21
the antigen and that antibody which have formed together--
00:21:25
go into the vessel wall.
00:21:28
And that causes your body to react to it
00:21:32
and causes the white cells to get there.
00:21:35
NARRATOR: Dr. G realizes vasculitis perfectly
00:21:39
ties together Leah's symptoms.
00:21:41
In the small blood vessels of her skin,
00:21:44
the inflammation gave her a vicious itch.
00:21:47
And in the large vessels of her heart,
00:21:49
the condition actually led to her death.
00:21:53
Her coronary arteries, when you look at them,
00:21:55
are completely inflamed.
00:21:57
The blood wasn't getting through those vessels enough.
00:21:59
And she ultimately has a heart attack.
00:22:01
She already had severe atherosclerosis.
00:22:04
And this was just the coup de grace.
00:22:07
NARRATOR: The extent to which vasculitis assaulted
00:22:09
Leah's body stuns Dr. G.
00:22:12
Now, it just so happens, in lupus,
00:22:14
it tends to occur in the smaller blood vessels.
00:22:18
You don't usually see it in the large blood vessels.
00:22:21
Coronary vasculitis in a lupus patient
00:22:23
would be extremely rare--
00:22:25
certainly less than 5% of patients,
00:22:28
and maybe even less than that.
00:22:30
NARRATOR: And Leah's vasculitis is not
00:22:32
just in the coronary arteries.
00:22:34
It's in the aorta, the biggest blood vessel in her body.
00:22:38
In the annals of forensic pathology,
00:22:41
Dr. G has made an almost unheard of finding.
00:22:45
Very, very, very rare.
00:22:47
It is vanishingly rare.
00:22:49
There's really only just a handful of cases truly that
00:22:53
are reported that lupus affects your aorta that way.
00:22:58
NARRATOR: But for her, it's more than
00:22:59
an incredibly rare discovery.
00:23:02
You know, and this is probably one in a million
00:23:04
for me to see in the morgue.
00:23:06
I'm probably never going to see that again.
00:23:08
But it's just really--
00:23:10
that's just a really cool part of the job,
00:23:12
is to put the pieces together and say, boy,
00:23:15
I can really explain what was going on with her.
00:23:24
NARRATOR: It's 7:00 AM on a Monday morning,
00:23:26
and Leah Conrad wakes up to a fierce, unfamiliar itch.
00:23:31
Believing it's an allergy, she tries to fight it
00:23:34
with diphenhydramine.
00:23:36
10 times more than what you should normally take.
00:23:41
NARRATOR: The drug impairs her motor functions.
00:23:44
She got some lethargy, some slurred speech.
00:23:46
NARRATOR: Fearing an overdose, her brother
00:23:48
rushes her to the hospital.
00:23:51
But unbeknownst to him, or the doctors, or even Leah herself,
00:23:56
the real threat to her life is neither
00:23:58
allergies nor antihistamines.
00:24:03
I think what happened is, about three to four days prior
00:24:06
to her hospitalization, she was starting to get a horrible
00:24:09
flare-up of her lupus, manifesting itself
00:24:13
in just diffused vasculitis.
00:24:16
NARRATOR: In her skin, white blood cells
00:24:18
ravaged the vessel walls, causing an unbearable itch.
00:24:22
And then they make an extraordinary move
00:24:25
into Leah's aorta.
00:24:27
She was getting more and more inflammation of her aorta.
00:24:31
The intima, or the lining, got irritated.
00:24:34
The blood tries to repair that by forming a clot on it.
00:24:40
NARRATOR: But the vasculitis also strikes
00:24:42
in her coronary arteries, which were already
00:24:45
narrowed by atherosclerosis.
00:24:48
Now severely inflamed, the vessels can no longer
00:24:52
carry blood to the heart.
00:24:54
Even as the diphenhydramine wears off,
00:24:56
the damage reaches a catastrophic peak.
00:24:59
And finally, Leah suffers a heart attack.
00:25:03
MAN: Can I get some help in here please?
00:25:06
Do it again.
00:25:07
Do it again.
00:25:08
Do it again.
00:25:09
NARRATOR: No amount of medical intervention can save her.
00:25:13
Ultimately, you can boil this whole thing down
00:25:16
as complications of systemic lupus erythematosus.
00:25:25
Life is random.
00:25:26
Lupus is part genetic.
00:25:28
It's part environmental.
00:25:30
Nobody really knows what combination
00:25:33
of those environment and genetics
00:25:35
causes you to get lupus.
00:25:36
It's quite unlucky to to have to deal with a disease like that.
00:25:41
And then she has, you know, added unluckiness
00:25:43
of a rare complication from it.
00:25:47
NARRATOR: Shane is relieved to finally have an answer.
00:25:50
But he's also overwhelmed by the truth behind his sister's
00:25:53
bizarre death.
00:25:55
He only wishes now that she had seen her doctor more often.
00:25:59
You know, a regular doctor might have picked up that this
00:26:01
was a flare-up of her Lupus.
00:26:03
Maybe this wouldn't have happened.
00:26:07
OK, that one's done.
00:26:11
NARRATOR: Sadly, sometimes no amount of medical care
00:26:15
nor all the love in the world can save a person's life.
00:26:20
Such is the tragic case of Deborah Grunow a beloved mother
00:26:24
whose fight against chronic pain may
00:26:27
have driven her to her death.
00:26:32
She's been expressing that she'd
00:26:34
like to die for a long time.
00:26:36
I'm sure that's very difficult to live with.
00:26:57
It's been a long week since my son Alex left for college.
00:27:02
I told you today about Alex calling me last night, right?
00:27:04
WOMAN: Yeah.
00:27:05
He is, like, so excited about school.
00:27:09
He's so excited about classes starting
00:27:11
and just, you know, having fun and doing
00:27:14
what he wants and, you know, the usual 18-year-old.
00:27:18
I miss him.
00:27:19
But you know, I can't complain.
00:27:20
Because in the morgue, I see plenty of people whose families
00:27:23
will miss them forever.
00:27:30
Tom, could you hand me a chart please, and an internal?
00:27:34
We have a 50-year-old white female
00:27:38
that was found unresponsive in a residence by her husband.
00:27:42
NARRATOR: As she begins to read through the investigator's
00:27:45
report, Dr. G is immediately drawn
00:27:47
to a devastating automobile accident, one that
00:27:51
occurred 30 years earlier and changed
00:27:53
Deborah Grunow's life forever.
00:27:55
She went off a cliff, and went into the windshield,
00:27:59
and hit the windshield with her head,
00:28:01
and caused the initial injury.
00:28:04
And then that just escalated over time
00:28:07
into degenerative disk disease.
00:28:10
NARRATOR: Deborah was lucky to survive.
00:28:12
But her life would soon become consumed with a string
00:28:15
of surgeries and treatments all in a seemingly futile
00:28:18
attempt to ease her suffering.
00:28:21
But incredibly, in light of her constant battle with pain,
00:28:25
her sense of humor and free spirit
00:28:27
made Deborah the heart and soul of her close-knit family.
00:28:31
MARK GRUNOW: Very enthusiastic about life.
00:28:34
She had a great sense of humor.
00:28:36
She was always cracking jokes.
00:28:37
And we always found something to laugh about.
00:28:41
In the name of love.
00:28:44
NARRATOR: But no one could have imagined that yesterday
00:28:46
evening would be the last time anyone
00:28:49
heard Deborah's laugh again.
00:28:53
It all begins at around 4:00 AM in the Grunow house.
00:28:57
Deborah is having difficulty sleeping
00:28:59
and decides to take a shower.
00:29:01
Her husband, briefly awakened by the noise,
00:29:04
drifts back to sleep in the bedroom down the hall.
00:29:07
And he hears the shower water go off.
00:29:10
That's the last he remembers.
00:29:13
NARRATOR: A few hours later, he wakes up.
00:29:18
From outside the room, he hears a strange wheezing noise.
00:29:22
I just remember thinking that it was the dog snoring.
00:29:26
Then I got up and opened the door.
00:29:29
NARRATOR: But it isn't the dog.
00:29:31
Honey?
00:29:31
She was on the floor there, just face down.
00:29:36
I lifted her head up to wake her up.
00:29:38
And I could tell by the look on her face
00:29:40
that it was-- it was big trouble.
00:29:43
NARRATOR: His wife of almost 25 years is barely breathing.
00:29:47
Frantic, Mark calls 911, then immediately begins performing
00:29:52
CPR until paramedics arrive.
00:29:55
They rush to the local hospital.
00:29:57
How long has she been like this, sir?
00:29:58
They try to resuscitate her for a good bit of time.
00:30:03
NARRATOR: But Deborah remains unresponsive.
00:30:05
EMT: I need you to step back.
00:30:07
We're going to have to shock her again.
00:30:08
They couldn't save her.
00:30:10
NARRATOR: Her daughters don't even
00:30:12
get a chance to say goodbye.
00:30:14
When I got to the hospital, they took us into the room.
00:30:19
And they told us that she was gone.
00:30:24
They pulled the sheet down, and I looked at her
00:30:26
and pretty much just lost it then.
00:30:29
But--
00:30:31
[LAUGHTER]
00:30:32
MARK GRUNOW: Ew.
00:30:32
- Don't spit. - No?
00:30:34
OK.
00:30:35
MEGAN GRUNOW: I miss Everything about her--
00:30:37
the way she smelled, the way that she would
00:30:40
just make everything better.
00:30:41
DESIREE GRUNOW: I talked to my mom everyday.
00:30:45
That's probably one of the hardest,
00:30:46
that I can't just pick up the phone and call.
00:30:48
[SNIFFS]
00:30:52
NARRATOR: But the family's loss is
00:30:53
made even worse by the mysterious circumstances
00:30:57
surrounding Deborah's death.
00:30:59
What could have cut down their beloved mother and wife
00:31:02
so suddenly?
00:31:04
Now, Dr. G is the only one who can try to provide
00:31:08
some sense of closure.
00:31:10
But it won't be easy.
00:31:13
As she studies Deborah's medical history,
00:31:16
she does notice one clear red flag.
00:31:19
She has a history of high blood pressure.
00:31:22
She doesn't necessarily take her high blood pressure medicine.
00:31:25
So her blood pressure is not well controlled.
00:31:28
NARRATOR: Deborah's hypertension,
00:31:30
or high blood pressure, had almost
00:31:32
killed her more than once.
00:31:34
Her blood pressure would be so high.
00:31:36
And there would be 100 people in the waiting room.
00:31:38
And they would usher her right in, because it
00:31:40
was so dangerously high.
00:31:42
NARRATOR: It is estimated that blood
00:31:44
pressure-related conditions, such as strokes and heart
00:31:47
attacks, kill approximately 300,000 people each year
00:31:51
in the US.
00:31:53
Perhaps Deborah was one of them.
00:31:56
She may have had a stroke.
00:31:58
But high blood pressure is also a risk factor for developing
00:32:01
coronary artery disease.
00:32:05
NARRATOR: But there's another red flag--
00:32:07
Deborah's history of degenerative disk disease.
00:32:11
This disease can develop after a severe accident,
00:32:14
resulting in damage to the disks of the neck and spine.
00:32:19
JAN GARAVAGLIA: They can get a lot of pain in the neck.
00:32:21
Most people, it's mild to moderate.
00:32:24
And with some people, it can be quite severe.
00:32:27
NARRATOR: This condition had plagued Deborah since her car
00:32:29
accident 30 years ago.
00:32:32
DESIREE GRUNOW: She tried massages.
00:32:33
She tried acupuncture, meditation, yoga.
00:32:37
NARRATOR: But nothing seemed to work.
00:32:40
Eventually, Deborah turned to medication for relief.
00:32:44
But over many years, the dosage she required to feel normal
00:32:47
continued to increase.
00:32:50
Dr. G knows that any time a decedent
00:32:52
is on prescription painkillers, there is a possibility
00:32:56
of an accidental overdose.
00:32:58
But that's not the only scenario the pills present.
00:33:02
Chronic pain and depression can go hand-in-hand.
00:33:05
She just didn't want to hurt anymore,
00:33:07
and she didn't want to hurt us anymore.
00:33:10
For Dr. G and Deborah's family,
00:33:12
her depression presents another fatal scenario,
00:33:16
one that her family can't bear to face--
00:33:19
suicide.
00:33:20
She talked about taking her life,
00:33:23
because she just couldn't take the pain anymore.
00:33:26
NARRATOR: Is it possible that this mother of two
00:33:29
took her own life, leaving her pain and her family behind?
00:33:44
The first thing Dr. G notices in the external exam
00:33:47
is three suspicious marks on Deborah's face.
00:33:50
A small abrasion on her chin and on her upper forehand
00:33:54
and one in her hairline.
00:33:56
NARRATOR: This in and of itself doesn't raise alarm bells.
00:33:59
But soon, she begins to uncover dozens of small injuries
00:34:03
all over Deborah's body.
00:34:06
She's got a lot of multiple bruises
00:34:09
on her body of various ages.
00:34:13
NARRATOR: The discovery raises an entirely new possibility.
00:34:17
Did Deborah simply die from some fatal injury?
00:34:37
I think it's just that left hand, isn't it?
00:34:40
NARRATOR: Dr. G catalogs 13 scrapes and contusions
00:34:44
as she continues the external exam on Deborah Grunow's body.
00:34:48
She certainly has a lot of bruises on her.
00:34:51
NARRATOR: Deborah, a 50-year-old mother of two,
00:34:53
died suddenly yesterday.
00:34:56
Based on her history of taking large doses of medication
00:34:59
for neck pain, Dr. G now speculates as to how she may
00:35:04
have gotten all those bruises.
00:35:06
Probably consistent with her falling,
00:35:10
as if she had been staggering for a while.
00:35:14
NARRATOR: If the pain medication had begun to impair Deborah's
00:35:17
motor functions, she may have fallen and suffered
00:35:20
a fatal internal injury.
00:35:22
Maybe she fell and hit her head.
00:35:26
And then she gets a subdural, or she gets bleeding.
00:35:31
NARRATOR: Every year, nearly 2 million
00:35:33
Americans trip or fall in their homes and land in the ER.
00:35:37
Thousands die from their injury.
00:35:38
[AMBULANCE SIREN]
00:35:40
I've had somebody fall where they get bleeding
00:35:42
into the lungs from a punctured lung or a torn vessel
00:35:45
from the fracture.
00:35:47
And we get some kind of delayed deaths from the fall.
00:35:51
NARRATOR: Now, Dr. G turns to the most likely place
00:35:55
to find signs of trauma--
00:35:56
the head.
00:35:58
If she can prove Deborah died from an injury and not suicide,
00:36:02
her findings could provide tremendous relief.
00:36:11
Keep your fingers crossed.
00:36:12
We've got the head.
00:36:14
NARRATOR: First, Dr. G pulls back the scalp,
00:36:17
then carefully takes off the calvaria,
00:36:20
or the roof of the skull.
00:36:22
I'm looking for anything unusual in her brain.
00:36:26
NARRATOR: So far, the organ looks normal.
00:36:29
Carefully, she extracts it for a closer look.
00:36:32
I slice it.
00:36:35
And I don't see any evidence of hemorrhage, any trauma.
00:36:40
NARRATOR: She also checks for infarcts, or dead tissue, that
00:36:43
may indicate that Deborah's hypertension
00:36:46
had triggered a deadly stroke.
00:36:48
But she finds none.
00:36:50
There's nothing that would suggest that her brain
00:36:54
was the cause of her problems.
00:36:57
NARRATOR: Deborah's brain may be clear of trauma and illness.
00:37:00
But in the fatal injury scenario,
00:37:03
several of the internal organs could still be likely suspects.
00:37:17
Dr. G makes her usual Y incision and reflects the skin.
00:37:21
Poor thing.
00:37:22
NARRATOR: Then she starts searching for injuries
00:37:24
and internal bleeding.
00:37:26
I'm looking underneath for hemorrhage.
00:37:28
I'm certainly looking at the ribs
00:37:29
to see if there are any rib fractures.
00:37:33
NARRATOR: But she soon realizes it's a dead end.
00:37:36
She's got a few little things, but nothing
00:37:40
that should have killed her.
00:37:43
NARRATOR: Deborah's bruises, likely caused
00:37:45
by repeated falls while under the influence
00:37:48
of her medication, were only superficial, not fatal.
00:37:53
But the medication may have had another possibly fatal effect--
00:37:57
an overdose.
00:38:00
It's a sad state of affairs.
00:38:03
She is constantly taking too much medication,
00:38:06
all because of chronic pain.
00:38:09
There would be times I would come home and find her curled
00:38:12
up in the fetal position on the floor,
00:38:14
just crying like a baby, just because of the pain.
00:38:19
NARRATOR: Did Deborah drug herself to death in a suicide?
00:38:23
Dr. G begins her search for evidence.
00:38:28
Often an overdose, whether intentional or accidental,
00:38:31
leaves the decedent with very heavy, wet lungs.
00:38:36
Whatever the reason, the lungs often will fill up with fluid.
00:38:41
NARRATOR: But Deborah's lungs are not congested.
00:38:44
You know, as soon as you just don't see those tremendously
00:38:47
heavy lungs, you kind of think, eh, maybe it isn't an overdose.
00:38:52
NARRATOR: Still, there is one other organ
00:38:54
that could clearly point towards an overdose and to suicide--
00:38:58
the stomach and its contents.
00:39:01
The stomach, on a case like this, may be important.
00:39:04
Because a lot of the stuff in her stomach is pills.
00:39:08
That usually indicates it might be a suicide.
00:39:12
People who want to kill themselves
00:39:14
will take a lot of pills at once--
00:39:16
20, 30 pills at once.
00:39:18
And some of those may still be in the stomach.
00:39:22
NARRATOR: To examine the contents, Dr. G
00:39:24
first ties off both ends of the organ
00:39:27
at the esophagus and the duodenum.
00:39:30
Then she cuts it open and empties it out
00:39:32
into a container.
00:39:34
I went up the gastric and scooped
00:39:35
out what was left there.
00:39:36
I took the duodenum, , what's in the duodenum scooped it out,
00:39:40
put that in there.
00:39:41
I can do it through a strainer.
00:39:42
I can sometimes just pour it over my gloved hands
00:39:46
and catch some of the solid pieces.
00:39:49
Or you can just swirl it around and look at it and smell it.
00:39:52
NARRATOR: It's a moment in the autopsy
00:39:54
that puts aspiring medical examiners to the test.
00:39:57
This would keep a lot of people out of this profession.
00:40:01
So stomach contents is a source in the autopsy where
00:40:05
some people will walk away.
00:40:07
It can have some type of melodious odor.
00:40:10
But it is an important part of the autopsy.
00:40:13
So if you can't look at stomach contents,
00:40:15
don't go into forensics.
00:40:17
NARRATOR: She painstakingly thumbs
00:40:19
through several indecipherable remnants of food
00:40:22
before finding her first clue.
00:40:24
I see two-- a fragment of maybe two pills.
00:40:27
NARRATOR: Her finding confirms that Deborah
00:40:29
had ingested medication shortly before dying.
00:40:33
But it's not nearly enough to have killed her on its own.
00:40:39
If I'd have found 20, it would have been a smoking gun.
00:40:42
But I'm finding fragments of two.
00:40:44
Eh, that'll help you get the tox.
00:40:46
NARRATOR: Any evidence of an overdose
00:40:48
will need to come from a toxicology screening.
00:40:51
Dr. G has her assistant, Arden Monroe,
00:40:54
package fluid samples from Deborah's arteries,
00:40:57
bladder, and eye.
00:40:59
But test results won't be in for several weeks.
00:41:02
Until then, there's nothing more Dr.
00:41:05
G can do to determine whether Deborah died from an overdose.
00:41:09
But she can look for evidence of the other suspected
00:41:13
culprit, high blood pressure.
00:41:17
She has been diagnosed with high blood pressure.
00:41:20
And she's not taking their high blood
00:41:23
pressure medication regularly.
00:41:26
NARRATOR: Dr. G knows Deborah's hypertension
00:41:28
didn't kill her with a stroke.
00:41:30
But it's possible that it thickened her heart
00:41:33
and led to a fatal arrhythmia.
00:41:35
So it's Deborah's heart that she examines next.
00:41:40
OK, let's see.
00:41:45
NARRATOR: Yet, after careful scrutiny,
00:41:47
Dr. G is surprised by the organ's condition.
00:41:50
I didn't see any evidence of heart disease.
00:41:54
She didn't have any evidence that it was failing.
00:41:57
Now I've pretty much ruled out that her heart
00:42:00
is a contributing factor.
00:42:02
It looked fine.
00:42:04
We've looked at the organs, the chest, the abdomen.
00:42:06
I don't see anything really wrong.
00:42:09
NARRATOR: No trauma.
00:42:10
No signs of an overdose.
00:42:12
No indications that their high blood pressure
00:42:14
caused a stroke or heart attack.
00:42:17
After a full autopsy, Deborah Grunow's death has become
00:42:20
more of a mystery than ever.
00:42:37
At a laboratory in Melbourne, Florida,
00:42:40
the blood and urine of Deborah Grunow spins in a centrifuge.
00:42:44
It's the first of many steps in identifying
00:42:47
what substances were in her fluids when she died.
00:42:50
For Dr. G, these toxicological tests
00:42:53
are the last hope of determining what killed
00:42:56
this 50-year-old mother of two.
00:42:58
I miss everything about my mom.
00:43:01
MARK GRUNOW: It was sudden and unexpected.
00:43:04
And it was very painful.
00:43:07
NARRATOR: But while the family is desperate to know what
00:43:09
happened, there's one answer they don't want to hear--
00:43:13
suicide.
00:43:14
I was very concerned that she may have taken her life.
00:43:19
I really was afraid of that.
00:43:21
NARRATOR: Will the truth bring Deborah's loved
00:43:23
ones relief or more heartbreak?
00:43:26
Ultimately, I get the scientific facts.
00:43:28
Certainly, my call will give them either peace or sometimes
00:43:32
anguish.
00:43:33
It always is a tough time for the family, and I know that.
00:43:44
NARRATOR: Dr. G Finally sits down with the report
00:43:47
from the toxicology lab.
00:43:49
And the extent of Deborah's medication regimen
00:43:51
soon becomes very clear.
00:43:54
JAN GARAVAGLIA: She's on three anti-anxiety medications.
00:43:57
She's on a lot of antidepressive medications.
00:44:02
NARRATOR: On top of that, she had
00:44:04
two potent painkillers in her system, one of which
00:44:07
is another sedative, methadone.
00:44:09
Her methadone level was very high.
00:44:13
And you put that with a combination of all
00:44:16
these medications levels.
00:44:17
It's clearly why she died.
00:44:20
So we have a cause of death.
00:44:21
And that's mixed drug intoxication.
00:44:25
NARRATOR: For the family, this could
00:44:26
be the answer they feared most.
00:44:29
Deborah might have killed herself.
00:44:31
But Dr. G must now weigh the evidence and make the call.
00:44:35
How am I going to determine whether it's
00:44:37
suicide versus accidental?
00:44:40
Which one is more compelling?
00:44:43
Which one is more compelling to me?
00:44:45
Well, one, you look at the history.
00:44:48
And we don't have any previous suicide attempts.
00:44:50
NARRATOR: Dr. G also considers the hard numbers
00:44:53
in the tox report.
00:44:55
All of those medications were in the therapeutic range.
00:44:59
And her level is all just a little bit high.
00:45:04
And we do know that she's chronically
00:45:06
trying to treat her pain.
00:45:10
NARRATOR: Taking into account all of this evidence,
00:45:12
Dr. G comes to her conclusion.
00:45:15
We know that she walks the line--
00:45:17
that razor line between what can kill her and what
00:45:21
puts her out of her misery.
00:45:23
This time, she just crossed the line a little too far.
00:45:26
And it really-- when you look at the combination of drugs
00:45:30
that she's on and the levels, it looks much more
00:45:33
like an accidental overdose.
00:45:35
And I think the preponderance of evidence in this case
00:45:38
is that it was accidental.
00:45:40
It's very difficult to really swing the other way
00:45:43
with suicide when we know she's taken
00:45:46
so many drugs for so long.
00:45:48
And it doesn't take much more to put her over.
00:45:52
NARRATOR: After careful analysis,
00:45:54
Dr. G can now replay the final hours leading
00:45:58
up to Deborah's tragic death.
00:46:05
It's 3:00 AM, and Deborah Grunow is too uncomfortable to sleep.
00:46:10
Her back and neck are aching again,
00:46:12
so bad she can barely stand it.
00:46:15
Hoping to get some relief, she takes several methadone pills.
00:46:19
But when that doesn't do the trick,
00:46:21
she opts for still more medication.
00:46:24
She probably pops a lot of drugs,
00:46:26
adding more central nervous system depressant.
00:46:30
NARRATOR: By 4:00 AM, she's likely
00:46:32
in a drug-induced stupor.
00:46:35
Then, at some point, she goes into the shower.
00:46:38
JAN GARAVAGLIA: Maybe she had vomited on herself.
00:46:39
Maybe she's trying to wake up.
00:46:42
NARRATOR: But inside Deborah's body,
00:46:44
the mixture of central nervous system depressants
00:46:47
is taking effect.
00:46:48
The drugs attached to receptors in Deborah's brain,
00:46:51
suppressing the signals that control her vital functions.
00:46:55
They affect sites in your brainstem
00:46:58
that control your restoration.
00:47:01
NARRATOR: Her breathing and pulse start grinding to a halt,
00:47:05
and Deborah falls into a coma.
00:47:08
When we hear the snoring, usually, it indicates to us
00:47:12
that the person's in a coma.
00:47:15
NARRATOR: By the time her husband finds her,
00:47:17
no amount of CPR, no amount of professional help
00:47:21
can bring her back to consciousness.
00:47:23
JAN GARAVAGLIA: It's too late.
00:47:24
She eventually stops breathing and dies.
00:47:28
NARRATOR: The cause of death is clearly
00:47:30
an overdose, but, according to Dr. G, not an intentional one.
00:47:34
On this night, she simply pushed the limits of
00:47:37
her many prescriptions too far.
00:47:40
I was very relieved to know that it wasn't a suicide.
00:47:44
And I felt very reassured after speaking with her.
00:47:47
DESIREE GRUNOW: She really, truly cared.
00:47:48
And she took the time to dig and find out what happened.
00:47:52
NARRATOR: But despite the reassuring finding,
00:47:55
Deborah's death continues to fill the family
00:47:57
with lingering grief.
00:47:59
MEGAN GRUNOW: My mom's still gone, so I can't change that.
00:48:04
I have regrets that I just couldn't have been there
00:48:06
with her right at the last minute,
00:48:08
and just to tell her how much I loved her,
00:48:10
and how much I cared for, and how much she meant to me.
00:48:14
I learned a lot from him what it was like on his end,
00:48:18
living with that.
00:48:20
So you know, I believe that's a big part of forensic.
00:48:23
You learn a lot from the family.
00:48:24
But you also can give them a lot of comfort.
00:48:29
And I get comfort from my family.
00:48:42
I made the mistake.
00:48:43
I bought roasted peanuts instead of raw.
00:48:45
Here, guys. You want one?
00:48:46
You want a peanut?
00:48:47
Do you like the roasted?
00:48:48
Do you like it?
00:48:49
Oh, he took it.
00:48:52
The worst part of Alex missing is, Eric
00:48:54
and I have to clean that cage.
00:48:56
[TRANQUIL MUSIC]
00:49:06
ANNOUNCER: Atlas.
