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[MUSIC PLAYING]
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NARRATOR: A woman survives a brutal attack,
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only to die five years later.
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It's sad because she survived the mugging.
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But now, she's dead on that couch.
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NARRATOR: And now, Dr. G wonders if her death is somehow
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related to that assault.
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Maybe she had severe brain trauma, who knows?
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NARRATOR: Then, a man tumbles 15 feet to the ground.
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They heard whoa, and this guy falls off the ladder.
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NARRATOR: But Dr. G believes there may be more to this case
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than meets the eye.
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Did he just slip and fall?
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Or did he have some kind of physical illness
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that affected him?
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[MUSIC PLAYING]
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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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[MUSIC PLAYING]
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I guess we start it at 9:00.
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WOMAN: Dr. G?
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Yeah
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NARRATOR: When you were in charge of one of the busiest
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morgues in Orlando, Florida, some days
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it feels like the bodies just keep on coming.
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They're dying like flies with that.
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This has been an abnormal, Abby day.
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Abby day.
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NARRATOR: So it's no wonder that Chief
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Medical Examiner Dr. Jan Garivaglia
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has learned to multitask.
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Let me finish hers, and then I'll come back.
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I'll be there in a second, Brian.
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Believe it or not, I'm juggling multiple cases at one time.
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Can we get this going?
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I think I left my ruler, my big ruler over here.
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I wish I could concentrate on one case,
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and then not do anything else till it's done.
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But they don't pay me for that.
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I got to do multiple things at once.
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This doesn't make any sense at all.
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NARRATOR: But sometimes, Dr. G encounters an autopsy
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so challenging that it demands every bit
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of her attention and focus.
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It's a breezy march evening in downtown Orlando, Florida.
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Tim Anders and his wife are just sitting
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down to dinner when they're interrupted
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by Tim's sister Cynthia.
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The 45-year-old has been living with the couple
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for the past five years.
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But today, something about her seems strange.
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The brother asked her if she wants to come to dinner.
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She didn't.
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She just kind of walked away.
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NARRATOR: But when Tim checks on her later that evening,
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he can tell right away that something is terribly wrong.
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She's got vomit on her shirt.
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And she was unresponsive Tim immediately calls 911,
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but by the time EMS arrive on the scene, it's too late.
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She was already dead.
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NARRATOR: Now, the distraught couple is desperate to know
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what happened.
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The brother is upset because his sister died,
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and he just wants answers.
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NARRATOR: When Dr. G. Arrives at the District 9 morgue
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the following morning, Cynthia Anders
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is first up on her roster.
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But before she even sees the body--
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Where's those medical records?
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NARRATOR: --she knows that this will be no ordinary case.
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911 was called.
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She was pronounced at the scene.
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None of us like to do middle aged women,
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because oftentimes at the end of the autopsy,
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you don't know why they died.
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For some reason, they tend to be more subtle.
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Just means it's going to be more work to try to figure it out.
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NARRATOR: And at first glance, the possibilities seem endless.
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Certainly, natural disease could've played a role.
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Maybe pulmonary emboli.
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Maybe heart disease.
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At this point, it can be anything.
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The circumstances surrounding this death
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are kind of interesting.
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NARRATOR: By all accounts, Cynthia Anders
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had been a fun loving woman with a zest for life.
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She was a waitress.
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She was married, and she had a normal life.
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NARRATOR: But one fateful day five years
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ago, something happened that changed her life forever.
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According to the brother's story,
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she was mugged and beaten about the head
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with the butt of a gun.
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This mugging supposedly had left her anxious, with depression,
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and not wanting to talk.
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She's not coping well with life.
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NARRATOR: And it wasn't long before Cynthia's family
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and friends began to notice some alarming
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changes in her behavior.
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It appeared she suffered some brain damage from the attack,
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and seemed haunted by the traumatic experience.
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She starts acting very odd, kind of withdrawn.
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Her social behavior kind of goes downhill.
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She didn't care about the way she looked,
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or how she took care of herself.
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NARRATOR: Eventually, Cynthia hit rock bottom when
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she separated from her husband.
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At that point, she had no choice but to move
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in with her brother, Tim.
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Their lives kind of spiraled out of control.
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Now 5 years later, she's dead on that couch.
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What is really going on?
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NARRATOR: Dr. G. now wonders if the circumstances
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surrounding Cynthia's attack could
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have led to a drug addiction.
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It wouldn't be unusual for people
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to suffer some major injuries, and then
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get addicted to pain medicine.
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Maybe she died for an accidental drug overdose.
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NARRATOR: But there is another, more disturbing possibility.
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If her life is really out of control, it may be a suicide.
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NARRATOR: And if this is the case,
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it could be devastating for her family.
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If we find that it's a suicide,
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they may feel terribly guilty, because she
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did it right in front of them.
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NARRATOR: But it's also possible that Cynthia's death
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was completely unrelated to her depression.
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Maybe she had severe brain trauma from the mugging
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five years earlier.
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And this is what caused her symptoms.
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NARRATOR: And despite the time that's passed since Cynthia's m
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if Dr. G. can make the connection
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that the complications from brain trauma caused her death,
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this becomes a homicide investigation.
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If we can link her cause of death,
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and connect it to the incident of when she was mugged,
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then this would be a homicide.
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Why can't they find that hospital record?
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Hold on.
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Let's get some info, and I'll be right back.
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NARRATOR: 21 years of experience tell
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Dr. G. that this case will be anything
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but a walk in the park.
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You're on tomorrow?
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Yes.
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These kind of deaths, these are very difficult because you
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do have to connect the dots.
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Thanks.
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I think we've got our work cut out for us.
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[MUSIC PLAYING]
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So this woman looks like she's got a lot of chronic problems.
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This should be funny.
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Oh my god, this woman's a mess, isn't she?
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I'm shocked.
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I'm really shocked at the way she looked.
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She looks terrible.
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She looks much older her stated age of 45.
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She's very thin and gaunt.
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She has clearly lost a lot of muscle mass.
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Don't take any blood out of here.
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Let me see her hands.
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She's got inner osseous muscle wasting.
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When you start losing muscle, you kind of
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see these little shallow dips in the backs of your hands,
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because your muscles are atrophying between the bones.
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She's got that.
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She's got vomit on her shirt.
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That's not unusual for a terminal kind of event.
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That part doesn't bother me so much.
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Don't take that out until--
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Her eyes are sunken within her eye sockets.
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Her hair is a mess, and her fingernails
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are long with what looks like feces underneath of them.
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She clearly is not taking care of herself.
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She's very difficult to autopsy.
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All righty, let's try her this way.
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I guess there's a possibility that she could have
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fallen, and just hit her head.
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I palpate her scalp, but I don't really
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feel anything except some matted, unkempt hair.
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NARRATOR: Given Cynthia's emaciated state,
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Dr. G will be on the lookout for any signs of drug use.
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She almost looks like she may be a methamphetamine user,
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or a chronic cocaine user.
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But I certainly don't see needle tracks, or any clear evidence
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of drug use.
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But of course, the toxicology results
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would play a major role.
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NARRATOR: But when Dr. G removed Cynthia's shorts,
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she makes another shocking discovery.
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Oh, my.
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There's something wrong here.
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Oh my.
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Let's see what we find under that.
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When I take off her shorts, she's
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got to an adult style diaper on, held together with duct tape.
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Why is she not taking care of herself?
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Why is she looking like this?
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Something is really wrong with this woman.
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What's going on here?
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She looks terrible on the outside,
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and I'm wondering what does she look like on the inside?
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[MUSIC PLAYING]
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Oh, gosh she's a mess.
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This one is bad.
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NARRATOR: From the external exam,
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Dr. G can tell that something is terribly
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wrong with 45-year-old Cynthia Anders.
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She's been having some definite problems.
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I think her life is falling apart.
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The brother is telling me she's depressed, withdrawn,
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anxious, not acting right.
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Well, you know, this is a 45-year-old woman
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whose fingernails are lined with feces underneath?
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Oh my.
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And she's got an adult diaper on.
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This is more than just not acting right.
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This is much worse.
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NARRATOR: She now believes that Cynthia's erratic behavior
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and sudden death could very well be connected to an assault five
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years earlier.
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Is it just a psychological event of the mugging,
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which has caused depression?
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Or is it really some type of a brain injury from that trauma
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she suffered?
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I'll definitely save this brain.
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If we have enough evidence to say that that lugging is
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what ultimately caused her death,
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then this would be a homicide.
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I've got doctors I'm calling.
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NARRATOR: Looking for anything that
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could shed light on Cynthia's case,
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Dr. G's investigators do their best to track down more
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information about the attack.
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Bye now.
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Nobody could find any kind of report.
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There was none that existed.
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OK.
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NARRATOR: But it's also possible that Cynthia's death
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had nothing whatsoever to do with her mugging.
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All right.
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Then, I'll be back.
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It's really unclear what this is going to be.
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I don't know what that body is going to tell me.
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[MUSIC PLAYING]
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OK, we're ready, right?
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As soon as I do my y incision, I make sure
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all the abdominal organs are intact, and they're fine.
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NARRATOR: Her first order of business
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is to collect samples of Cynthia's blood and urine
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to send to the lab.
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I do toxicology because that might be our answer.
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Maybe this is an overdose.
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We'll have to see what the tox shows.
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Depending what kind of drugs she has in her system,
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it may take anywhere from two weeks to 12 weeks for me
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to get that toxicology result back.
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NARRATOR: The next step is to examine Cynthia's heart.
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Her heart is a normal size and weight.
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The blood vessels that supply blood to the heart look good.
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The heart muscle looks good.
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Everything looked fine.
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Heart looks good.
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NARRATOR: Dr. G then turns her attention to Cynthia's lungs.
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Because she's clearly sitting a lot,
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not doing a lot of movement.
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I would worry that maybe she does have pulmonary emboli.
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NARRATOR: People like Cynthia, who are physically inactive,
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are at greater risk of developing
00:13:50
blood clots in the legs.
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These clots can break loose, travels
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through the bloodstream, and lodge themselves in the lungs,
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cutting off all blood supply to the lungs,
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and in turn, the heart.
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That would cause you to die suddenly.
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Let's see what's in her lungs.
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But when I cut the lungs out, the main pulmonary arteries
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are without blood clots.
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Well I'm looking.
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I don't see any.
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And I cut the lungs themselves, and there's
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no pulmonary emboli.
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She doesn't have any.
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But it isn't long before Dr. G spots something
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else, something curious.
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Oh, wow.
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There's something going on in that lung.
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Her lungs don't look right.
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Her lungs are heavy, and kind of dense.
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The bronchi have some kind of creamy, white material in them,
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that look kind of like pus.
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I'm very worried she might have pneumonia.
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NARRATOR: Pneumonia is an infection of the lungs,
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usually caused by bacteria.
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Look at this.
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This is nasty.
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I really need to look under the microscope
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to see how extensive this disease is in her lungs.
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NARRATOR: Dr. G collect tissue samples from Cynthia's lungs
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and prepares to send them to the lab for processing.
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I'll take a little biopsy of tissue
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from each lobe of both lungs.
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I usually have all my cassettes laying
00:15:18
next to my cutting board, with the case
00:15:21
number on the cassette.
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So I'll take little snippets of lung,
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and put each snippet in a different cassette.
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They come back to me, usually within a week or two weeks,
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and then I can read those slides under the microscope.
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NARRATOR: If the micros confirm the presence of pneumonia,
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she could have her cause of death.
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All right, then I'll be back.
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NARRATOR: For now, all Dr. G can do
00:15:47
is wait until the slides come back from the lab.
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So, I guess another one we're not
00:15:52
going to know until we look at the micros,
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are going to look at the tox.
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NARRATOR: But Cynthia's gaunt appearance gives Dr. G an idea
00:16:01
as to where to look next.
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Because she is so thin, could she have something wrong
00:16:07
with her GI tract?
00:16:09
I need to still look at those bowels.
00:16:11
Any time you do an autopsy, you're looking
00:16:13
at their digestive tract.
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Their esophagus, their stomach, they're
00:16:17
large and small intestine.
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Let's see what's going on in this little belly.
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That doesn't look bad.
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NARRATOR: But right away, she can cross the organ
00:16:25
off her list of suspects.
00:16:27
Her bowels look perfectly normal.
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NARRATOR: Unfortunately, the rest of the internal exam
00:16:33
provides little in the way of answers.
00:16:36
No gallstones.
00:16:37
Should doesn't look bad.
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Her liver.
00:16:40
She has a spleen.
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Her spleen, her kidneys, all look pretty good.
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It's already done.
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I did it.
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NARRATOR: But there's something about this case
00:16:49
that still troubles Dr. G.
00:16:52
What surprises me is her bizarre behavior.
00:16:57
Her not taking care of herself.
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My question is, what's causing her to be like this?
00:17:04
I still need to look at her head,
00:17:06
because that's where I think the answers are going to be.
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[MUSIC PLAYING]
00:17:16
NARRATOR: Dr. G's morgue technician, Tom Hemphill,
00:17:18
carefully saw through Cynthia's cranium.
00:17:21
We're going to look to see if there's evidence
00:17:23
and maybe an old skull fracture, evidence of a blood,
00:17:26
maybe contusions or bruising on the brain.
00:17:29
And she could still have natural disease in her head.
00:17:32
Who knows?
00:17:34
So, I reflect the scalp.
00:17:36
Now five years later, I certainly
00:17:37
wouldn't expect a bruise.
00:17:39
But I could see possibly evidence
00:17:41
of an old skull fracture.
00:17:42
Well, it's underwhelming.
00:17:44
But everything looked fine.
00:17:46
Scalp looks completely normal.
00:17:49
NARRATOR: Dr. G gingerly removes the skull cap,
00:17:52
and exposes the brain.
00:17:54
Ah!
00:17:55
And I'm shocked.
00:17:56
I don't see anything that looks like old trauma.
00:17:58
She doesn't have any evidence of old blood.
00:18:02
I see no old skull fractures.
00:18:05
She doesn't have any of them.
00:18:07
NARRATOR: One thing is now clear,
00:18:09
there is no evidence of any brain damage
00:18:13
as a result of her mugging.
00:18:15
Oh my god.
00:18:17
Look at that.
00:18:18
But I do see something very odd.
00:18:21
What's shocking is the frontal lobes were all shrunken down.
00:18:27
NARRATOR: In fact, the entire front part of Cynthia's brain
00:18:30
has atrophied, or wasted away.
00:18:33
Something's wrong here.
00:18:36
It was such an odd appearing brain,
00:18:38
that I really wanted Dr. Pearl, my neuropathologist to see it.
00:18:42
Let's see.
00:18:43
We got a brain knife?
00:18:45
Brain pathology is difficult, and it takes
00:18:48
a lot of special knowledge.
00:18:51
I enjoy working with Dr. G. We review
00:18:53
cases together every two weeks.
00:18:55
Her cases are always very interesting.
00:18:57
Yeah, that's right.
00:18:59
In this case, the striking finding
00:19:02
was severe atrophy of the frontal lobes of the brain.
00:19:07
That's not normal.
00:19:09
I love those cases that you think gets going one way,
00:19:12
and then the autopsy changes the whole direction.
00:19:15
I mean, how cool is that?
00:19:17
[MUSIC PLAYING]
00:19:35
NARRATOR: Dr. G and Dr. Pearl have just
00:19:38
made an unexpected discovery during the cranial exam
00:19:42
of 45-year-old Cynthia Anders.
00:19:45
She's got something wrong with her brain.
00:19:47
Her frontal lobes are all shrunken down.
00:19:51
I've never seen it that bad.
00:19:53
NARRATOR: In order to determine what is causing this wasting
00:19:56
of the front part of her brain, Dr. Pearl
00:19:59
collects tissue samples to examine under the microscope.
00:20:02
He has special stains that I don't have access to.
00:20:06
I wish I could look at those slides right that second.
00:20:10
But it has to be processes, that has to be returned
00:20:13
a couple of weeks later.
00:20:17
NARRATOR: In the meantime, Cynthia's toxicology
00:20:20
report comes back from the lab.
00:20:22
And she doesn't have a thing in her system, not a thing.
00:20:24
The fact that her toxicology was negative,
00:20:27
it ruled out a suicide, or an accidental drug overdose.
00:20:32
When I looked at the eye fluid, the electrolytes,
00:20:35
it did show that she was dehydrated.
00:20:37
Not dehydrated enough to kill her.
00:20:40
But kind of went along with her general appearance
00:20:42
of not taking care of herself.
00:20:44
NARRATOR: Two weeks later, the micros from Cynthia's lungs
00:20:48
are delivered to the District 9 morgue.
00:20:51
When I get the slides, and I put
00:20:53
those long slides under the microscope,
00:20:56
I have my suspicions.
00:20:58
I believe she's got pneumonia.
00:20:59
NARRATOR: And all it takes is a quick look under the lens
00:21:03
to prove her right.
00:21:05
There it was.
00:21:06
She had extensive bronchi pneumonia,
00:21:09
and that's ultimately why she died.
00:21:12
NARRATOR: Dr. G is now certain of the cause of death.
00:21:16
But this crucial finding raises more questions than answers.
00:21:20
We have the reason for her death,
00:21:21
but why would a 45-year-old woman have pneumonia?
00:21:26
And what's causing her behavioral problems?
00:21:30
NARRATOR: Dr. G believes that the missing
00:21:32
link may lie in the stain samples prepared by Dr. Pearl
00:21:37
I just need all the pieces of the puzzle
00:21:39
together on this one.
00:21:41
NARRATOR: Finally Dr. Pearl reviews
00:21:43
his much anticipated findings with Dr. G.
00:21:46
When he showed me his slides, that he had prepared
00:21:49
of the brain and the special stains,
00:21:51
it confirmed our suspicions.
00:21:54
I had my answer.
00:21:55
Oh, yeah.
00:21:56
I see it.
00:21:57
All of that makes sense now.
00:22:03
NARRATOR: It's 7:00 PM, and Tim Anders has just sat down
00:22:07
to dinner with his wife, leaving his sister Cynthia
00:22:10
to relax on the couch.
00:22:13
Little does he know, she's slowly
00:22:14
dying and has been for years.
00:22:17
I suspect she probably did start her symptoms
00:22:21
at least five years earlier.
00:22:23
NARRATOR: But in a cruel coincidence,
00:22:25
just as Cynthia begins to exhibit strange behaviors,
00:22:29
she gets mugged.
00:22:32
Everybody is attributing her behavioral changes
00:22:36
to this mugging, when this had nothing to do with her mugging.
00:22:40
She has said neurologic degenerative disease
00:22:44
called frontal lobe dementia.
00:22:47
NARRATOR: Dementia is a loss of mental function severe enough
00:22:51
to interfere with daily life.
00:22:53
So behavior and personality, reasoning, language functions,
00:22:59
any of those can be affected.
00:23:02
NARRATOR: There are many different types of dementia,
00:23:04
each with a different root cause.
00:23:07
Not all dementia is the same.
00:23:08
We all think of Alzheimer dementia,
00:23:10
where it starts out initially as memory loss,
00:23:15
or being unable to recognize people.
00:23:18
But frontal lobe dementia has to do
00:23:20
with the way you act, the way you take care of yourself.
00:23:24
Sometimes your language.
00:23:25
So they may not have problems with reasoning or memory,
00:23:30
but they'll have problems with social interactions.
00:23:34
Her bizarre behavior, her not taking care of herself,
00:23:40
her feces under the nails, her diaper, for all of that
00:23:45
is classic for a frontal lobe dementia.
00:23:50
I know people think 45, that's too young to have dementia.
00:23:54
But frontal lobe dementia is much younger onset than some
00:23:59
of the other dementias.
00:24:01
It's not uncommon to start with those behavioral problems
00:24:04
at a very early age.
00:24:07
NARRATOR: And while the condition is often
00:24:09
known to influence behavior, it can affect
00:24:12
basic motor functions as well.
00:24:15
In Cynthia's case, her gag reflex no longer
00:24:19
works properly, and bacteria from her saliva
00:24:22
is inhaled into her lungs.
00:24:25
That bacteria is coming from her oral cavity,
00:24:28
and making a home in the lung, where it's not supposed to be.
00:24:32
NARRATOR: The bacteria begin to multiply,
00:24:35
and that causes a deadly pulmonary infection.
00:24:39
She doesn't even know she's sick because her brain
00:24:42
has shrunken down that much.
00:24:45
She had no ability to even realized something was wrong.
00:24:50
She was getting sicker and sicker,
00:24:53
and she slowly succumbs, and slips into a coma, and dies.
00:25:00
You know, if her pneumonia was caught earlier, sure,
00:25:03
they'd have saved her this time.
00:25:05
But there was no stopping the progression of her dementia.
00:25:09
And ultimately, that's what did kill her.
00:25:12
NARRATOR: With all the information in hand,
00:25:14
Dr. G is finally ready to contact Cynthia's brother
00:25:17
Tim to share her findings.
00:25:19
Yeah, this is Dr. Garavaglia.
00:25:21
He was flabbergasted.
00:25:22
He had no idea.
00:25:24
He really thought that she just had some kind of depression.
00:25:29
NARRATOR: But nothing can prepare Tim
00:25:31
for what she tells him next.
00:25:33
You know, in many of these people it's a genetic defect.
00:25:37
Oftentimes, it's inherited.
00:25:39
So that had huge implications for the family.
00:25:42
I'm really sorry.
00:25:43
NARRATOR: Sadly, there is no test
00:25:45
that can predict whether someone will develop this condition
00:25:48
or not.
00:25:50
There's nothing he can do.
00:25:51
They just have to wait and see.
00:25:58
NARRATOR: As for the alleged mugging,
00:25:59
it's unclear whether it ever happened.
00:26:02
We never could find a police report,
00:26:04
and I didn't really see any clear cut evidence of trauma.
00:26:09
Maybe the assault never occurred.
00:26:11
Maybe because of her dementia, she
00:26:13
fabricated that whole thing.
00:26:16
I don't know.
00:26:17
I don't think we'll ever know.
00:26:22
What did we end up doing?
00:26:24
Six cases, right?
00:26:26
Four full autopsies?
00:26:27
MAN: Yes.
00:26:28
Oftentimes in forensics, you come across cases that
00:26:31
have misleading circumstances.
00:26:35
But you ultimately have to let the body speak to you.
00:26:39
I love how an autopsy can give you just unexpected answers
00:26:44
sometimes, and that's what makes this job great.
00:26:47
It's the surprises.
00:26:49
[MUSIC PLAYING]
00:26:55
NARRATOR: Despite this seemingly simple circumstances
00:26:58
of her next case, Dr. G knows she must
00:27:01
dig deeper to find the answers.
00:27:03
He fell and he hit the ground, but did he
00:27:05
have some kind of physical illness that affected him?
00:27:08
Or did he just slip and fall?
00:27:13
[MUSIC PLAYING]
00:27:31
When I come in to see our cases in the morning,
00:27:34
this report states that this is a man that's 48 years old.
00:27:38
He's Puerto Rican, and it looks like he fell off of a ladder.
00:27:48
Today, we have a case that seems pretty cut and dry.
00:27:51
NARRATOR: According to the investigators report,
00:27:53
Leo Guzman worked as an independent contractor.
00:27:58
Yesterday afternoon, he and a small crew of men
00:28:01
were outside painting a house in nearby Kissimmee, Florida.
00:28:05
DR. GARAVAGLIA: He's got his ladder up, ladders pretty high.
00:28:08
About 15 feet.
00:28:10
He's up near the top rung.
00:28:12
People below heard whoa.
00:28:17
And this guy falls off the ladder.
00:28:21
Once he hit the ground, they could see that he
00:28:24
clearly had a broken leg.
00:28:26
It's kind of all cattywampus.
00:28:28
He's unconscious.
00:28:29
NARRATOR: Workers at the scene immediately call 911.
00:28:33
Paramedics arrive within minutes,
00:28:36
and rush Leo to the ER.
00:28:39
But he's dead on arrival by the time
00:28:41
they make it to the hospital.
00:28:44
NARRATOR: Leo's body is then transferred
00:28:46
to the District 9 morgue.
00:28:49
Now, it's up to Dr. G to determine the cause of death.
00:28:53
And on first glance, this one looks pretty straightforward.
00:28:57
Sounds like a pretty simple case, no mystery.
00:29:02
Ladder's pretty high, it's about 15 feet.
00:29:05
And that's about the height when we start seeing
00:29:08
some very dangerous things.
00:29:10
My number one theory is if he just falls off the ladder,
00:29:13
and most likely hits his head.
00:29:15
The number one way to die from a fall from a height.
00:29:18
OK. That's good.
00:29:19
That's what I needed.
00:29:20
Thanks.
00:29:21
NARRATOR: But Dr. G can't discount
00:29:23
the possibility that Leo's death was more
00:29:25
than just a simple accident.
00:29:28
He fell and he hit the ground.
00:29:30
But is there anything else that may have played a role
00:29:33
in him falling off that ladder.
00:29:35
Although he's at work, believe it or not,
00:29:38
50% of people who fall off ladders tend to be intoxicated.
00:29:43
I would hope he's not on the job intoxicated,
00:29:46
climbing the ladder, but I've seen stupider things.
00:29:52
[MUSIC PLAYING]
00:29:54
NARRATOR: It's also possible that Leo's death
00:29:57
is one of the many electrocutions
00:29:59
that come through the morgue.
00:30:02
I get a lot of people, there doing things
00:30:05
and they hit the electrical wire,
00:30:07
and that shocks them, and causes them to fall.
00:30:09
That's the first thing we always ask the witnesses.
00:30:11
Was there anything that could have caused an electrocution?
00:30:14
And in this case, no.
00:30:16
NARRATOR: Or could the Florida heat
00:30:18
have contributed to his death?
00:30:20
The investigators report states it was a steamy 94
00:30:24
degrees the day Leo died.
00:30:26
94 degrees here in Orlando in the summer is lovely weather.
00:30:31
But it's hot to work outside in that temperature.
00:30:35
So, I always worry about heat stroke.
00:30:39
Heat stroke is your body's inability
00:30:42
to get rid of produced heat, and your temperature
00:30:45
can go up to 106.
00:30:47
So the first thing I'll look at is the EMS run sheet.
00:30:52
And in this case, when I look at those records,
00:30:54
his temperature is 98.4.
00:30:56
Not heat stroke.
00:31:00
NARRATOR: Still, 21 years of experience
00:31:03
also tells Dr. G that an underlying medical condition
00:31:07
could have just as easily triggered the fall.
00:31:10
Did he have some kind of physical illness
00:31:11
that affected him?
00:31:14
We did find out that he had a sister here
00:31:16
in the United States with him, and she felt
00:31:18
that he was in great health.
00:31:21
But you always worry that there may
00:31:22
be some natural disease, even at the age
00:31:24
of 48, that's going untreated.
00:31:27
So I'm worried about a stroke, or maybe a heart attack.
00:31:33
He doesn't have a regular job.
00:31:35
He just freelances.
00:31:36
He doesn't have health insurance.
00:31:38
And people like that tend to not get a lot of preventative care.
00:31:43
He's certainly, as a man, more apt not
00:31:47
to go get preventative care.
00:31:49
NARRATOR: And sure enough, as she
00:31:51
reads through Leo's medical history,
00:31:53
Dr. G spots a red flag.
00:31:57
A-ha.
00:31:58
He'd been complaining of leg pain.
00:32:00
And when people have leg pain, and then
00:32:02
die suddenly, and unexpectedly well
00:32:05
we think of a pulmonary embolism.
00:32:08
NARRATOR: But a pulmonary embolism
00:32:09
isn't her only concern.
00:32:11
Some things are not--
00:32:12
Even though his sister says he's in great shape,
00:32:16
she did hint that he may have diabetes.
00:32:19
There are a lot of silent killers,
00:32:20
high blood pressure, coronary artery disease, even diabetes.
00:32:24
So to me, they're not in great shape
00:32:27
until the autopsy says he's in great shape.
00:32:31
So basically, we'll let the body speak to us.
00:32:35
Is there anything that we'll be able to get
00:32:38
from that autopsy that'll help us understand what
00:32:42
happened to this poor fellow?
00:32:43
Well right now, I'm not quite sure.
00:32:45
It's hard to say.
00:32:54
When I first see him, I notice he looks the stated
00:32:57
age of 48, maybe even younger.
00:32:59
Fairly muscular.
00:33:01
A lot of intravenous lines on him.
00:33:04
They were trying to pump fluids in him,
00:33:06
in his neck, and his groin, in his arms.
00:33:08
And they have him intubated.
00:33:09
None of that seemed to work, because he was dead on arrival.
00:33:15
It looked like he was a painter.
00:33:17
He's got shorts on with some paint.
00:33:19
He's got high top boots, safe appearing shoes.
00:33:23
His shirt has already been cut off.
00:33:24
That didn't come in with him.
00:33:28
NARRATOR: As a first step more technician,
00:33:30
Brian Muholski carefully removes Leo's clothing,
00:33:33
while Dr. G inspects his personal belongings.
00:33:37
In his personal effects, there is something really telling.
00:33:40
He had cigarettes and cigarette lighters.
00:33:44
I'm venturing maybe those insides aren't as good
00:33:47
as that sister says.
00:33:53
NARRATOR: Next, Dr. G inspects Leo's body,
00:33:56
looking for injuries he may have sustained in the fall.
00:33:59
He certainly shows evidence that he hit his head.
00:34:01
He's got an abrasion on the right side.
00:34:04
He's got a laceration between his eyebrows.
00:34:07
He's got a broken leg that you don't even want to look at,
00:34:09
you know?
00:34:10
One part of his legs one way, and the other parts is another.
00:34:14
NARRATOR: Moving down the leg, she turns
00:34:16
your attention to Leo's calves.
00:34:18
One of the ways we look for a pulmonary embolism
00:34:21
is to look to see if the legs are symmetrical.
00:34:25
Maybe there's a deep vein thrombosis that's
00:34:27
causing the leg to swell.
00:34:32
NARRATOR: But in this case, Leo's broken leg makes
00:34:35
this task close to impossible.
00:34:38
So I would have to wait until I get to his lungs
00:34:41
to see if he has an any pulmonary emboli.
00:34:45
NARRATOR: Finally, Dr. G spots a potentially telling clue.
00:34:50
Leo has creased ear lobes.
00:34:53
The medical issue has gone back and forth
00:34:55
for years about the meaning of the creased ear lobes,
00:34:59
because many papers said it was associated
00:35:01
with coronary artery disease.
00:35:05
Well as it turns out, as you get older, a lot of people
00:35:08
get creased ear lobes, and it is not associated
00:35:12
with coronary artery disease.
00:35:15
Now in the younger male population,
00:35:18
there is some correlation, but it's pretty weak.
00:35:26
NARRATOR: But before she goes digging into Leo's heart
00:35:28
and lungs, Dr. G has a much more likely suspect
00:35:32
to investigate, the head.
00:35:35
I think the other possibility on this one
00:35:37
is going to be the head.
00:35:39
Head trauma is how most people die
00:35:41
when you have a fall from a height of 15 feet or higher.
00:35:45
So I'm going to go to where I think the money is, the head.
00:35:50
[MUSIC PLAYING]
00:35:55
What I'm going to be looking for in the head are two things.
00:35:58
One, document the trauma, which I suspect there is.
00:36:03
And two, check to see if there's any natural disease.
00:36:05
Anything that was going on in his head that caused
00:36:08
him to fall off that ladder.
00:36:11
NARRATOR: Dr. G begins by slicing Leo's scalp from ear
00:36:14
to ear.
00:36:15
And as she peels back the skin, something
00:36:18
takes her completely aback.
00:36:20
Something shocking occurs when I reflect that scalp.
00:36:23
Oh my gosh.
00:36:29
[MUSIC PLAYING]
00:36:42
NARRATOR: Dr. G has just made a surprising discovery
00:36:45
in the cranial exam of 48-year-old Leo Guzman,
00:36:49
who fell off a 15 foot ladder yesterday in Kissimmee.
00:36:53
There is no scalp contusions.
00:36:55
And one would suspect that when falling 15 feet,
00:36:59
hitting your head.
00:37:02
That doesn't mean he didn't die from head trauma,
00:37:05
but I won't know until we get in.
00:37:10
NARRATOR: Using an oscillating saw,
00:37:12
morgue technician Kelly Wood saws open the skull cap,
00:37:16
then Dr. G steps in to get her first look at the brain.
00:37:20
I notice that there's no blood over the brain.
00:37:24
No blood, no trauma.
00:37:27
NARRATOR: But as she carefully removes the organ,
00:37:30
something catches her attention.
00:37:32
Oh my god.
00:37:33
Look at that.
00:37:35
What was remarkable was that he has
00:37:37
after a atherosclerotic plaque on the vessels
00:37:40
at the base of his brain.
00:37:42
We tend to see that in much older people.
00:37:47
But it wasn't enough to really cause him any problems.
00:37:51
NARRATOR: However at age 48, this finding
00:37:55
suggests that something else may be going on inside Leo's body.
00:38:00
Just the fact that it was there
00:38:02
made me think he's not quite as healthy
00:38:04
as his sister thought he was.
00:38:09
I got to look at it.
00:38:10
NARRATOR: Next, Dr. G begin slicing through the brain
00:38:13
tissue itself, looking for any signs
00:38:16
of trauma or natural disease.
00:38:18
When I cut his brain, he's two too little what we would call
00:38:22
lacunr infarcts.
00:38:24
It's basically a tiny little stroke.
00:38:26
This guy was not going to live to a ripe old age,
00:38:29
I don't think.
00:38:31
Now they're sometimes considered associated with high blood
00:38:34
pressure, diabetes, but nobody really
00:38:37
knows truly what causes those.
00:38:41
NARRATOR: It's a suspicious discovery,
00:38:43
but his Dr. G examines the tissue more closely,
00:38:46
she can see that the damage is not recent.
00:38:49
They appeared that they've been there for a while.
00:38:52
So his lacunar infarcts are probably not the reason
00:38:55
he fell off of that ladder.
00:39:00
NARRATOR: So far, none of the findings in Leo's brain
00:39:02
indicate a definitive cause of death.
00:39:05
He also doesn't have anything that
00:39:07
would indicate why exactly he would
00:39:09
have fallen off that ladder.
00:39:12
He doesn't have any trauma.
00:39:14
NARRATOR: But she still must search
00:39:16
for fatal injuries and signs of natural disease
00:39:19
inside Leo's body.
00:39:22
So next, since his head isn't giving us the answer,
00:39:26
we need to do the rest of the autopsy.
00:39:28
[MUSIC PLAYING]
00:39:38
NARRATOR: With scalpel in hand, Dr. G cuts through the skin
00:39:42
and performs a standard Y shaped incision.
00:39:46
So when I reflect his skin, and subcutaneous tissue,
00:39:50
I noticed right off he's got a rib fracture.
00:39:52
NARRATOR: But as she takes a closer
00:39:54
look at the broken bone something
00:39:56
catches her attention.
00:39:58
There's no hemorrhage surrounding it.
00:39:59
That indicates to me that his heart isn't pumping.
00:40:05
So in this case, most likely that's from resuscitation.
00:40:10
NARRATOR: Once the body is open, Dr. G draw samples of Leo's
00:40:14
blood for toxicology tests.
00:40:16
I need blood to check for drugs and alcohol,
00:40:19
because about 50% of people who fall from a height
00:40:24
will be intoxicated, even people who are working.
00:40:27
NARRATOR: But the results won't arrive for several weeks.
00:40:31
In the meantime, Dr. G examines Leo's organs in situ
00:40:35
for any signs of fatal trauma.
00:40:38
DR. GARAVAGLIA: Let's see what we've got here.
00:40:40
So when I remove the chest plate,
00:40:42
there's no evidence of any kind of puncture to the lungs.
00:40:46
The heart sac is intact.
00:40:48
The liver's intact, the spleen is intact.
00:40:51
There's no free blood, and there's no evidence of trauma.
00:40:55
NARRATOR: Suddenly, it's looking like the case of Leo Guzman
00:40:58
may not be as cut and dry as it once seemed.
00:41:02
What are we missing?
00:41:04
At this point, we're changing our focus.
00:41:07
I'm starting to suspect that it might be natural disease.
00:41:11
NARRATOR: And at the top of her list
00:41:12
of suspects is a pulmonary embolism.
00:41:15
So her first stop is the lungs.
00:41:18
When I take out his lungs, immediately you
00:41:21
can see that his lungs, even at the age of 48,
00:41:24
are already starting to break down
00:41:26
because of the chronic effects of smoking cigarettes.
00:41:31
But that's not what caused him to die.
00:41:34
NARRATOR: Still on the hunt for blood clots,
00:41:36
Dr. G begins a careful dissection
00:41:39
of the lungs themselves.
00:41:42
I cut the pulmonary artery, and when I look at that,
00:41:45
there is no blood clot.
00:41:48
Everything looks good.
00:41:51
NARRATOR: With the lungs now ruled out,
00:41:53
she turns her attention to another likely culprit,
00:41:57
the heart.
00:41:58
Immediately when I see the heart I see it's enlarged.
00:42:02
Like I would see in high blood pressure.
00:42:05
That's a big heart.
00:42:07
This is a fellow that's not very big.
00:42:09
He's of rather small frame, but his heart weighs 550 grams.
00:42:14
That is a big heart.
00:42:15
It shouldn't weigh more than 350.
00:42:19
NARRATOR: As a next step, Dr. G slices through the muscle,
00:42:23
and into the coronary arteries.
00:42:25
The left coronary artery has a 75% narrowing
00:42:30
by atherosclerotic plaque.
00:42:34
But it gets worse.
00:42:35
The left anterior descending has a 90% narrowing,
00:42:39
and then the circumflex coronary artery
00:42:42
has about an 80% narrowing.
00:42:44
NARRATOR: And as her scalpel cuts into Leo's last remaining,
00:42:47
artery Dr. G discovers what could be the smoking gun.
00:42:51
Wow.
00:42:52
This is a man that was a ticking time bomb.
00:42:57
[MUSIC PLAYING]
00:43:11
Using your scalpel, Dr. G slices into the right coronary artery
00:43:16
a 48-year-old Leo Guzman's heart,
00:43:20
and there she makes a key discovery.
00:43:23
Oh my.
00:43:25
When I get to the right coronary artery,
00:43:28
there's about a 75% narrowing, and just an adjacent
00:43:32
to that there's a clot.
00:43:35
That totally cut off the blood to that part of the heart.
00:43:39
It's a classic heart attack.
00:43:41
But that clot was already very aged.
00:43:44
You could see it's brown.
00:43:47
NARRATOR: This tells Dr. g that Leo's heart attack didn't
00:43:51
happen the moment he fell.
00:43:56
And when she dissects the heart muscle itself,
00:43:59
Dr. G spots another clue.
00:44:02
There's already a hemorrhage in the back of his heart,
00:44:05
and his heart muscle was in the process of dying.
00:44:10
NARRATOR: That means his heart attack
00:44:11
occurred, at least 24 hours before he fell off the ladder.
00:44:16
Yeah, this isn't that old.
00:44:19
NARRATOR: And just a few centimeters away
00:44:21
she surprised to find another, even older attack.
00:44:26
He'd already suffered a previous heart attack.
00:44:29
There's already scar tissue.
00:44:31
He has a severely damaged heart.
00:44:36
NARRATOR: For Dr. G, This is the final piece of the puzzle.
00:44:40
The fact that he fell off of that ladder,
00:44:43
along with what I saw in his autopsy,
00:44:46
we know what killed him.
00:44:47
So it doesn't really matter what is in his tox.
00:44:51
This trumps anything else I found.
00:44:59
[MUSIC PLAYING]
00:45:05
NARRATOR: To everyone around him,
00:45:07
Leo Guzman is in seemingly great health.
00:45:10
But looks can be deceiving.
00:45:13
He had high blood pressure, but he probably
00:45:15
didn't know he even had it.
00:45:18
NARRATOR: And left untreated, Leo's high blood pressure
00:45:21
begins to damage almost every vessel in his body.
00:45:26
And it didn't help that he smoked, also causing
00:45:30
injury to those vessels.
00:45:32
He had a history of diabetes.
00:45:35
Diabetes also caused injuries to the vessels
00:45:39
if it's not controlled.
00:45:41
So he had a triple whammy of the smoking, the high blood
00:45:46
pressure, and the diabetes.
00:45:49
NARRATOR: Over the years, this triple whammy wreaks havoc
00:45:52
on the vessels in Leo's brain.
00:45:55
He had two small strokes to the brain,
00:45:58
and we saw the plaques in the blood vessels of his brain
00:46:01
also.
00:46:03
NARRATOR: But the most lethal destruction
00:46:04
occurs within the vessels of Leo's heart.
00:46:07
He had changes in his heart from having
00:46:10
to pump against that high blood pressure.
00:46:12
High blood pressure also predisposes
00:46:14
you to coronary artery disease.
00:46:17
And at some point in the past, he had
00:46:20
had a previous heart attack.
00:46:24
NARRATOR: Then on the day before his death,
00:46:26
he suffers yet another heart attack.
00:46:29
The blood starts forming a clot
00:46:32
totally occluding any blood from getting to that blood vessel.
00:46:37
So that heart muscle starts to die.
00:46:41
And that's an irritant.
00:46:43
NARRATOR: But Leo doesn't seek medical treatment.
00:46:46
Why did he not go to the hospital?
00:46:48
He must have been having either a silent heart
00:46:51
attack, where he's not even feeling pain,
00:46:54
or is ignoring his symptoms.
00:47:01
NARRATOR: The next morning, he reports to work as scheduled.
00:47:05
But his severely damaged heart can't
00:47:07
handle the combined stress of physical labor in Florida heat.
00:47:12
He just climbs that ladder like he's in great shape,
00:47:16
but he doesn't know that that heart muscle
00:47:19
is already starting to die.
00:47:21
The stress of probably climbing that ladder
00:47:24
was enough to cause his heart to go into an arrhythmia.
00:47:28
His heart starts to flutter.
00:47:31
No blood is going to the brain.
00:47:33
He starts feeling woozy, probably lets out the whoa,
00:47:37
and falls over.
00:47:39
He's dead before he hits the ground.
00:47:42
He never felt that fall.
00:47:45
NARRATOR: With this, Dr. G can finally close the book
00:47:48
on 48-year-old Leo Guzman.
00:47:52
And for Dr. G, this case serves as yet
00:47:55
another lesson in the importance of preventative care.
00:47:59
This may or may not have been prevented.
00:48:02
Not everybody has the same symptoms,
00:48:05
but men tend to ignore their symptoms more.
00:48:09
Or he's rationalizing it as something else.
00:48:12
Men tend to do that more than women.
00:48:16
He could have done a lot, particularly stop smoking.
00:48:20
He should have known his blood pressure was elevated,
00:48:24
and he should have taken better control of his diabetes.
00:48:28
I'm sure he'd lived a lot longer.
00:48:31
You know, I think the important message on this case
00:48:34
is that you can look good on the outside.
00:48:36
You can feel good.
00:48:38
But if you're going to ignore knowing what
00:48:40
your blood pressure is, you're not going
00:48:42
to look good on the inside.
00:48:43
You just aren't.
00:48:45
You need some basic information about yourself.
00:48:48
You need to know what your cholesterol is.
00:48:50
You need to know what your glucose is.
00:48:52
You need to know your blood pressure is.
00:48:54
Those are silent killers.
00:48:56
And what you take away from this case,
00:48:59
is the silent killer strike again.
