Dr. G: Medical Examiner - Season 1, Episode 5 - The Chain of Life and Death - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A 94-year-old woman passes away following a stay in the hospital,
but why doesn't anyone want to sign the death certificate? DR. G: She made it through surgery,
and then she just dies suddenly. NARRATOR: Can Dr. G bring solace to a grieving family?
Closure is not what I felt. NARRATOR: In an instant, a 24 year old's bicycle ride
turns out to be his last. TODD HASTINGS: Bam, over the curb, and right in the center of that lane.
NARRATOR: Did this young man have a secret? And did he have an inkling of what was to come?
MARIA PEREZ: One month before he died, he said, if I die, I want to be cremated.
NARRATOR: A woman who makes her living as a stripper enjoys the company of friends.
Hours later, she is found dead. Did a secret cost her her life? DR. G: It's one more new kind of way
that now I know you can die. [MUSIC PLAYING] NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations-- these are the everyday cases of "Dr. G, Medical Examiner."
It's 1916, and six-year-old Rita Harris is about to suffer a moment of sheer horror.
When she was a small child, her mother was doing laundry out in the yard. NARRATOR: In those days, laundry was often
washed using liquid lye, a highly caustic abrasive that today is used in drain cleaners.
They made their own lye soap. And somehow she got into this laundry water with lye soap in it.
NARRATOR: Oblivious to the danger, little Rita swallows a mouthful, searing the lining
of her throat. She recovers, but for the rest of her life, she never forgets the terror of her throat on fire.
88 years later, Rita, now 94, is in the hospital suffering a fatal convulsion. By the time help arrived, she is dead.
However, old age is not the only culprit in this passing. Incredibly, a complex series of seemingly unconnected
medical events has transpired to take Rita's life, events that may have been connected to her poisoning 88 years earlier.
Rita's recent medical history took a turn for the worst just weeks earlier, when she visited the hospital for a routine procedure,
an endoscopy to remove a piece of food that was lodged in her throat. The operation reportedly goes off without a hitch.
But in recovery, Rita runs into trouble. On her way to the bathroom, she falls, breaking her hip.
Now, two weeks later, she is dead. Her family is grief stricken. The doctor came into the room to talk to us.
He said they weren't sure exactly what had happened, that they weren't sure if it was a heart attack
or if it was a stroke. He had said they were having a hard time finding anyone to sign the death certificate.
He wasn't going to sign it. She was dead when she got there. And he said they had--
they had spoken with her personal physician, and he didn't want to sign it, because he hadn't
seen her in about a month. NARRATOR: Because no one has signed the death certificate,
the case is automatically forwarded to the Orlando County Medical Examiner, Dr. Jan Garavaglia,
better known as Dr. G. What is the deal with him? WOMAN: There you go. DR. G: OK.
[MUSIC PLAYING] DEAN SMITH: What we have is an elderly white female, was DOA at a local hospital last night.
Today, the family has called up and questioned the possibility of this being related to a recent accident
this lady's had. We're getting conflicting stories. So the case was made a medical examiner's case
for further examination of the medical examiner to determine the manner and cause of death at that time.
DR. G: Well in this case, there's a lot of misinformation, a lot of information that was unclear.
It initially came in as just an old person dying suddenly at a nursing home. And then more information comes in, in that, no,
this was a person who died as that she just had a hip repair. Well, hip fractures are certainly
an accidental death, not a natural death, so we have to get involved. NARRATOR: A 94-year-old woman's life expectancy
is about 3 and 1/2 years. But what deeply concerns Dr. G is a kind of epidemic. DR. G: This is very much a public health problem,
old ladies who break their hip. Chances of dying after you break your hip are very, very high.
She made it through surgery. She does have supposedly an enlarged heart. And then she just died suddenly.
NARRATOR: Despite Dr. G's suspicions, it is possible that Rita's death had nothing to do with her fall.
One of Rita's attending physicians suggests that Rita might have died from a heart
attack or a stroke. And, in fact, Dr. G learns from Rita's medical records that she had suffered a stroke six years earlier.
Dr. G will be on the lookout for these and other clues when she begins the external exam.
OK, She's got arthritis in her knuckles. She's got interosseous muscles. She's got old lady disease, somewhat obese,
the old gallbladder scar. She actually looks really good for 94. NARRATOR: It's an observation confirmed by Rita
Harris's granddaughters. She was on less medication than you or I. Oh, yeah. Before she was at that hospital,
she was on less medication than either one of us are. NARRATOR: Having completed the external examination,
Dr. G turns next to perform the internal autopsy. We got a bunch, right? NARRATOR: Immediately, it's clear that Rita's bones
were ravaged by osteoporosis. This woman's bones are very thin, very thin. She had CPR and pretty much all her ribs are fractured.
People think, oh, I'm going to die from heart disease. Well, you know, it's a simple fall, you break your hip,
and there's a chance you can die. NARRATOR: Given the severity of Rita's osteoporosis,
it's no wonder her hip broke when she fell. She turns next to examine Rita's 94-year-old heart.
A lot of people will have really bad hearts, and just the stress of breaking your leg and all the pain,
they can have an arrhythmia right away. Let's see what she's got here on her aortic.
Yeah, some slight sclerosis around her aorta, not so bad, though. There's calcium in the walls, but the lumen, where
the blood goes, is just fine. So, I mean, she's got a lot of old, 94-year-old stuff,
but nothing-- nothing too bad. NARRATOR: And so her heart checks out. What about evidence of a stroke?
Rita suffered one some years ago. Did fracturing her hip trigger a repeat? To find out, Dr. G examines her brain.
Switch gears again-- NARRATOR: With both heart attack and stroke ruled out, Dr. G moves on to other possibilities.
When "Dr. G, Medical Examiner" continues, the question remains-- did breaking a hip cause Rita's death?
And was her childhood poisoning, nearly a century earlier, somehow a factor? It was a real shock.
Closure is not what I felt. I was devastated. NARRATOR: And later, the puzzle of this cyclist's
untimely death. DR. G: It's very difficult to die walking, talking, or riding your bike one second, active, talking,
and their dead the second. [MUSIC PLAYING] NARRATOR: For Rita Harris's family, the cause of her passing is a heartbreaking mystery.
For countless others, it holds a warning. Well into Rita's 90s, people took her for being
20 years younger than her age. But does Rita's death fit the common causes of death following hip surgery?
A lot of times they die during surgery, or just before surgery, from just the stress
of the pain and the incident. Some even have allergic reactions to some of the cement they used.
I've had a couple like that. NARRATOR: For a medical examiner, some cases take months to unravel.
Other times, the cause of death is revealed over a matter of seconds. [MUSIC PLAYING]
I know why she died. Two blood clots went to her lung. Yeah, you can see them when I cut the-- see, I'll show you.
See them? NARRATOR: To Dr. G, this is very familiar territory. Blood clots in the lungs, pulmonary embolisms,
are often a fatal complication following hip surgery. In fact, they're to blame almost 50% of the time.
So these, we just pulled out of the heart. There are more going into her lung. These are blood clots that were-- you
can even see the vessels, the tributaries in the veins. These were loose, somewhat loose in her heart
and going towards her lungs, going into the pulmonary artery. It's definitely a complication of the hip fracture.
And it's a very big problem with older people and falling. NARRATOR: When Dr. G calls Rita's family,
all the pieces of the puzzle start to come together. Her arteries looked pretty good.
NARRATOR: And incredibly, it also becomes clear that the chain of events that led to Rita's death
stretch back to her childhood accident, 88 years earlier. After six-year-old Rita drank lye and burned her throat,
scar tissue developed in her esophagus as part of the healing. And for the rest of her life, she had difficulty swallowing.
Always, all her life, she had to be very careful when she ate and make sure that she chewed her food thoroughly
before she tried to swallow it. We had-- a couple of times a year, we had to take her to the emergency room
to get something removed from her throat. NARRATOR: That's exactly what happened
a few hours prior to breaking her hip, two weeks before she died. DR. G: The story was is that she'd
actually come into the emergency room for some difficulty swallowing. Some food was stuck.
NARRATOR: To remove it, Rita was sedated and then underwent a routine endoscopy.
They gave her the relaxants. And they also give her something to help calm her, to keep her a little bit calmer, some sort
of a mild tranquilizer. NARRATOR: The endoscopy was uneventful and the food was successfully removed from Rita's esophagus.
They got that out. There wasn't a problem. After the procedure, she relaxes in bed, until she
gets up to go to the bathroom. DR. G: This is a woman who was fairly independent.
NARRATOR: Rita makes her way to the bathroom unassisted. And at some point, falls.
While she was in the hospital she fell? They said, yes, that's what happened. NARRATOR: When she falls, her hip, severely weakened
from osteoporosis, breaks. After her surgery, Rita spends most of her time in bed.
The lack of mobility takes a toll. Within the deep veins of her legs, her blood begins to pool and clot.
DR. G: There's a lot of things that predispose you to blood clots-- obesity, immobility, a hyper-coagulability
of your blood, increased estrogen. The only thing it really applies to her is immobility.
And that's usually what happens, is they stay in bed, and the blood doesn't move is as much.
NARRATOR: At some point, several clots break free and are swept through the venous system,
upwards towards her heart. Rita's heart, still vigorous at 94, pumps the blood clots into the pulmonary artery, which
supplies blood to the lungs. And there the blood clots stop, obstructing the blood flow into the lungs.
DR. G: They get caught up into the lungs, and no blood can then go into the lungs.
And thus, they get bilateral, both sides, pulmonary embolism. NARRATOR: In her bed, Rita struggles to breathe.
Deprived of oxygen, her brain begins to seize. Within minutes, she is dead. VERTA HARRIS: It was a real shock.
She had been in very good health for a 94-year-old woman. Mm-hmm. And-- I'm sorry-- and then she was gone.
NARRATOR: Over many years, Dr. G has found that her autopsy reports often help families come to terms with their loss, but not always.
For her to die for something so stupid, I was very angry. NARRATOR: For Dr. G, Rita's passing
triggers thoughts about the chain of life and death. Well, if she had not swallowed the lye, which then caused
the chronic problem with her esophagus and caused her chronic choking problem, she wouldn't have gone into the hospital.
But that's fate, and that's not what caused the hip fracture. The hip fracture is what started the chain of events that
then caused her ultimate death. A lot of people say, you know, it's your time, and when it's your time, it's your time.
I don't really believe that. I think we have a lot of control over that. I think you can control what you eat.
You can control driving fast. You can control driving recklessly. You can control buying drugs.
All of those things causing you to have an early death. So I don't believe that, that the fate--
just, it's your time, no. [MUSIC PLAYING] Next on "Dr. G, Medical Examiner," was riding without a helmet this man's fatal mistake?
DR. G: We'll see when we open him, but it doesn't look like he has any trauma from falling.
NARRATOR: And later, the death of a stripper. Did hiding a secret cost her her life?
[MUSIC PLAYING] It's 10:00 in the morning and Eric Perez is cycling along a busy roadway
outside Orlando, Florida. With each mile, the 24-year-old closes in on his new ambitions--
lose weight, join the Navy, cycle across Europe. They're the goals of a reformed workaholic, who's
finally learning to enjoy life. He worked with coffee shops. He became a manager.
Then he worked at Disney. He just did any job. And he'd work 70 hours. And then he'd save up money.
MARIA PEREZ: Now he want to be riding his bike, be relaxed, write a book maybe. In his free time--
He would just say, oh, I'm not going to work as much now, because I have a lot of money saved up.
I'm going to start taking-- I'm going to buy a bicycle and I'm going to start taking trips everywhere.
And meet different people in different countries, different cultures. NARRATOR: But the drivers traveling behind Eric
know nothing of this young man's hopes and dreams. To them, he's just an anonymous cyclist, until he goes down.
Remarkably, Eric's accident is witnessed by a trained paramedic, Todd Hastings. TODD HASTINGS: It was almost like he
tried to miss something, but there was nothing there. I mean, he went right off the road to the left, just bam,
over the curb, and right in the center of that lane. Unresponsive, possible seizure.
NARRATOR: It's immediately clear to Todd that this is not a typical bike accident.
The gentleman appeared to be having a seizure. NARRATOR: Moments later, the ambulance arrives.
But it's too late. Eric's vital signs have disappeared. He stops breathing and is never revived.
TODD HASTINGS: It was a shame, a young man. My thoughts were possibly, I wish I could have done more.
NARRATOR: Over 700 people die each year in bicycle accidents across America, many because they weren't wearing helmets.
For now, Eric's death is a mystery. Did he lose control of his bike and injure his unprotected head?
Or did something else caused Eric to collapse without warning? It's up to Dr. G to find out.
He's 24 years old, way too young to die. And unfortunately, I see people dying of all ages.
When they die younger, it presents a different set of possibilities of why they died.
And I just-- I have a job to do. I have to find the facts. I have to help the family figure out why they died.
And that's why I'm there, not to get emotional about the death. NARRATOR: From witness reports, Dr. G
knows that whatever took Eric's life did so suddenly and without warning. She get some more information from his medical records.
DR. G: The doctor diagnosed high blood pressure on him already, at the age of 22, obesity, and what he said
was mitral valve prolapse, with mitral valve insufficiency, meaning that the valve wasn't particularly competent.
It was kind of leaking, you could say. NARRATOR: Mitral valve prolapse is a congenital heart defect
that causes enlargement of the mitral valve flaps in the heart's left atrium. In a healthy heart, the mitral valve acts like a floodgate,
controlling the flow of blood from the left atrium to the left ventricle. But with mitral valve prolapse, the valve flaps
do not close tightly. Instead, they collapse backward. And with every pump of the heart, a bit of blood leaks
back through the valve. Just breathe normal. NARRATOR: But mitral valve prolapse is
usually not a fatal condition. In fact, it's one of the most common heart valve defects, affecting 1 out of every 100 people.
That doesn't stop Eric's mother from wondering, could the condition have been responsible for Eric's death?
The doctor told me he doesn't need any treatment at all, that he can live his entire life with that condition
and it wouldn't give him any problem. NARRATOR: But Eric's life was not problem free.
He grew up without a father. And by the age of 14, he worked as many as two full-time jobs to support his mother and sisters.
MARIA PEREZ: His birthday, he told me, mom, you know what, I want for my gift be that you take me to anyplace and I can apply for a job.
And that is what we did. And he started to work the next day. He was almost like the man of the house.
He was very good working, and saving money, and helping the family. ALMA PEREZ: Growing up with him was kind
of like having a second dad. My sister and I, he took us everywhere. And we were like his little babies.
When we needed something, he was the first one there, without questions asked. Anything, he was just right there-- anything-- financially
supportive, anything. NARRATOR: Now his grieving family wants to know, did Eric's faulty mitral valve, which doctors told him
not to worry about, kill him? Or was it something else? Dr. G learns from his mother that in the days
before his final bike ride, Eric seemed somehow different. In a notebook he had just purchased,
he had begun to write letters. To his mother, Maria, the letters read eerily, like a farewell.
MARIA PEREZ: One to mom, and the other one says to the father I never had. That letter, he explained to his dad
how much he suffered when he was a little kid, because the dad was not with him.
In that letter, he forgive him for how he hurt us. And he is still loving him. And he know that his dad loves him.
And the letter really is almost like he say goodbye. Because he was explaining everything,
was like a poetic letter, the way that he write it. And he was a very tough guy, that you
never would believe that he write letters like that. NARRATOR: And in hindsight, there
was other strange behavior. Eric also told his mother what he wanted done with his body
if he were to die. MARIA PEREZ: Like one month before he died, he has started to talk about death.
He has started to say, if I die, I want to be cremated and I want you to spread my ashes in Puerto Rico.
NARRATOR: Dr. G can't know what may have been on Eric's mind, but she is confident that his body
will reveal the cause of death. She must begin with the obvious-- was it the fall from his bike that killed him?
As Dr. G begins the external exam, a tattoo on Eric's arm immediately draws her attention.
DR. G: OK, now I got to see what this banner says. Is this like-- I don't get it--
to live is to suffer. What are you reading? His tattoo. To live is to suffer. WOMAN: Survive is to--
DR. G: --find meaning in the suffering. NARRATOR: But as Dr. G examines Eric's body for injuries,
she finds none. DR. G: I don't see a bit of trauma on him. We'll see when we open him, but it doesn't look like he
has any trauma from falling. And that the witnesses account that he just collapsed off the bicycle is true, appears to be true.
NARRATOR: The external exam yields nothing and leads Dr. G to wonder more and more whether the answer
to Eric's fatal collapse lies somewhere else. To find out for sure, Dr. G must look inside.
First, she makes a Y incision across the torso, cutting from shoulder to sternum,
to fully reveal the internal organs. Once inside, her instincts take her to the organ she most suspects.
DR. G: OK, I'm going to take the heart then. NARRATOR: Immediately, it's obvious to Dr. G
that Eric's heart is defective in more ways than one. Well, his heart is definitely abnormal.
There's no question about it. His heart is way too big for him. 600-- about 620.
A 24-year-old young man shouldn't have a heart more than 390 grams, maybe 400 at max.
This heart weighed 620 grams. That's huge. NARRATOR: An enlarged heart can be caused by, among other things, high blood pressure.
Over time, it's a condition that could cause heart disease or stroke. To find out more, Dr. G must dissect the heart itself.
His corners look fine. Because they have a normal take off from the aorta, which is good.
There's no acute angle. They have no atherosclerosis or narrowing. NARRATOR: She also finds Eric's mitral valve, the one that was
diagnosed as having a defect. I'd have to agree with that doctor-- very minor. He has a little bit of abnormality
in his papillary muscle, but I don't think it's causing him any problem. So his valve really doesn't look--
really look that bad at all. NARRATOR: It appears that Eric's doctor's diagnosis had been correct.
The faulty mitral valve was not anything to worry about. DR. G: Physically, mitral valve prolapse
is kind of a ballooning. It doesn't balloon that much. NARRATOR: With this discovery, every assumption about Eric's
death is thrown into question. If the mitral valve defect didn't kill him, what did?
Coming up, did Eric harbor a secret vice, one that he knew could kill him? MARIA PEREZ: I said maybe someone give him some drugs.
Maybe he took some drugs. NARRATOR: And later, she seemed full of life. So what caused this stripper to fall into a coma.
And die? [MUSIC PLAYING] Eric Perez was only 24 years old when he suddenly fell off his bike and died.
With no trauma from the fall, Dr. G knows that something inside Eric caused his death.
A diagnosed faulty heart valve is her chief suspect, until she discovers that it is too
minor to have caused his death. Dr. G's leads are drying up fast when Eric's family raises the question of possible drug use.
MARIA PEREZ: I said maybe someone give him some drug. Maybe he took some drugs. I know that he don't use drugs, but you know,
always it's a possibility. NARRATOR: At the outset, Dr. G orders a battery of tests that
will detect the presence of drugs and other toxins in Eric's system. We're going to make sure there's
nothing toxicologically wrong. NARRATOR: For Dr. G, death by drugs would certainly not be unusual.
Nearly one in every 10 cases that pass through the Orange County Medical Examiner's Office
is drug related. DR. G: You can die from an overdose of drug the very first time you use them.
NARRATOR: Eric's blood, urine, and eye fluid samples are sent to the forensic pathology lab, where they will
be screened on a gas chromatographic mass spectrometer, which can identify the presence of drugs
by their molecular structure. But despite suspicions, the tests come back absolutely definitive--
Eric Perez had no drugs in his system. The only thing that even registers is a small amount of caffeine.
For Dr. G, Eric Perez's autopsy is not revealing any secrets to the cause of his death, yet.
DR. G: It's not over till the fat lady sings. It's not over until every organ's cut.
So you never know. NARRATOR: But as she wraps up her internal exam, there is still no clear answer.
No pulmonary thromboemboli, no blood clots going to his lung. That's another reason somebody can just go down pretty fast.
His kidneys look fine. I think the rest of him is going to look normal. It's very difficult to die walking, talking, or riding
your bike one second, active, talking and then dead the second. And almost, that really makes us think of cardiac arrhythmia,
something with your heart. Without any symptoms whatsoever and you just got out like that,
usually it's your heart. NARRATOR: With all other possible explanations exhausted, Dr. G's instincts tell
her to take a closer look at Eric's unusually large heart, all 620 grams of it. DR. G: I'm impressed by how big his heart is
on somebody just 24 years old. Usually, you see this after really long standing high blood pressure.
So I'm really worried that maybe something else is going on here. NARRATOR: While high blood pressure could cause
an enlarged heart, it usually takes many more years than Eric's been alive. And for Dr. G, that raises a concern.
DR. G: So we're going to look under the microscope at that heart muscle. NARRATOR: As she examines the muscle tissue itself,
Dr. G makes a critical discovery-- Eric's heart is far from normal. Muscle cells in a healthy heart align
in a parallel structure, each cell neatly stacked in a row. But Eric's heart cells are zigzagged and full
of scar tissue. DR. G: You look under the microscope, and the heart, the fibers are enlarged,
there's fibrosis between the fibers. And even small places where the fibers have been replaced
by fibrosis or scar tissue. And there's some disarray to them. When we see that under the microscope,
you actually see muscles in disarray. NARRATOR: From examining his misaligned muscle structure,
Dr. G is able to finally diagnose Eric's condition. He had a congenital heart defect, known
as hypertrophic cardiomyopathy. And no one knew it. DR. G: Hypertrophic means big.
It's hypertrophied-- the muscle's gotten big. Cardiomyopathy, meaning cardiac muscle--
so big cardiac muscle. And that's what he had. This is something he was most likely born with.
It just is manifesting itself now. It's a congenital problem. It's something that's in their genes,
in their chromosomes, that's causing that heart to get enlarged. NARRATOR: Unlike Eric's mild mitral valve defect,
this congenital heart condition is sometimes fatal. DR. G: The way hypertrophic cardiomyopathy kills someone,
you have that increased heart muscle, harder to get blood into. It disrupts the electrical system.
And they end up dying suddenly and unexpectedly. About 2% to 3% a year will die from sudden cardiac arrest,
from an arrhythmia, from an abnormal electrical rhythm in their heart. NARRATOR: So it wasn't Eric Perez's
mitral valve that killed him. It wasn't his high blood pressure. And it wasn't drugs.
What killed Eric was hypertrophic cardiomyopathy, a congenital heart defect that went completely undiagnosed.
DR. G: The biggest contributing factor, you're born with it. You're not going to predisposed to it.
You need to be checked. If it's in your family, if you have a history of hypertrophic cardiomyopathy, you probably know it,
and you need to tell your doctor, without a doubt. Or if one of your siblings died from hypertrophic ,
cardiomyopathy you need to tell your doctor so that they can put you on treatment.
NARRATOR: Having confirmed the defect microscopically, Dr. G can now put together the events that led up to Eric's
death on the Orlando roadway. Eric is riding his bike home to meet his mother. His heart muscle, more than 70% larger than normal,
struggles under the increased strain of exercise. His malformed cardiac cells begin to short circuit.
You have that increased heart muscle. They have that interstitial fibrosis. It's just-- it disrupts the electrical system.
NARRATOR: Eric's heart goes into cardiac arrest while on his bike. From inside his car, paramedic Hastings witnesses Eric
swerve suddenly into traffic and collapse. But even though he's not wearing a helmet,
it's not the fall that kills him, it's his heart, now in a deadly arrhythmia. On the ground, Eric's brain is deprived of oxygen
and he begins to seize. DR. G: Once your heart isn't in an arrhythmia, once your heart isn't pumping correctly
and you're not getting enough blood to your brain, you may seize. NARRATOR: Within moments, Eric's defective heart
ceases to beat entirely. And so he's pretty classic for the hypertrophic cardiomyopathy.
NARRATOR: Help arrives. But EMS workers are unable to restore Eric's heart rhythm.
He dies on the scene. With the truth behind Eric Perez's sudden death finally revealed, Dr. G calls his family
to relate the circumstances of his collapse and the conclusion that his death was one of natural causes.
When she explained me, I feel like she was-- she understand already my pain. And she was able to explain me, almost like woman to woman.
I think they were very happy to find out the definitive cause of death. I think they were happy to find out
that there was a known cause and the mystery was solved. NARRATOR: But there is one last lingering
mystery of Eric's death, one that may never be solved. When he wrote the letters to his mother and father,
did Eric sense somehow that his life was reaching its end? His mother, Maria, still wonders.
MARIA PEREZ: That letter, he explained me how much he loved me and the thank you for all the sweet things that I did before then.
And then he say, over every thing, thank you for my life. NARRATOR: Coming up, did this young woman
have something to hide? Did she pay for it with her life? [MUSIC PLAYING] Most cities have their wild side and this Texas
town is no exception, with its topless bars and strip clubs. This was how 28-year-old Kim Cantel
made her living, until one ill-fated summer evening. It is around 7 PM when Kim returns home
after running some errands. Her brother, Joe, and his wife, Alice, are visiting.
Kim says she's feeling dizzy and nauseous. She goes into the bathroom and immediately passes out.
Joe begs her to go to the hospital. But Kim convinces them that all she needs is some much deserved rest.
But less than 12 hours later, Joe and Alice find Kim dead in bed. When emergency response personnel arrive on the scene,
there are no signs of trauma. But something does stand out. Fresh needle marks on Kim's breast
suggests possible drug use. There was also several medications found on the dresser, which also led
to some suspicion of some type of drug possible overdose. NARRATOR: Could Kim have OD'd?
With that suspicion in the air, her brother shares a family secret. He reveals to police on the scene
that his sister, Kim, was once his brother, Tim. This was a person that was in the process of having
the sex change and had already come back, after having the male organ removed and the change up in Canada.
NARRATOR: But while the disclosure of Kim's recent sex change shocks the police, it still does not explain
Kim's strange and sudden death. The mystery can only be solved by an autopsy. At the morgue, gender is rarely in doubt.
When Kim's body arrives, Dr. G agrees that Kim has all the appearances of a genetic female.
DR. G: If I wasn't told that she'd had a transgender operation, I may have not picked up on it.
NARRATOR: Dr. G examines the field report to get a better sense of Kim's complicated history.
She was born Tim Cantel in a small southwestern town. But at the age of 19, Tim adopted the name Kim.
When she turned 28, a sex change operation finalized her gender transformation. STACEE REICHERZER: It's a very difficult thing to have,
to be male and have an identity that's a heterosexual female, for example. Stacey Reicherzer, who counsels transgendered people,
has had male to female sex change surgery. The drive is, in many cases, a need to feel like what's on the outside fits what an individual
is experiencing in the inside. NARRATOR: In the United States, there are up to 500
sex change operations a year. Basically, what you're going to have to do is, on the male
to the female, you're going to have to take that penis off and you're going to have to make a vagina.
NARRATOR: In a male to female sex change, an incision is made in the penile skin.
It is turned inside out and stitched back together to form a vagina, in a gap year the pelvic bone.
Though the procedure is usually safe medically, it changes life irrevocably. People do experience themselves as having
a new life, a new beginning. NARRATOR: While complications can occur with any surgery,
Dr. G doubts Kim's sudden death had anything to do with her procedure several months earlier,
but she is mindful of another possible killer-- drugs. And Kim's friends are more than suspicious.
DR. G: They were very angry that she probably died of a drug overdose. They were very adamant that somebody should pay,
the pusher should pay. NARRATOR: But when the toxicology reports finally come in, Kim's friends
are surprised by the results. Well, we concluded it wasn't drugs, because the toxicology
didn't indicate drugs. NARRATOR: For Dr. G, ruling out a possible overdose only deepens the mystery.
What could have stopped this otherwise healthy 28-year-old in her tracks? As she begins the external exam, Dr. g has an immediate focus.
If drugs were not the culprit, how can she explain the injection marks on Kim's breast?
What we did find were the injection sites in her breasts, very engorged firm breasts that just were very tense.
NARRATOR: To explore the unusual condition of the breasts, Dr. G presses on the puncture wounds.
When she does, a clear viscous liquid leaks out. DR. G: We knew there was a problem
even before we opened her, once we started drawing her blood. NARRATOR: Dr. G recognizes the liquid immediately.
It's silicone, and there's lots of it. Did Kim have silicone breast implants that were leaking?
Except for clinical trials in breast reconstruction, silicone implants have been banned in the United States
since 1992. But they're easily obtained in other countries. DR. G: We were able to actually just gently press on the breast
and the silicone would pour into the vial. NARRATOR: Dr. G makes the classic y incision to open Kim's chest.
But what she finds comes as a stunning surprise. It's immediately obvious that Kim
does not have breast implants. Silicone is indeed oozing, but not from fluid filled pouches.
The silicone is seeping from the body itself. The silicone was under tremendous pressure
in her breasts. NARRATOR: In a desperate attempt to augment her breasts on the cheap, Kim has been participating in rituals
known as pumping parties. She'll be at somebody's apartment, or maybe at a motel.
And what's done is that the silicone doctor, who's not really a doctor, will inject the liquid silicone directly
into the tissue. NARRATOR: Typically, the silicone used is not medical grade, but the type found in hardware stores.
DR. G: This is a procedure that's from even the 1940s. Women would do it to try to impress men,
particularly coming back after the war, some of the Asian women. And they would inject it.
NARRATOR: While it's a brutal way to alter body shape, silicone itself isn't automatically harmful.
DR. G: Overall, it's kind of inert. If it would just stay there, it would probably be OK.
But the problem is it can migrate. And it goes other places. We were then, at that point, hunting
for where that silicone had gone and how dispersed it was in the body. NARRATOR: Had the normally inert silicone invaded
Kim's body with deadly effect? The key to the mystery lies under the microscope.
DR. G: We could see that in the blood vessels, in the capillaries, where blood should be,
every once in a while we would see a hole, a clear space. And that was the where the silicone had been.
And what's silicone going to do to the organ? The silicone is keeping that organ from getting nourishment
and oxygen from the blood. NARRATOR: In other words, Kim had been suffocated from inside her own body.
It's not a suffocation in that she's not getting enough oxygen. Her body is getting
enough oxygen. It's just she can't get it into where it's supposed to be. NARRATOR: Her investigation complete,
Dr. G is now able to recreate the chain of events that ended with Kim's death. Hours before she dies, Kim participates
in a dangerous ritual known as a pumping party, where unscrupulous medical practitioners
inject Kim's breasts with store bought silicone. While Kim has repeatedly undergone
the procedure with no ill effects, her final procedure is different. At some point during the procedure,
silicone is forced directly into Kim's bloodstream. DR. G: Whether it's due to a mass effect,
by just pure pressure being just pumped in so hard, or maybe they even actually maybe hit a vein, or a vessel,
or an artery, they're hitting a blood vessel. NARRATOR: Because it is inert, the silicone
doesn't kill Kim right away. But when it enters her bloodstream, it triggers a deadly chain of events.
DR. G: What's killing her is that her cells can't work because they're not getting oxygen, because the silicone's
replacing the blood. NARRATOR: Had she agreed to be taken to a hospital, Kim's life may have been saved, but she refused.
STACEE REICHERZER: It wouldn't surprise me for a transsexual to choose her looks over her life.
There's a fear of going back to a time when life was hell. And I think that probably for Kim, for probably a lot of us,
most of us, the idea of going back to that is worse than death. NARRATOR: Although the circumstances of Kim's death
are unique, for Dr. G, there's a broader lesson to be learned about taking risks with the human body.
DR. G: It's just not natural to be injecting silicone in your body. It's one more new kind of way that now I know you can die.
[MUSIC PLAYING]

A 94-year-old woman dies in the hospital after having a convulsion. The case becomes the business of the medical examiner's office when no one will sign her death certificate.

A Florida medical examiner takes viewers through puzzling cases while explaining procedures and conclusions.

Brief Summary

Dr. G investigates three mysterious deaths linked to medical complications and dangerous body modifications.

Key points

A Mysterious Death. A 94-year-old woman dies suddenly after surgery, leaving her family searching for answers.
The Tragic Fall. A young cyclist's life is cut short under mysterious circumstances, prompting an investigation.
The Mystery of Eric's Death. Dr. G discovers Eric's heart defect was congenital, not caused by drugs or a faulty valve.
Kim's Shocking Transformation. Kim's sudden death leads to the revelation of her past as Tim, a transgender individual.
The Dangers of Pumping Parties. Kim's death is linked to dangerous silicone injections during a pumping party.

Episode highlights

Episode quotes

Closure is not what I felt. I was devastated.

Reflecting on the loss of a loved one.

8:25WatchMay 14, 2021

Tension

75/ 100High tension

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