Dr. G: Medical Examiner - Season 3, Episode 1 - Ticking Time Bomb - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A young man dies in a freak car accident. There's no real reason why he would run off into this fence.
NARRATOR: Now it's up to Dr. G to get to the bottom of this tragic and mysterious death.
JAN GARAVAGLIA: The family wants to know. People have questions, and we're here to find
the cause and manner of death. I can't just put a car accident. NARRATOR: Then, the naked, decomposing body
of a middle-aged man is found at the foot of his staircase. Oh god. Was he drunk and fell?
Did he have some natural disease that caused him to fall, or did he collapse right there?
NARRATOR: But can Dr. G uncover the truth behind this bizarre scene? [MUSIC PLAYING]
Altered lives, baffling medical mysteries, shocking revelations. These are the everyday cases of Dr. G, medical examiner.
[MUSIC PLAYING] It's a typical Tuesday morning, and like over 200 million other Americans, Dr. Jan Garavaglia
will get behind the wheel of her car today to take her kids to school and go to work.
But unlike most drivers, Dr. G views the road with a medical examiner's eye. She views every mile, every curve as a potential pitfall.
408 is just terrible. You take your chances. Any of us could die at any minute. NARRATOR: And in fact, 1.2 million people die worldwide
in car accidents each year. Of course, the exact mechanism of death often reveals itself only through an autopsy.
And sometimes, as in Dr. G's next case, the truth can be quite surprising. Today, Dr. G will spend her time trying to unravel the mystery
behind the vehicular death of Manny Alvarez, an ambitious young warehouse manager and father.
JAN GARAVAGLIA: We have an interesting case. He's a relatively young man, only 30 years
old, that just drives his car off of a parking lot into a fence. NARRATOR: According to the investigator's report,
paramedics responded yesterday afternoon to a 911 call from a warehouse just outside Orlando.
There they discover a peculiar scene, a car at the edge of the lot with its hood
punched through the fence. The driver, Manny, is slumped and unrestrained in the front seat.
JAN GARAVAGLIA: It doesn't look like a very high speed crash, but there is some trauma to the car, they say.
NARRATOR: At first, Manny appears uninjured, but the medics quickly realize something's wrong.
He's very combative. NARRATOR: After a minor struggle, they manage to move him to a stretcher.
JAN GARAVAGLIA (VOICEOVER): He's fighting them off. He's saying crazy things. NARRATOR: But then to their shock.
JAN GARAVAGLIA: He codes, meaning they lose his heartbeat. NARRATOR: The paramedics work desperately
to resuscitate Manny. Initially, the defibrillator works, and they rush him to the ER, but the triumph is short lived.
JAN GARAVAGLIA: And then he codes again, doesn't have a heart rate, doesn't have
blood pressure at that point. NARRATOR: This time, despite repeated efforts, they're unable to revive him.
Just a short time after mysteriously crashing into a fence, Manny Alvarez is dead.
The news devastates Manny's wife, who's left alone to raise their young son and come to terms with his bizarre and unexplained
tragedy. JAN GARAVAGLIA: The family wants to know. People have questions. NARRATOR: With no witnesses to the actual event, finding
the answers will be tough. But based on her experience with vehicle related deaths,
Dr. G has a strong suspicion. Trauma. In Manny's case, Dr. G is particularly concerned
about a head injury and for good reason. The fact that he's combative, often people with head trauma
can be very combative. NARRATOR: On the other hand, Dr. G must consider other scenarios
that don't involve trauma. JAN GARAVAGLIA: It can be natural disease. Maybe he had a heart attack and just
died and ran into the fence. NARRATOR: But this type of accident is very rare. Roughly 2% to 3% of all traffic homicides
occur because of natural causes. NARRATOR: But after reading the report, Dr. G's first priority is to figure out the cause of death,
not the cause of the crash. And it boils down to one question. Do we have just trauma, or do we
have just pure natural disease going on here? My job is to figure it out. NARRATOR: As soon as the external exam begins,
Dr. G realizes Manny's injuries, if any, won't be easy to find. JAN GARAVAGLIA: We don't have any blood on him.
We don't really see any trauma. No anterior wrist scars. There is no wrist scars, like he's trying to--
committed suicide or attempted suicide before. OK, so-- NARRATOR: Even a small cut or bruise could
belie a fatal internal injury. JAN GARAVAGLIA: Oftentimes, it's very subtle, like maybe contusions to the chest or contusions
to the abdomen. NARRATOR: She also pays special attention to the head, where the hair can hide inconspicuous wounds.
Yes, sir. I, of course, look at his head very carefully, and I'm feeling for any bruises or contusions, swelling.
NARRATOR: But her search comes to a surprising end with no sign of visible trauma whatsoever.
[MUSIC PLAYING] Still, Dr. G remains suspicious of what she might find inside his body, especially his head.
You can't always tell what the trauma is from the outside, so I'm really going to have to wait for the internal
to figure out what's going on here. [MUSIC PLAYING] NARRATOR: To see if Manny had suffered a fatal brain injury,
Dr. G begins the internal exam by opening up his skull. JAN GARAVAGLIA: I've seen many people with almost completely
trauma free externally and still have severe trauma internally. NARRATOR: She must also consider another possibility--
that Manny's brain will reveal a natural disease that killed him. JAN GARAVAGLIA: A bleed in his brain or a stroke
or a ruptured aneurysm at the base of the skull could have been a reason for him to become unconscious and go
off the side of the road. NARRATOR: First, she reflects the scalp, Then removes the cranium and extracts the brain.
JAN GARAVAGLIA: Let's hope he didn't hit his head. NARRATOR: She closely inspects it for broken vessels
and unusual pockets of blood. Until finally, she arrives at her verdict. JAN GARAVAGLIA: There is no trauma to the brain whatsoever.
There's no trauma, no natural disease. NARRATOR: Dr. G has now ruled out two of the most promising explanations
for Manny's death-- head trauma and natural disease in the brain. Will the rest of the internal exam
lead to answers or more dead ends? So far, I don't really see much. [MUSIC PLAYING]
NARRATOR: Coming up next, an alarming discovery stuns Dr. G. It's a twist. But where's it coming from?
What's causing it? I don't know. NARRATOR: When "Dr. G, Medical Examiner" continues.
[MUSIC PLAYING] Continuing her search for trauma, Dr. G makes the standard Y incision along the torso
of 30-year-old Manny Alvarez. Yesterday afternoon, the young father had what appeared to be a minor car accident,
but after struggling with paramedics, he suddenly collapsed and died. JAN GARAVAGLIA: You know, it's so out of the blue.
It's so lightning strike. It's hard to believe. NARRATOR: So far, she's found no trace
of trauma or natural disease. If the cause remains elusive, Manny's family may never be able to come to terms with his untimely death.
Dr. G proceeds to open the abdominal cavity, ready to inspect his internal organs.
But there, she makes a startling discovery. Oh my gosh. He's got a tremendous amount of blood in his abdominal cavity.
NARRATOR: Dr. G immediately measures out the fluid to find out if this internal bleeding caused
his death. And after removing all the excess blood from Manny's abdominal cavity, it measures
in at a devastating 2.2 liters. JAN GARAVAGLIA: So he's lost a tremendous amount
of blood, for him a little less than half of his blood volume. That's clearly his cause of death.
NARRATOR: Dr. G has now determined what killed Manny-- this massive loss of blood.
But the autopsy is far from over. To complete Manny's story, she must now determine why he lost so much blood in the first place.
JAN GARAVAGLIA: Where's it coming from? What's causing it? I don't know at this point.
Yeah, it could have. NARRATOR: Typically, a car accident leads to internal bleeding in one of two ways.
The first is when the vehicle suddenly stops, but the heart continues its forward motion
in the body cavity, ripping surrounding vessels such as the aorta. JAN GARAVAGLIA: Part of the aorta is free,
and part of the aorta is anchored to your back. And so what happens when you have a deceleration injury,
it tears right there, right at the point where it's anchored. NARRATOR: But a torn aorta located above the heart
would not have bled into the abdomen. That blood would be in the chest cavity. NARRATOR: Instead, Dr. G suspects
Manny died from the second major source of internal bleeding in a crash-- injured organs.
JAN GARAVAGLIA: I'm thinking, he's got to have torn his spleen or his liver. NARRATOR: Now, Dr. G examines Manny's
organs in situ, while they're still inside the abdominal cavity. If he had ripped open his spleen or liver,
she'll be able to see the gash or feel it with her hands. But shockingly, she can't find any wounds anywhere.
JAN GARAVAGLIA: The liver was clearly not damaged, and the spleen, it was intact also.
It didn't have any tears to it. NARRATOR: This lack of trauma baffles Dr. G. So at this point, I don't know why
he has this blood in his belly. NARRATOR: The entire case hinges on whether she can find the mysterious source of bleeding.
As a next step, she preserves some of the collected blood for a toxicology screen.
JAN GARAVAGLIA: I have to remove blood, because did alcohol play a role? Why did he go off the side of the road?
NARRATOR: Then, she extracts the organs for further examination. She first removes his lungs and heart.
JAN GARAVAGLIA: And then I'll do my routine dissection. NARRATOR: But these organs reveal no new clues.
Whatever is wrong with him is in his abdominal cavity. That's where he's lost the blood.
NARRATOR: With her options dwindling, Dr. G begins to remove and dissect the spleen,
but then something next to the spleen grabs her attention. I notice that there is something wrong.
NARRATOR: It's not an injury, but an unusual patch of fat on the splenic artery, a major blood
vessel that supplies oxygenated blood to the spleen. The splenic artery, the artery that's going to the spleen
runs right across the top of the pancreas. And there's a little bit of fat, mesenteric fat,
adhered to in the area of the tail of the pancreas. NARRATOR: Now, Dr. G must determine
what this strange finding means, and could it somehow be linked to Manny's massive internal bleeding?
Coming up next, Dr. G discovers a shocking time bomb in Manny Alvarez's body. It happened very suddenly, and it's just
one of those freaky things. NARRATOR: When "Dr. G, Medical Examiner" continues. [MUSIC PLAYING]
Dr. G carefully inspects a little piece of fat, oddly attached to Manny Alvarez's splenic artery.
She is determined that the 30-year-old father died from massive internal bleeding after running
his car into a fence. But so far, she's found no trauma to any organ. JAN GARAVAGLIA: So it really wasn't making a lot of sense
where this blood was coming from. NARRATOR: Could this little piece of fat hold the key
to Manny's untimely death? [MUSIC PLAYING] Dr. G gingerly removes this bit of fat.
And right underneath it on the splenic artery itself, she finds the answer she's been looking for.
JAN GARAVAGLIA: And lo and behold, I see that there is an aneurysm. He's got an abnormality.
Instead of just having the nice tube of a vessel with blood going through it, we have a tube of a vessel
with like a little balloon attached to it, almost an inch by an inch in size. It's fairly big.
NARRATOR: An aneurysm is an abnormal ballooning of the artery, caused by the weakening of the artery wall.
Aneurysms most often occur in the brain or the aorta, a major artery that carries blood from the heart
to the rest of the body. Each year, they afflict over two million Americans often
with little or no symptoms. But if they go untreated, aneurysms can silently grow, thinning out the wall of the vessel.
Eventually the vessel wall can become so thin that it can no longer hold in the circulating blood,
and it tears open. People die rather suddenly when those burst. NARRATOR: Immediately, Dr. G can tell that's exactly
what happened to Manny Alvarez. The aneurysm in his artery wall leading to the spleen
became stretched beyond capacity and burst open. JAN GARAVAGLIA: It looks like it had a big pop or a big opening.
That's worrisome. Which caused all that blood to rush out into his abdomen. NARRATOR: It's clear right away that this
is not a result of trauma sustained in the accident. JAN GARAVAGLIA: Trauma doesn't cause your vessel to balloon.
NARRATOR: In fact, the little patch of fat proves that the aneurysm had been slowly leaking
blood for at least a week. JAN GARAVAGLIA: I can tell because the body's trying to stop it.
The fat kind of goes there and tries to block off that kind of oozing. It's sticking like glue to it.
It was just too much for the body to fix. NARRATOR: For Dr. G, there's no question now
that this burst aneurysm is at the root of Manny's massive internal bleeding. But splenic aneurysms are an extremely rare cause of death,
especially among men. In fact, they are four times more common in women. Pregnant women are at the greatest risk.
JAN GARAVAGLIA: With gestation, they think there are some changes to the walls of the vessels that
maybe make them more relaxed, and it makes it more vulnerable to out pocketing and a ballooning out.
NARRATOR: Though the cause of splitting artery aneurysms is not fully understood, they can
be the result of a congenital defect in the artery wall. And Dr. G believes that this is likely
what caused his aneurysm. JAN GARAVAGLIA: You know, what's happened is he was born with a weakening of the wall
of that blood vessel, and it's just one of those freaky things. NARRATOR: With this unusual finding in hand,
she can finally tell Manny's wife, and family exactly what happened on the day of his fatal crash.
[MUSIC PLAYING] Up until his death, Manny Alvarez seems to be living a perfectly healthy life.
But over the years, a virtual time bomb has been ticking away deep inside his body--
an aneurysm on his splenic artery, most likely the result of a defect in the blood vessel
that had been there since birth. JAN GARAVAGLIA: For whatever reason, that weakened area of the blood vessel starts to balloon.
He doesn't have any symptoms from that. NARRATOR: A week or two before his death, the aneurysm
reaches a critical point. It begins to bleed just slightly. Maybe it drops, just oozing a little bit.
His body fights to contain the blood. JAN GARAVAGLIA: The fat kind of adheres to it from the abdomen,
but it's not enough. NARRATOR: Then one day, as Manny is driving out of the parking lot at his warehouse,
the bomb goes off. JAN GARAVAGLIA: He's probably feeling great as he gets into his car, until it burst.
NARRATOR: Blood gushes from the hole, pouring into the abdomen. Overcome by hemorrhagic shock, he loses control of the car.
Runs off the road into the fence. NARRATOR: He suffers no trauma, but the paramedics
find him in critical condition. JAN GARAVAGLIA: When they get to him, his blood pressure is getting low.
He's combative. That's because his brain isn't getting enough blood. NARRATOR: Eventually, his heart also begins to shut down.
The paramedics try to resuscitate him, but to no avail. JAN GARAVAGLIA: And he codes.
He cannot maintain his blood pressure anymore, because the blood is all going into his abdomen.
The blood is just pouring out of that tear too fast. NARRATOR: Then, drained of more than two liters
of the life-sustaining fluid, Manny dies from internal bleeding. [MUSIC PLAYING]
Dr. G rules the manner of death as natural, not accidental. JAN GARAVAGLIA: Now, in this case,
it's the pure natural disease. He clearly just died from a ruptured splenic aneurysm
that was developing over a long period of time. There was no trauma associated with that car accident.
NARRATOR: Instead, it was a rare case in which natural disease caused both the accident and the death.
His wife and family are relieved to have an answer, but are still stunned by the findings.
JAN GARAVAGLIA: When I tell them they has a weakness of splenic artery aneurysm,
and that's why he died, I think they're shocked. They're like, what? It's hard for them.
It's hard for them to grasp. NARRATOR: Dr. G knows all too well death can take anyone by surprise.
JAN GARAVAGLIA: You may have an aneurysm that's getting ready to blow any minute.
[MUSIC PLAYING] Maybe you ought to go hug your loved one. NARRATOR: The only thing to do is make the most of every day.
Life is a crapshoot. You never know when it's going to end. Think about that and maybe change the way you live.
You know, you may not have forever. [MUSIC PLAYING] NARRATOR: Coming up next, a landlady
discovers the contorted decomposing body of a man in his home. Did he accidentally fall, or is something
more sinister to blame? Anything's a possibility. NARRATOR: When "Dr. G, Medical Examiner" continues.
[MUSIC PLAYING] JAN GARAVAGLIA: It's a busy day. We've got about eight autopsies, a couple
homicides, a decomp coming in, about four car accidents. There's a lot of things that come into my office that
are uncommon. Let me go get my-- We don't always see the common. we often see those things that are a little bit
odd, a little bit different. NARRATOR: And that's exactly the case with Dr. G's next autopsy of the day.
[MUSIC PLAYING] As a first step, Dr. G reads over her investigator's report, which describes the circumstances
behind 65-year-old Sam Gray's unusual death. So it looks like we have a fellow that's naked at the bottom of the stairs.
NARRATOR: The decedent is a retired salesman who had moved into a small two-story apartment in Orlando
after his wife's death. He basically lives alone. We don't know anybody that really has contact with him.
NARRATOR: Shy by nature, Sam leads a reclusive life and seldom interacts with his neighbors.
But after hearing complaints of a strange odor in the building, his landlady stopped by to investigate.
They haven't seen him around. There's starting to be a little bit of an odor coming from the apartment.
Something wrong over there, be it, you know, a gas leak or a dead animal or a dead person.
Obviously, they're all hoping that it's not a dead person. Sam? NARRATOR: When Sam doesn't answer the door--
The landlady used a passkey to get in. NARRATOR: Moments later, she comes face to face
with a gut-wrenching sight-- Sam, naked, dead, and decomposing. Police immediately notified the medical examiner's office.
JAN GARAVAGLIA: My investigator went out there, took pictures, and investigated.
It looked as though he had fallen from somewhere up on the stairwell. His lower legs and feet were still on the stairs.
The body-- NARRATOR: After evaluating the scene, police find no reason to suspect foul play.
It was a secured apartment, OK? And they had to use a key to get in, and there were no signs of forced entry.
I mean, that certainly wasn't a break in. NARRATOR: The real question is, did this man simply
die of trauma from the fall, or did natural disease play a role? It's either going to be that the fall killed him--
maybe he broke his neck, maybe he hit his head-- or that he died of maybe a heart attack
or a stroke, something that would have caused him to go down immediately. NARRATOR: Despite the fact that Sam Gray was an older man who
lived alone, Dr. G is determined to figure out exactly how he died. As a medical examiner, it is her responsibility
to investigate any unwitnessed or unusual death. Unfortunately, one big piece of the puzzle is missing--
Sam's medical history. JAN GARAVAGLIA: We don't know what he's got a history of.
NARRATOR: In hopes of gathering information about Sam's medical history, investigators
attempt to track down any surviving family members. They're only able to locate his daughter,
and she reacts with both shock and guilt. She hadn't spoken to her father in years,
and she knows nothing of his health. But now, she is desperate to know exactly what caused
her father's untimely death, and might it have been prevented had help been closer by?
With little information about his medical history, Dr. G must work from a blank slate.
JAN GARAVAGLIA: It's really not the best way to practice forensics. When it's not there, you deal with it,
and you see what you can find. [MUSIC PLAYING] NARRATOR: Dr. G begins the external exam,
searching for any hints about Sam's life that could help explain his death. Immediately, a few clues speak to her loud and clear.
Overall, he looked kind of thin. He's got muscle wasting of his arms and legs, but yet, he has some protuberance to his belly.
NARRATOR: Next, she physically examines the belly. If Sam had suffered an internal injury from the fall,
the bulge may be a result of massive bleeding. JAN GARAVAGLIA: I palpated and check
to see if there's maybe ascites or fluid collection, but it feels like fat. NARRATOR: Apparently, Sam is simply overweight,
albeit primarily around his stomach. But this trait could indicate a pre-existing medical problem,
such as alcoholism. JAN GARAVAGLIA: It's something we see with people who maybe drink a lot.
NARRATOR: If Sam was an alcoholic, it's possible that the fall and death were the result
of a drunken accident. He could have maybe been drunk at the top of the stairs and fallen down, broken his neck.
NARRATOR: Then she makes another discovery, a distinct wound pattern on his head.
JAN GARAVAGLIA: He's got two abrasions on his forehead just above kind of the medial or middle portion
of his eyebrow on the left. So when you put together the picture of where he is found,
it's probably where he hit the side of the wall with his head. NARRATOR: An impact like that could
cause bleeding in the brain, a likely cause of death. We'll see how significant those
are when we look internally. [MUSIC PLAYING] NARRATOR: Coming up next, Sam's body
unleashes a Pandora's box of problems, but the cause of death remains elusive. There's nothing that says that this is what killed him.
NARRATOR: When "Dr. G, Medical Examiner" continues. [MUSIC PLAYING] Dr. G's morgue technician, Arden Monroe,
reflects the scalp of 65-year-old Sam Gray. I'm going to look for a bruise where he hits
his head against the stairs. NARRATOR: Yesterday, Sam's landlady found his body, naked and decomposing
at the bottom of a staircase. That's the worst nightmare for an older person who
lives alone, that something could happen to them and nobody notice, and nobody find them.
NARRATOR: Now, Dr. G follows a clue from the external exam-- one that may unravel the case or drive
her deeper into the mystery. [MUSIC PLAYING] She painstakingly examines Sam's reflected
scalp and the exposed cranium, and surprisingly, finds no injuries. His skull looks intact.
I don't see any skull fractures. I don't see any bruises. NARRATOR: Still, she's not ready to rule out head trauma
as a cause of death just yet. I really need to look at his brain. NARRATOR: If his brain sustained a fatal injury,
Dr. G would expect to find excess blood in and around the organ itself. I open up his skull, take the calvarium off.
NARRATOR: And upon extracting the brain, she immediately has her answer. JAN GARAVAGLIA: And I see that his brain
has no evidence of trauma. NARRATOR: Whatever killed Sam, it's not a head injury from the fall.
Now Dr. G must look for clues to Sam's mysterious death in the internal exam. [MUSIC PLAYING]
Dr. G makes the standard Y incision, exposing the abdominal cavity. First, she checks for any blood or fluids that
could indicate internal trauma. JAN GARAVAGLIA: Open them up, oftentimes we'll see rib fractures when you fall down the stairs.
I don't find any rib fractures. All his organs look in place. There's no free fluid.
I don't see any trauma yet in any of the body cavities. NARRATOR: Now, the only place left
to look for trauma is his neck. JAN GARAVAGLIA: I need to see his vertebrae where
his spinal cord goes through, and I need to see his neck to make sure he didn't break his neck.
NARRATOR: Broken vertebrae are a common cause of death in accidents such as this.
Falls or other trauma to the upper body can damage the spinal cord, shutting down critical nerve
signals to vital organs. But upon dissecting the area, she finds no damage whatsoever
to the bones or the cord. And I don't see any signs of trauma. I really don't think that trauma is going
to play a role in his death. NARRATOR: At this point, she can safely rule out a fatal injury from the fall as a cause of death.
But if an accident didn't kill Sam, what did? JAN GARAVAGLIA: I don't know yet. I'll have to look at each organ individually to see.
We're going to have to look for evidence of natural disease. [MUSIC PLAYING] NARRATOR: Now, Dr. G begins inspecting
the organs one by one. [MUSIC PLAYING] And it doesn't take long before suspicious clues emerge.
JAN GARAVAGLIA: One of the first things I notice is his liver is abnormal, and the liver should be
brown with a nice sharp edge. His liver has a rounded edge, kind of large, and has kind of a yellow appearance
as if there's fat in the liver that we see often with alcoholism. NARRATOR: Then Dr. G discovers another ailing organ that
also hints at alcohol abuse. JAN GARAVAGLIA: And his pancreas shows some disease.
Some of the tissue has turned waxy and died, and there's little calcifications in it.
NARRATOR: She recognizes the illness as pancreatitis, or inflammation of the pancreas.
I see evidence of chronic pancreatitis, which the vast majority is usually due to chronic alcoholism.
NARRATOR: As she makes her way to the lungs, it becomes obvious that alcohol isn't Sam's only vice.
JAN GARAVAGLIA: The lungs are-- there's anthracotic pigment, that blackening that we often see with smoking.
I don't know anything for sure, but his insides look like a smoker and a drinker.
NARRATOR: A fatty liver, a diseased pancreas, and black lungs. Dr. G no longer has a blank slate,
but a myriad of health problems. Still, none of these spell out a cause of death.
JAN GARAVAGLIA: They wouldn't have caused him to die suddenly that I can find. Let's do this heart--
NARRATOR: Now, Dr. G turns to one of the last major organs she's yet to examine--
the heart. When I get to the heart, I realize that his heart's enlarged. It's heavy.
It weighs more than it should. This is what we would see in high blood pressure.
The heart is definitely abnormal. NARRATOR: And as Dr. G cuts into Sam's heart, she makes another critical discovery in his main arteries.
It has coronary artery disease, narrowing to the blood vessels that supply blood and oxygen in the heart.
NARRATOR: The condition is severe. Sam's main arteries are up to 90% blocked. I really hardly ever see it that bad.
He certainly has enough heart disease to cause his death. And that disease would have killed
him, possibly in bed, while he's walking down the stairs. He could have died very quickly from that.
NARRATOR: The blocked arteries fit with the earlier signs of smoking, a habit known to increase
the risk of heart disease. With this highly restricted blood flow, Sam was in constant danger of collapse.
JAN GARAVAGLIA: Basically, what he has is he's probably walking down the stairs,
and he has a sudden arrhythmia, an irregular electrical heartbeat. NARRATOR: But an arrhythmia does not
leave behind any concrete evidence within the heart itself. JAN GARAVAGLIA: There's nothing that says
that this is what killed him. I have to rule everything else out. NARRATOR: To eliminate any other possible causes of death,
her morgue tech collects blood and fluid samples to send to the toxicology lab. JAN GARAVAGLIA: I'm going test him for glucose.
I'm going to test him for any kind of drugs. Certainly going to test him for alcohol.
We're going to look to see if anything else could've killed him. NARRATOR: Dr. G's final ruling now hinges
on the toxicology report. She hopes those results will provide her with some definitive answers to Sam Gray's mysterious death.
[MUSIC PLAYING] Coming up next, a number turns the case upside down. I am actually quite astonished.
NARRATOR: When "Dr. G, Medical Examiner" continues. [MUSIC PLAYING] Dr. G sends Sam Gray's blood and eye fluid samples to the lab
for a full toxicology screen. The 65-year-old widower had died alone, his body later discovered at the bottom of his staircase.
Based on the severe heart disease she found in the internal exam, Dr. G believes Sam suffered
a sudden heart arrhythmia. I've ruled out trauma. I've ruled out other diseases.
The heart may be the smoking gun. The heart may be where it's at. You know, it was all consistent with the way he's found.
I think that's all she wrote for now. We have to stay tuned until I get more info.
NARRATOR: But she cannot make her final ruling until the tox report comes back. That's another pending.
[MUSIC PLAYING] NARRATOR: Six weeks later, Dr. G receives the tax report for Sam Gray.
And the results are nothing short of shocking. JAN GARAVAGLIA: What was astonishing
is he's got very little alcohol in him. NARRATOR: Instead, he has a conspicuous amount of blood
sugar, also known as glucose. JAN GARAVAGLIA: Glucose is a sugar that fuels your body.
It's your fuel. NARRATOR: But in some people, the body cannot use this fuel because they don't have enough insulin,
the hormone that normally carries sugar into cells. As a result, glucose accumulates in the blood.
This is the illness known as diabetes. JAN GARAVAGLIA: He's got a very high glucose.
That's telling me he's diabetic, which was really a surprise to me, because we had no idea he was diabetic.
NARRATOR: But what astounds Dr. G even more is just how high his glucose level is.
JAN GARAVAGLIA: Most of my cases, when I check the glucose, it's almost a zero, because glucose goes down rather quickly after death.
His glucose is over 600, which means that when he was alive, it was probably well over 1,000.
NARRATOR: That's almost 10 times the norm-- an extraordinary number that tells her Sam's diabetes
was out of control and very deadly. JAN GARAVAGLIA: He doesn't have the insulin to get
the glucose into the cells. And what the cells are feeling is, I have no fuel. I have nothing.
I'm starving here. NARRATOR: To compensate, Sam's body needs to break down fats and proteins
to use as emergency fuel. This produces ketones, a byproduct that turns blood dangerously acidic.
JAN GARAVAGLIA: That's bad for your body. Your body can't get energy. The cells can't get energy.
You cannot function. You also get extremely dehydrated. You just can't maintain your blood pressure,
and you collapse, and you die. NARRATOR: This fatal condition is called diabetic ketoacidosis.
JAN GARAVAGLIA: It's a deadly complication if not treated. Now, once you get to the hospital,
I mean, the mortality is very low. It's maybe only 2%. But no treatment, it's about 100% fatal.
NARRATOR: Weighing all the evidence under a different light, Dr. G considers a new cause of death--
one that could not only explain his collapse, but almost every other finding in the autopsy.
JAN GARAVAGLIA: I originally kind of put the pieces together that he's an alcoholic, disheveled guy that walks
around naked, but certainly, diabetes, and his diabetes being out of control, could have also been the answer
to a lot of what I found. NARRATOR: His wasting muscles. JAN GARAVAGLIA: His diabetes has probably been out of control
for a long time. It's probably why he's losing weight. NARRATOR: The recurrent pancreatitis.
JAN GARAVAGLIA: It could destroy the cells that produce the insulin. NARRATOR: The fatty liver.
JAN GARAVAGLIA: With a diabetic liver, you can see a very fatty liver, and it may
not be due to alcohol at all. Well, looking back, putting it all together, that really fits.
NARRATOR: Dr. G also considers the fact that Sam lived alone, was on no medication,
and seemed to pay little attention to his health. JAN GARAVAGLIA: I really don't think he knew he was diabetic,
and that is not unusual that the first presentation of diabetes is diabetic ketoacidosis.
NARRATOR: Ultimately, Dr. G has no doubt as to what killed Sam Gray. JAN GARAVAGLIA: There is very few things that I would think
would trump the heart in this case, but I think a glucose with ketones will trump it.
I believe he died from diabetic ketoacidosis. NARRATOR: Now, she can finally replay
the entire story behind Sam Gray's unusual death. [MUSIC PLAYING] Widowed for years and his only daughter estranged
and far away, Sam Gray pays little mind to his health. JAN GARAVAGLIA: I doubt that he's gone to a doctor recently.
I doubt that he's taken good care of himself. NARRATOR: And he's got not one, but two serious illnesses--
heart disease and diabetes. In his heart, plaque has built up, blocking off up to 90%
of his main arteries. JAN GARAVAGLIA: He would have died from his heart disease probably in the near future.
NARRATOR: But surprisingly, his heart is not the first to give way. Instead, the diabetes chips away relentlessly at his life.
JAN GARAVAGLIA: And his diabetes is getting worse and worse. He's probably starting to lose weight.
NARRATOR: Then, in the last few weeks, his glucose reaches a dangerously high level.
JAN GARAVAGLIA: He's getting more and more thirsty. [MUSIC PLAYING] Getting headaches, not feeling well, feeling weak.
NARRATOR: A few symptoms may even drive him to shed his clothes. JAN GARAVAGLIA: He's probably vomiting.
He's probably urinating a lot, because his body's trying to get rid of all that sugar.
Probably got terrible diarrhea, and he just figures, to heck with it, it's easier to be naked.
NARRATOR: Unfortunately, the little comfort he gains does nothing to curb the effects of sugar
and acid rising in his blood. JAN GARAVAGLIA: His blood sugar is going higher and higher.
The cells are starting to starve because he doesn't have any insulin. NARRATOR: To compensate, his body begins to break
down fat and protein for fuel. But this unleashes the deadly byproduct ketones, which disrupt the body's control of fluid levels
and nerve functions. Now, on the day of his death, the condition spirals out of control.
And while trying to make his way down the stairs, he slips into a coma. JAN GARAVAGLIA: He just collapsed.
That just happened to be where he was. NARRATOR: With no one to call an ambulance,
Sam has no chance of survival. JAN GARAVAGLIA: And dies at the bottom of the stairs.
[MUSIC PLAYING] NARRATOR: For Dr. G, the case highlights a golden rule of forensic science--
keep an open mind, especially when starting from a blank slate. A new piece of information may totally
change the picture of what he was like and how he died. NARRATOR: Thanks to the complete autopsy, Sam's daughter
can now faced the truth and reality of her father's death. But she may never overcome the guilt of not being there
when he needed her most. JAN GARAVAGLIA: It's sad that people-- you know, here he is, he lives alone.
He's not taking care of himself. You know, he dies, and nobody really checks on him for a couple days.
The only reason anybody checks on him is because he's kind of starting to smell.
It is sad. It's sad that people are so isolated in this world. [MUSIC PLAYING] MALE: [WHISPER] Atlas.

Manny Alvarez mysteriously crashes his car into a fence. He dies en route to the hospital, leaving behind a wife and son. It is up to Dr. G to find out what cut this young man’s life short.

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

Brief Summary

Dr. G investigates two deaths: Manny's car accident linked to a ruptured aneurysm and Sam's fatal diabetic ketoacidosis after a fall.

Key points

Manny Alvarez's Mysterious Death. A young father dies unexpectedly after a minor car accident. What caused his death?
Dr. G's Shocking Discovery. Dr. G uncovers a rare aneurysm as the cause of Manny's death, not trauma from the accident.
The Mystery of Sam Gray's Death. Dr. G investigates the unusual death of Sam Gray, uncovering a complex medical history.
A Shocking Discovery. Toxicology results reveal Sam's dangerously high glucose levels, indicating uncontrolled diabetes.

Episode highlights

Episode quotes

It's so out of the blue.

Dr. G reacts to the unexpected nature of the case.

8:44WatchJun 8, 2021

Tension

75/ 100High tension

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