Dr. G: Medical Examiner - Season 3, Episode 3 - Deadly Destination - Full Episode | Forensic Files

[DRAMATIC MUSIC] NARRATOR: An elderly man dies at home from apparent natural disease.
He has severe coronary artery disease. He has hypertension, he has diabetes. NARRATOR: But when his family discovers his car is missing,
they wonder if something more sinister is to blame. JAN GARAVAGLIA: I think everybody is thinking,
could this be foul play. NARRATOR: Now, Dr. G must solve this puzzling mystery. JAN GARAVAGLIA: We're going to bring him back
from the funeral home, and I'm going to make sure there's no evidence of trauma.
NARRATOR: And then, a 73-year-old grandfather takes a relaxing trip to Orlando with his family,
only to find himself wracked with pain on his first night in town. JAN GARAVAGLIA: The next morning,
he eats breakfast and then just doubles over in abdominal pain. As soon as he went down, he was dead.
NARRATOR: Can Dr. G determine what suddenly overwhelmed this seemingly healthy man?
I have to think a what could cause the abdominal pain and then kill you? NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations. These are the everyday cases of "Dr. G, Medical Examiner."
This morning, Dr. G's day won't start in the morgue. Instead, in an effort to stay fit and healthy,
she's off for a jog. JAN GARAVAGLIA: I got the radio on, the Bee Gees going. I listen to some great music.
Usually something to get your blood going. And then I'll start running, and I can run a couple miles.
Even though I have a hectic home life, you gotta make time for yourself in one good way,
and you can kill two birds with one stone, I find, is if you exercise, because you're
doing something good for yourself, and it's a great stress reliever. I would love to be a couch potato,
but I know it's good for me, and I it's a good way to relax. NARRATOR: But by 8:15 AM, she is in the morgue, ready to start
work on the day's autopsies. This morning, Dr. G's first case is a man who was found dead in his home in Deltona, Florida
late last night. JAN GARAVAGLIA: So this is a fellow we got a call from yesterday.
He's an older man, 81. He has a locked apartment. NARRATOR: As a first step, Dr. G reviews the case
file of Ricardo Sanchez and learns the events leading to his death. According to investigator, Bill Stratton, friends and family
last saw Ricardo four days earlier when he left a small get-together just before dusk.
BILL STRATTON: The decedent was going to drive home before dark, because he didn't like driving at night because
of his age and his eye-- he had some minor eye problems. NARRATOR: Bill Stratton learned from his family
that Ricardo was an energetic man with a great sense of humor. During the last several years, he had spent most of his time
with his close-knit family, enjoying his retirement. Like many of the elderly, Ricardo,
who had lived alone since his divorce 10 years earlier, clung to his independence.
He insisted on driving rather than rely upon others for transportation. He also refused any professional home care
despite his failing health. As far as his family and friends knew, Ricardo made it home safely that evening.
However, four days later, no one has heard from him. JAN GARAVAGLIA: His family worried about him.
They did a welfare check on him and found him deceased in his locked apartment. NARRATOR: Ricardo's son and sister discover him face down
on the floor wearing the same outfit he had on at the family get-together. JAN GARAVAGLIA: He is just dead right
there as if he had collapsed. NARRATOR: According to the police officer who was called
to the scene, the body is already beginning to decompose, but there were no signs of foul play.
HAROLD FELSHAW: There was nothing that appeared to be out of the ordinary or suspicious
in nature. His door was locked. There was nothing in disarray. He had his car keys in his pocket.
He had his billfold in his pocket. He had his jewelry on. His clothes were intact.
Everything seemed fine. It looked as if he had just collapsed. Our belief, the police department's belief,
and the medical examiner's office was that this was a natural death. We didn't have any reason to believe otherwise.
NARRATOR: And when contacted, Ricardo's private physician agrees with the assessment.
JAN GARAVAGLIA: We called the doctor, the doctor said, yeah, he has severe coronary artery disease.
He has hypertension. He has diabetes. He could have died at any time. NARRATOR: Ricardo's death is classified as natural,
and his body is transferred to a funeral home for burial. But only hours later, his family makes a startling discovery,
one that raises new suspicions. His car is missing. JAN GARAVAGLIA: The detective gave us a call
and said, you know, the fellow that we released, everything was still-- it was fine, except where's his car?
So that right there is kind of a red flag to indicate that something's not right.
I think everybody is thinking, could this be foul play? I said, well, you know, we should look at him.
We should go back. We should go to the funeral home, bring him in, at least do X-rays and look at him externally.
NARRATOR: Based on this new information, Dr. G wonders if Ricardo did not die from natural causes
after all. JAN GARAVAGLIA: We'll go ahead, we'll check on him any type of trauma, and we'll
go ahead and do X-rays and see if we see anything. NARRATOR: Before the examination,
morgue technicians take extensive X-rays of Ricardo's body. JAN GARAVAGLIA: We did an X-ray of his skull.
We did an X-ray of his ribs and long bones. NARRATOR: While soft tissue internal injuries may not
be detectable in an X-ray, if Ricardo sustained any fractures in an attack, these will show up on the film.
While the images are being developed, Dr. G prepares for the external exam. She will search for any signs of trauma
that might indicate Ricardo was the victim of an assault. JAN GARAVAGLIA: But I certainly didn't
see any major trauma on him. NARRATOR: And when Dr. G reviews the X-rays a few minutes later,
she finds no fractures or skeletal injuries either. JAN GARAVAGLIA: We really don't have any foul play.
We don't have anything really that suspicious. NARRATOR: Because she finds nothing out of the ordinary,
Dr. G decides not to perform a full autopsy. Instead, just after noon, Ricardo's body is
returned to the funeral home. However, with explanations wanting, the Sanchez family remains unsettled
by the elderly man's death. JAN GARAVAGLIA: They're concerned what happened to him.
But they're more concerned what happened to the car and did it relate at all to his death?
NARRATOR: Then, just hours after Ricardo's body is released from the morgue, the Orlando
Police Department calls Dr. G with startling new information. [PHONE RINGS] Ricardo's vehicle has been located in an auto wrecker lot.
Yeah. We ran into a little difficulty. Now we knew that this man was involved in a motor vehicle crash.
JAN GARAVAGLIA: Now I have to worry, was he injured from the car accident? NARRATOR: Given the unusual circumstances surrounding
Ricardo's death and to bring closure to his family, Dr. G must perform a full autopsy.
JAN GARAVAGLIA: And so lo' and behold, this changes the complexity of the case. NARRATOR: When his family receives the disturbing news
that Ricardo's death may be due to a car accident, their distress and grief are compounded by another emotion.
JAN GARAVAGLIA: The family feels a lot of guilt because they know that their loved
one's older family member's driving skills aren't probably as good. But yet, they don't want to take it away, because then
you take away their freedom. NARRATOR: The body must be immediately transported from the local funeral home to the morgue for a second time.
JAN GARAVAGLIA: So what we're going to do is figure out what killed him. NARRATOR: Coming up next, Dr. G opens
the body of Ricardo Sanchez, and the case takes a sharp turn. JAN GARAVAGLIA: He was a walking time bomb.
He could have died at any time. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] Early in the morning, the body of 81-year-old Ricardo Sanchez returns to the District 9 morgue in downtown Orlando.
Orlando police have just discovered that he was in an auto accident on the day of his death.
Now, his family and Dr. G want to know if Ricardo's death was caused by an injury in the accident and not
natural disease, as they had suspected. JAN GARAVAGLIA: If I hadn't have called that booty back,
I would have been remiss in my duties as a medical examiner. NARRATOR: Before beginning the examination,
Dr. G learns the specifics of the crash from the investigating officer at Orlando PD.
JAN GARAVAGLIA: Classic kind of old-person accident. He fails to yield and makes the turn in front of a car
that's coming in that lane. NARRATOR: Now, Dr. G must determine if Ricardo Sanchez's death was in fact caused
by a tragic car accident. JAN GARAVAGLIA: So what we're going to do is look for trauma,
look for natural disease. Bottom line, figure out why he died. And so I do the Y incision.
Keep in mind, he's decomposed. He won't have any blood left. So I'm having a hard time doing tox.
He does have some maroon bloody decomposition fluid that we typically see in his chest cavity.
I would remove that for toxicology. NARRATOR: Dr. G then examines Ricardo's internal organs.
She's looking for any signs of internal trauma that may have been sustained from the accident.
JAN GARAVAGLIA: One thing that I'd worry about is maybe a delayed complication would be a spleen that
had ruptured or maybe a liver laceration, where blood is accumulating. I was worried about that.
Didn't have that. Didn't really have any trauma to his abdomen. OK. I don't see anything.
NARRATOR: But Dr. G sees no ruptures or lacerations. And she finds no sign of internal bleeding.
JAN GARAVAGLIA: And I don't see any free blood anywhere. I don't see any free blood in his chest, just
that decomp fluid in his belly. NARRATOR: Based on these findings, it seems that Ricardo's death was not related to the accident
after all. Dr. G is now left with the original hypothesis, that the 81-year-old man died of natural causes.
His medical history certainly supports this possibility. According to Ricardo's doctor, he
suffered from high blood pressure, emphysema, and heart disease. Dr. G will now weigh and dissect each organ to search for signs
of fatal natural disease. She starts with the heart. He has narrowing of every vessel sectioned.
They were at least 75% narrowed in every section that I looked at. So he was a walking time bomb as far as dying from that heart.
NARRATOR: At this point, Ricardo's diseased heart is looking like the culprit. JAN GARAVAGLIA: And that is a possibility.
And that's right now all we can find. NARRATOR: But she must complete the full autopsy
to know for sure. JAN GARAVAGLIA: I have to make sure there's nothing that trumps that heart.
NARRATOR: Coming up next, Dr. G examines another organ, and the case veers off course yet again.
JAN GARAVAGLIA: I find blood, and it's fresh blood. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] OK. So he's ready to go up to the head. - Up to the head. - OK.
NARRATOR: Dr. G prepares to examine the brain of 81-year-old Ricardo Sanchez. Internally, she's discovered evidence of extensive heart
disease and suspects that he may have suffered a fatal heart attack only a few hours after being involved
in a minor car accident. This would mean that Ricardo did, in fact, die of natural causes, as was first suspected.
JAN GARAVAGLIA: He certainly had enough heart disease to have killed him. NARRATOR: But before she can close the case,
she must complete the autopsy and rule out everything else. Was there anything else that could've killed
him instead of that heart? NARRATOR: As a next step, Dr. G examines the skull of Ricardo Sanchez to feel for any softness
that might indicate trauma. But this exam is particularly difficult due to the state of decomposition.
It was just a little bit mushy throughout because of the decomp. You know, a lot of gases form and fluid collects.
And particularly, as you're on your back, there's some fluid that collects in the back.
NARRATOR: Next, she cuts open the scalp and reflects it to expose the top of the skull.
And there she sees for the first time something unmistakable. He's got a bruise on the back.
There was just a bruise there. This was quite clear as soon as I cut open. It was a bruise in the back of his head,
and it was also what we call subgaleal. It was over that thin covering over the bone.
How that relates to any of this, we're not sure yet. We just know he bumped his head.
So the next thing we have to do is look inside the brain. And I know I only have a second here, because that brain
is going to be very soft. NARRATOR: As the brain decomposes, it turns into a semi-liquid state, which can obscure
signs of trauma or disease. JAN GARAVAGLIA: I'm not going to be able to see subtle things on his brain,
because it's going to be green and pasty. And it's going to lose a lot of its contour.
So I'm hoping there's something either very obvious or nothing at all. NARRATOR: And in this case, it's very obvious.
JAN GARAVAGLIA: As my assistant cuts open the calvarium, and I'm kind of looking.
I'm the one that then takes it off and immediately looks and, oh. I find blood overlying the cerebral hemispheres,
overlying the brain, and it's fresh blood. You know what? Let's get time to collect this, my love.
NARRATOR: What Dr. G finds is a subdural hematoma, a bleed in the brain that occurs under the dura,
the protective membrane that covers the brain. And these little bridging veins with some trauma
can shear, and then blood starts collecting. Well, where's that blood going to go?
It doesn't have a lot of places to go, because you have that brain usually up tight against there.
So it starts pushing on the brain. Well, at this point, it's fairly clear. He definitely has trauma to the brain.
NARRATOR: It's a shocking discovery. Lo' and behold, that's his cause of death. NARRATOR: Dr. G now knows for certain
what killed Ricardo Sanchez, a significant head injury. And she also knows how the fatal trauma must have occurred.
JAN GARAVAGLIA: And it's consistent with a car accident. It's typically what we will see with a car accident
with shearing forces tearing those bridging veins. Wow, he really hit hard. Lo' and behold, he did die from the car accident.
It's an accidental death. You know, initially we thought it was going to be natural.
You could not see the trauma. Do you have one that's kind of clean? At least we eventually got the right answer.
NARRATOR: It's an unexpected ending to a highly unusual case. After several stops and starts, Dr. G
can at last inform Ricardo Sanchez's bereaved family of her tragic findings. According to family and friends, Ricardo
leaves a get-together to drive himself home sometime near dusk. JAN GARAVAGLIA: He is a smart enough fellow
to know he has to leave the party before it gets dark, because his vision is not as good.
He has trouble with glare, most likely. NARRATOR: Unfortunately, only a few miles from home,
his trip is cut short. JAN GARAVAGLIA: He's trying to make a left-hand turn. He probably either doesn't see the car
or doesn't react well enough to the car coming and turns right in front of the car,
causing that car to hit him. NARRATOR: The force of the impact causes the blood vessels beneath his dura to tear
and slowly begin to bleed. JAN GARAVAGLIA: The subdurals are venous blood, and it may not bleed real fast.
NARRATOR: Had he requested medical attention at the scene, Ricardo might have survived.
But Ricardo likely did not realize the severity of his condition for two reasons.
Initially, the bleeding can be slow and often does not cause any problems. Also, like many elderly individuals,
Ricardo's brain has atrophied with age and is actually better able to accommodate the bleeding.
JAN GARAVAGLIA: As you get older, your brain shrinks. Now that is the reason why he might not have noticed it right
after the accident, because there is a little space there for the blood to collect, not causing
so much trouble to his brain. NARRATOR: After the accident, Ricardo's car is towed to an auto wrecker yard and someone from the yard
drives him home. Once in his apartment, the delayed effects of the injury begin to hit full force.
JAN GARAVAGLIA: He probably isn't home very long when the blood just starts accumulating more and more.
It gets to the point, by the time he gets home, that there is no space left. But the blood keeps pumping, and then it puts
too much pressure on the brain. NARRATOR: As Ricardo gets up from his chair, the increasing pressure on the vital centers of his brain
suddenly causes him to lose consciousness. Soon, he slips into a coma. JAN GARAVAGLIA: If you increase the pressure
into the cranial cavity, you're putting pressure on the whole brain, the cerebral hemispheres.
Eventually, you're going to pass out. You're going to stop breathing, and your heart will stop.
NARRATOR: The news devastates Ricardo's family. They now know that his death may have been preventable, if only
he had requested medical treatment or if he had not insisted on continuing to drive.
It was sad for the family to know, because this is their loved one driving. They think he's still probably OK to drive,
and it ends up killing him. I think it was a little more comforting to think that he just had an arrhythmia from his heart disease
and died. I mean, I wish I could have told them that. But unfortunately, I have to tell them the truth
of what really happened. NARRATOR: Coming up next, a grandfather travels from England to Orlando to visit his family.
But in an instant, his long-awaited vacation turns tragic. They were just very surprised and maybe a little guilty.
NARRATOR: When "Dr. G, Medical Examiner" continues. [DRAMATIC MUSIC] It's been a long day for Dr. Jan Garavaglia,
chief medical examiner of Orange and Osceola Counties. And the stress of multiple cases is beginning to take its toll.
If it's a busy day, and I have a lot of cases, you're basically on your feet the whole time
you're down here. You're standing on your feet, and you're literally cutting. Let's just think about standing at your kitchen counter,
constantly cutting for eight hours, six hours, seven hours. And so it is very exhausting.
NARRATOR: But she can't rest yet. Well, I mean, you want to keep going, because everybody
wants your answer. And you want to do a good job, and you want to keep going because there's work to be done.
There's answers to be had. NARRATOR: Her last body of the day is an elderly man named Julian Noble.
As a first step, Dr. G reads the investigator's report and learns about the circumstances
surrounding Julian's death. JAN GARAVAGLIA: We have a 73-year-old man this morning that I may or may not autopsy somebody that age.
But he's got a very interesting presentation. He just comes in from Europe. He's on vacation here.
So I don't know anything about him. He's got atypical symptomatology of like doubling over
in abdominal pain and then just dying. It'll be interesting to see what that is.
NARRATOR: Yesterday, the widowed businessman from England arrived in Orlando to visit his family,
whom he hadn't seen in over a year. JAN GARAVAGLIA: When he landed, the plane landed, he started complaining of some of abdominal pain.
By that evening, he tries to eat some soup and still has some abdominal pain. NARRATOR: His son, Thomas, is concerned.
But Julian assures him that he'll be fine, and he goes to bed. The next morning, he is able to eat breakfast but then just
doubles over in pain in his abdomen and then collapses. NARRATOR: Thomas immediately calls 9-1-1.
In minutes, paramedics arrive on the scene and attempt to stabilize Julian. But their efforts are in vain.
By the time they get him to the hospital, he's already without a pulse. Dead on arrival.
NARRATOR: Now, Julian's son is desperate to know what killed his father so suddenly.
Because he's from abroad, there was little background information on Julian, making it difficult to narrow down
the possible causes of death. JAN GARAVAGLIA: He's complaining of abdominal pain.
So it'll be interesting to see what we find on him. There are many things that can cause
abdominal pain in the elderly. And sometimes it can be a real fooler, and it can be from other causes, even heart attacks.
It can be a very atypical presentation. But I have to think, what could cause the abdominal pain
and kill you? NARRATOR: Keeping this question in mind, Dr. G hopes the external exam will provide some useful clues.
JAN GARAVAGLIA: Well, what we're looking for externally is anything that would give us
any hint about his lifestyle. All I know is that he smoked some, and he doesn't drink,
according to the family, or drinks socially. And so I'm looking for kind of lifestyle.
I look to see if he's obese. He's not. he's normal weight and height. NARRATOR: Given Julian's complaint of stomach pains
immediately before his death, Dr. G pays close attention to one particular area.
JAN GARAVAGLIA: I feel the abdomen, and a lot of times, like with a peritonitis or inflammation
in the abdominal cavity, I'll feel very tense abdomen. Even after death, believe it or not,
they can get a very kind of bloated, tense abdomen. NARRATOR: But after careful inspection,
the external condition of the abdomen is yielding few clues. JAN GARAVAGLIA: His wasn't particularly tense.
But again, I've been fooled before after death. The cause of death may still be there.
Once I open it up, I'll know. NARRATOR: To begin the internal exam, Dr. G makes her standard Y incision
just below Julian's clavicles and all the way down to his navel. Her techs draw samples of Julian's fluids
to send to the toxicology lab. And then Dr. G begins the exam, focusing on the abdomen.
JAN GARAVAGLIA: I will think, wow, something in his abdomen must have killed him.
He had abdominal pain, relatively acute onset. NARRATOR: Based on Julian's symptoms,
Dr. G considers several conditions that could have killed him. JAN GARAVAGLIA: Abdominal aortic aneurysm, diverticulitis,
perforated bowel. There's many things that could kill you relatively quickly that we see in here that might be
preceded with abdominal pain. NARRATOR: First, Dr. G searches Julian's abdominal cavity
for signs of an aneurysm. An abdominal aneurysm develops when the aorta, which runs from the heart to the abdomen,
becomes blocked with cholesterol or plaque. This blockage can in turn cause the aorta to weaken
and eventually rupture. JAN GARAVAGLIA: It gets a thinned wall, and then it bursts.
NARRATOR: Blood then quickly rushes into the abdomen, and the victim dies within minutes from internal bleeding.
JAN GARAVAGLIA: What I will look for as soon as I open that abdominal cavity is free blood.
NARRATOR: But Dr. G gets her first clue in what she does not see. JAN GARAVAGLIA: He doesn't have free blood
in the abdominal cavity. So he didn't die from an aortic aneurysm. NARRATOR: She next examines Julian's colon,
looking for signs of a deadly condition called diverticulitis. Diverticulitis develops when pouches form
on the outside of the colon. JAN GARAVAGLIA: You have out-pocketing of the colon
because of just pretty much a lifestyle problem, lack of fiber, lack of exercise.
NARRATOR: If the pockets of the colon become inflamed and burst, this can lead to a fatal infection
in the abdomen. JAN GARAVAGLIA: And you can get severe abdominal pain or infection in those.
And you can eventually die. NARRATOR: If this happened to Julian, Dr. G would find the telltale signs of infection
in his abdominal cavity, free fluid or pus. But after a thorough examination, she comes up empty.
JAN GARAVAGLIA: He didn't have free fluid in his abdomen. So he didn't die from infection of his abdomen.
The walls of the abdomen looked fine. NARRATOR: But Dr. G still has one last condition
to look for within Julian's intestines, an infarcted bowel. JAN GARAVAGLIA: Another main reason why older people can die
from abdominal pain is infarcted bowel, meaning that the blood doesn't get to the bowel.
Basically, the bowel itself dies inside the body. NARRATOR: Dr. G carefully dissects
Julian's bowels, looking for signs of dead tissue. But once again, her search yields
nothing out of the ordinary. JAN GARAVAGLIA: It looks normal. The bowels look good.
The walls of the abdominal cavity look just smooth and pink and shiny, just like they're supposed to look.
NARRATOR: Dr. G now knows that Julian did not die from an aortic aneurysm, an abdominal infection,
or infected bowel. JAN GARAVAGLIA: And lo' and behold, we've ruled out a lot of things right from the start,
but what killed him? I still don't know. NARRATOR: Coming up next, Dr. G makes an unexpected discovery.
JAN GARAVAGLIA: It's peaking out at me. I can see that it's inflamed and that it's thickened.
NARRATOR: When "Dr. G, Medical Examiner" continues [DRAMATIC MUSIC] Dr. G lifts up the intestines of 73-year-old Julian Noble
so she can examine the rest of his abdominal cavity. Julian was on vacation from England
when he began experiencing severe abdominal pains. The next morning, he collapsed and died.
As soon as he went down, he was dead. NARRATOR: So far, Dr. G has ruled out three potentially
fatal conditions, an abdominal aneurysm, a fatal infection, and an infarcted bowel.
Unfortunately, he's dead, and I still don't have a reason. NARRATOR: Next, Dr. G inspects the rest
of Julian's abdominal cavity inch by inch, eventually coming to the gallbladder.
This pear-shaped organ sits at the base of the liver and plays an essential role in digestion.
And here, Dr. G gets her first clue. JAN GARAVAGLIA: I can see that it's inflamed
and that it's thickened. NARRATOR: As she cuts into Julian's gallbladder, she immediately can see what's causing the inflammation.
JAN GARAVAGLIA: I can feel that there's at least three gallstones in there. NARRATOR: These gallstones are likely
the cause of Julian's abdominal pain, but the question is, did they kill him? Gallstones are a common condition that affect 1 in 10
adults in Europe in America. JAN GARAVAGLIA: Oh, my. They're so crunchy. NARRATOR: They develop when excess cholesterol
builds up in the bile. JAN GARAVAGLIA: You have this increased amount of cholesterol, and these form stones.
NARRATOR: In Dr. G's experience, gallstones are rarely fatal. And at first glance, it appears that they
did not cause Julian's death. He's just got a little bit of an inflamed gallbladder,
not by infection, but because of the gallstones itself. So that in and of itself is not going to cause his death.
NARRATOR: But it is possible that Julian's gallstones could have led to a more serious disease.
JAN GARAVAGLIA: Gallstones can kill you with pancreatitis, and that's an inflammation of the pancreas.
Well, how does a gallstone cause inflammation of the pancreas? NARRATOR: If gallstones get stuck in the bile duct,
they can block the flow of digestive juices in the tubes that lead from the pancreas.
JAN GARAVAGLIA: It will cause then the pancreas to kind of start digesting itself.
And you can die from that. And sometimes you can die relatively quickly from that.
And so that's a possibility, and so I'll still need to check the pancreas. NARRATOR: Dr. G lifts up the stomach
and liver to view the pancreas. And there, she finds her answer. His pancreas looks like normal,
kind of tanned, nice, lobular structure that I normally see. So in no way did he have pancreatitis
and in no way did that kill him. NARRATOR: She now wonders if Julian's abdominal pain was completely unrelated to his death.
Maybe All of his pain was his gallbladder, which had nothing to do with his death.
NARRATOR: Or perhaps there is another explanation. JAN GARAVAGLIA: Maybe he's having
atypical heart pain, which is causing his abdominal pain. OK. I'm going to go ahead and take the heart.
NARRATOR: With this thought in mind, Dr. G next removes Julian's heart. JAN GARAVAGLIA: Could have had an arrhythmia
from lack of oxygen and blood to the heart from atherosclerosis, a common problem in my office.
And I guess that's part of why. NARRATOR: But when she sees Julian's heart up close,
she is shocked by the shape it's in. JAN GARAVAGLIA: His heart actually looked great.
I will be so lucky if at 73 my coronaries look so clean. And his heart muscle looked fine.
No anatomic reason for that heart to have killed him. NARRATOR: Now, she finds herself at a crucial crossroads.
I've ruled out any type of abdominal problem. I've ruled out the next most common
culprit would be his heart. We're pretty much back where we started. NARRATOR: Coming up next, an unexpected discovery
changes the course of the autopsy and shocks Julian's family. They had a hard time believing it.
You don't think that grandpa's going to die because you took him to Orlando. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] That's a good point. NARRATOR: Dr. G removes Julian Noble's lungs,
one of her last hopes for finding a cause of death in the internal exam. Her examination of Julian's abdomen and heart
yielded no clues. In fact, his organs were in surprisingly good shape. Now, Dr. G is more determined than ever
to unravel the mystery behind this seemingly healthy man's death. I want an answer at the end of the autopsy.
NARRATOR: Dr. G begins the dissection of Julian's lungs, hoping to find some sort of clue.
And right away, she hits paydirt. Sticking out right at me are blood clots in both right
and left main pulmonary artery. NARRATOR: These blood clots in the arteries leading to Julian's lungs are also known as thromboemboli.
They form when blood in the veins begins to harden and congeal. Basically, blood clots are platelets
and a protein called fibrin and then enmeshed in that are your cells. And basically, for whatever reason,
the platelets start sticking together and forming a clot. NARRATOR: In Julian's case, these clots
lodged in his lungs, cutting off his blood and oxygen supply. JAN GARAVAGLIA: Once they clog up
your main vessel that goes and brings blood to the lungs, you can't live. Incompatible with life.
No question, this is why he died. NARRATOR: After an exhaustive examination, Dr. G has finally found Julian's killer.
However, one mystery remains. So the question is, where did these emboli come from?
These are blood clots that formed in another part of the body. NARRATOR: Dr. G knows the vast majority of pulmonary blood
clots form in the legs. And this is the first place she looks. I dissect the backs of the legs
to look at the veins in the legs, and sure enough, he still has residual thrombi in the veins.
NARRATOR: Now that Dr. G has discovered exactly what killed Julian, she can at last piece together
the chain of events that led up to his tragic death. Julian Noble has just flown more than 4,000 miles
from London, England to visit his son and grandkids in Orlando. But the long flight has had an unexpected effect.
Hours of immobility on the airplane have caused Julian's blood to become sluggish.
And if it's sluggish, the platelets start sticking together and forming a clot. NARRATOR: When Julian walks off the plane, pieces of this clot,
which formed in his legs, break off and flow up through the vascular system. He started complaining of some of abdominal pain.
Sometimes these pulmonary emboli are asymptomatic. Maybe all of his pain was his gallbladder.
I don't know. It was atypical referred pain to his abdomen or was his pain all the time due to his gallbladder, which had
nothing to do with his death? I don't know. NARRATOR: The next morning, the pains are still there,
but Julian joins his family for breakfast anyway. He eats breakfast and then just kind of doubles
over in abdominal pain. Falls to the floor and they have to call an ambulance to take him to the hospital.
NARRATOR: Two large blood clots have traveled to his lungs and lodged in the pulmonary arteries, the blood
vessels leading to the lungs. He's not even responding. JAN GARAVAGLIA: It's a death sentence.
You're not getting any oxygen. You have no way to get oxygen. NARRATOR: As his family looks on in horror,
paramedics arrive and attempt to save Julian. Stop. I'm going to check for pulse.
Still no pulse. All right. NARRATOR: But before they even reach the hospital, Julian's heart, deprived of oxygen-rich blood,
ceases to beat, and he dies in the ambulance. Flying is one of the safest ways to travel.
In fact, 30 times more people die in car accidents than in plane crashes each year.
But deep vein thrombosis is a hidden danger that Dr. G sees several times a year in her morgue.
JAN GARAVAGLIA: It's a syndrome. It's called economy class syndrome. You're like squished up in the little economy seats,
and you don't move. You have no way to stretch. You get a little bit dehydrated, which
then predisposes you also. And the immobility and the probably little bit of dehydration causes the blood
to just kind of not move. NARRATOR: Fatal deep vein thrombosis resulting from air travel is uncommon.
But Julian Noble was among the unlucky few. But for anyone who is about to fly, Dr. G has a few words of wisdom.
JAN GARAVAGLIA: It is scary. And you know, when I'm sitting in the airplane, and I'm cheap.
I fly economy class. What I make sure is that I'm well hydrated. You need to exercise your legs.
You need to put pressure on them. You need to squeeze your calf muscles, move around, try to get up every hour.
NARRATOR: Unfortunately, this advice has come too late for Julian Noble and his grieving family.
JAN GARAVAGLIA: They're surprised, because a lot of people have no clue that a risk
factor for dying is sitting on an airplane for a long period of time. And so I think they were shocked.
They had a hard time believing it. You don't think that grandpa's going to die because you took him to Orlando
and made him sit on an airplane.

A retired businessman travels from England to Florida to visit his family but dies soon after arriving. Dr. G must now determine what mysteriously killed this healthy man so suddenly.

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

Brief Summary

Dr. G investigates the deaths of Ricardo Sanchez and Julian Noble, revealing foul play and deep vein thrombosis as causes.

Key points

A Mysterious Death. An elderly man's death is initially ruled natural, but suspicions arise when his car goes missing.
The Shocking Discovery. Dr. G uncovers a significant head injury during the autopsy, changing the case's direction.
A Sudden Death. Julian Noble collapses after experiencing abdominal pain, leading to a tragic outcome.
The Cause of Death. Dr. G discovers blood clots in Julian's lungs, revealing the cause of his death.
The Hidden Danger of Flying. Dr. G explains the risks of deep vein thrombosis during long flights.

Episode highlights

Episode quotes

Could this be foul play?

Jan Garavaglia questions the circumstances of a man's death.

6:04WatchJun 8, 2021

Tension

75/ 100High tension

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