Dr. G: Medical Examiner - Season 3, Episode 4 - Toxic Forces - Full Episode | Forensic Files

[DRAMATIC MUSIC] NARRATOR: A young woman is stricken with an aggressive illness after volunteering in the Hurricane
Katrina relief effort. She was fine one minute. She started getting short of breath.
NARRATOR: Within a day of falling ill, she dies in the ICU. JIM REESE: She was just gone.
NARRATOR: Will Dr. G be able to tell her grieving parents what killed their only child?
JIM REESE: There was no reason for this to happen. She was a really healthy, strong person.
When you lose a child, it's got to be the worst event that can happen on earth. NARRATOR: And then, a man with a history of mental disease
is found dead in his home. And the chief suspect is a tragic suicide. Suicides are always the saddest cases,
always the saddest cases. NARRATOR: But findings in the autopsy threaten to turn the investigation upside down.
When I first saw that tox, I went how unusual. I mean, it's not what I expected.
NARRATOR: Altered lives, baffling medical mysteries, shocking revelations. These are the everyday cases of Dr. G, Medical Examiner.
It's early on a Tuesday morning in Orlando, Florida when Dr. G arrives at the District 9 morgue.
While most mornings are busy at the morgue, today brings a brief but unusual respite for the staff.
Oddly, there is only one case waiting examination, the body of a 25-year-old woman named Amanda Reese.
For now, she is Dr. G's sole focus. As a first step, Dr. G consults her investigator's report,
which describes the circumstances surrounding the young woman's sudden and unexpected death.
JAN GARAVAGLIA: This case, I knew about this poor girl coming in before my investigators did,
because I got a call from one of the doctors at the hospital. NARRATOR: According to the physician,
Amanda became abruptly ill on her way to a basketball game with friends. JAN GARAVAGLIA: She got hot.
She started getting hives and started getting short of breath. NARRATOR: Amanda's friends call 9-1-1,
and she's rushed to the hospital. Initially, ER doctors believe she is having an aggressive and potentially fatal
allergic reaction known as anaphylaxis. But in the hospital, Amanda does not respond to treatment.
JAN GARAVAGLIA: They do all the medications for an allergic reaction and anaphylaxis,
but it didn't seem to do anything for her. NARRATOR: When Amanda's condition doesn't improve,
doctors are immediately alarmed. They wonder if she might have a massive infection, not
anaphylaxis, as they first suspected. To fight a possible deadly infection, they treat her with powerful antibiotics.
But Amanda's condition continues to worsen. Within only hours, she slips into a coma
and is placed on life support. JAN GARAVAGLIA: She continues to have problems. Her blood pressure couldn't be maintained,
and she's on a ventilator almost right from the beginning. She's on, even actually having to put on pressors or something
to help that blood pressure be maintained. That didn't even work. NARRATOR: Within only 29 hours, 25-year-old Amanda Reese
suffers a fatal heart attack while in the ICU. To the shock of her parents and friends,
she is pronounced dead at 10:25 PM. We were hoping she could just hold on long enough to come out of it, but her heart
failed in the end. JIM REESE: She was just gone, and all of her organs shut down, and there wasn't anything anybody could do.
So that was it. NARRATOR: According to the investigator's report, physicians suspect an infection ultimately
caused Amanda's death. Her sudden decline is one reason for this conclusion. Her recent work is another.
Amanda was a volunteer for AmeriCorps, a national volunteer community service organization.
Several days before she grew ill, Amanda had been in Biloxi, Mississippi, helping in the Hurricane Katrina relief effort.
While no widespread outbreaks of serious illness had been detected in the area, health care officials,
including the Centers for Disease Control, were closely monitoring the Gulf region
for a potential infectious disease epidemic. Amanda's death now raises concerns.
JAN GARAVAGLIA: They're very worried that she has some weird infectious disease.
They called me and pleaded with me on the grounds of public health. NARRATOR: Is it possible Amanda contracted
an infection from a hurricane victim in Biloxi? The hospital asks Dr. G to test for a number
of potentially deadly contagions, some of which are very rare. JAN GARAVAGLIA: And they were even thinking SARS.
They were thinking hantavirus, which is a hemorrhagic lung disease. They were thinking all sorts of different viruses,
like maybe hemorrhagic fever, maybe some weird virus or some weird bacteria. NARRATOR: If Amanda's recent work in Hurricane Katrina
isn't cause enough for concern, her medical history presents troubling information as well.
Dr. G learns from her parents that Amanda had suffered complications from several insect bites, one of them
only a day before she grew ill. JAN GARAVAGLIA: Well, we do know that she's got some medical problems, especially for somebody
so young, 25. She had Lyme disease a couple years ago from the bite of a tick and supposedly had
gotten over that. And recently, within the past year, she'd had a spider bite that she'd had some problems with.
I was also told that she was recently stung in her left arm, and I was curious about what that would look like.
Does her doctor say she-- NARRATOR: In this case, it is difficult for Dr. G to untangle the significant from the inconsequential.
But she hopes that through an autopsy, she will find answers for Amanda's grief-stricken parents.
JAN GARAVAGLIA: When you lose a child, it's got to be the worst event that can happen on earth.
And I'm not sure knowing exactly why she died is peace to them or not, but at least it might give
them a little bit of an answer. CAROLE REESE: Stunned. That's the only word. I wasn't thinking about her dying.
I never expected it, and I'm still stunned. Why to her? I ask myself that every day.
But that's-- that's the way it goes. She was a great person. She really was. NARRATOR: Dr. G carefully examines
the body of Amanda Reese and comes to her first conclusion. JAN GARAVAGLIA: She looks very ill.
And believe it or not, when your dead, sometimes you can look good and sometimes you can look ill.
And she looked ill. NARRATOR: And then Dr. G sees something curious. On the inside of Amanda's left upper arm is a small mark,
perhaps the bite Amanda reported the day before she died. JAN GARAVAGLIA: I incised it with my scalpel,
and I certainly looked under the microscope to see if there was any reaction to it.
There really wasn't. It looked very benign. Couldn't really see a stinger or anything
like that when I cut into it. NARRATOR: Unfortunately, the external exam of Amanda
Reese yields very little. JAN GARAVAGLIA: There just wasn't a lot of significance
to our external exam. Nothing that I could pinpoint or give a better idea of why she died.
NARRATOR: Whatever killed Amanda left no trace externally. Whether any clues linger internally is yet to be seen.
Coming up next, in the internal exam, Amanda Reese's body is opened, and Dr. G sees the ravages of her killer
but not the killer itself. JAN GARAVAGLIA: At this point, we're back to square one,
and I don't know what direction I'm going to go. [DRAMATIC MUSIC] NARRATOR: At the District 9 morgue in downtown Orlando,
the body of 25-year-old Amanda Reese is prepped for internal examination to discover the cause of her unexpected death.
Amanda died the day before from an aggressive and unknown illness. The doctors who treated her in the hospital
worry that she may have contracted a rare infection while volunteering in the Hurricane
Katrina relief effort. JAN GARAVAGLIA: There were some weird-- it was more of the weird kind of viruses
that they were worried about. NARRATOR: Dr. G opens Amanda's body with a Y incision
from the shoulder blades to the pelvis. The effects of Amanda's acute illness are immediately apparent.
JAN GARAVAGLIA: When I do the Y incision, I see a lot of fluid in her subcutaneous tissue.
I see evidence of end-organ failure. Her organs-- her body wasn't getting enough blood.
Her blood pressure wasn't maintained enough. So parts of her body were pretty much dying.
NARRATOR: But what could have caused this young woman's major organs to fail so catastrophically?
A critical part of this examination will be toxicology, which can determine what substances were in Amanda's body at the time of her death.
JAN GARAVAGLIA: I'm going to do just the general bacterial cultures on her blood.
I would take some of viral cultures, send it to microbiology to see if they can see anything growing.
I am taking regular blood check for substances, our normal urine screen, then looking for some of the drugs
of abuse as well as drugs of-- prescription drugs that we can find. NARRATOR: Once samples are drawn,
Dr. G begins to remove and dissect each organ, looking for any abnormalities or disease.
Yet, outwardly at least, she sees no indication of an infection. JAN GARAVAGLIA: I mean, I could have lucked out
and found a pocket of pus that would have been the source of her infection that would
have just given us the answer or some type of infected organ. And unfortunately, that wasn't the case.
NARRATOR: Like the external examination, the internal exam of Amanda Reese is yielding few solid findings.
Amanda's heart is normal. Her lungs are very heavy, triple the weight that they should be.
But Dr. G finds no signs of infection in the tissue. JAN GARAVAGLIA: Her lungs are very, very heavy.
But I'm looking for pneumonia. I'm looking for pus. I'm looking for white cells or what type of process
is going on. But with her, she looks like she's got lungs from being on a respirator and not being able to maintain
her blood pressure, something we see all the time, a lot of fluid build up in her lungs and changes
consistent with that. After I do her chest and abdomen, I still have to look at her head.
Certain meningitis, certain bacterial infections of the meninges, the covering of the brain,
can cause you to die really quickly and have symptoms very quickly. NARRATOR: Dr. G opens Amanda's brain
and carefully inspects the organ. But once again, there was nothing suspicious. No inflammation, no infection, no disease.
There is nothing classic about an infection here that I can find. NARRATOR: A 25-year-old woman is dead,
but at the end of the autopsy, Dr. G has no explanation. It is a difficult conclusion for her
and an unbearable one for Amanda's parents. She was a really healthy, strong person.
And to try and figure out now what had happened, we don't know. And that's difficult for us.
At this point, we're back to square one, and I don't know what direction I'm going to go.
NARRATOR: The most frustrating cases for a forensic pathologist are those deaths that
threaten to remain mysteries. Dr. G is loath to allow Amanda Reese's case to become one of them.
JAN GARAVAGLIA: I'm going to take the route of starting at the basics again and starting at the basics is I think I need
a better description of what she was like before she got to the hospital. NARRATOR: Coming up next, Dr. G finds one of the witnesses
to Amanda's sudden illness and refocuses her investigation. I actually got my investigator to track down the girl that
was with her in the van that day when she started having symptoms. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] Hi. Steve Hansen at the ME's office. NARRATOR: Dr. G asks her chief death investigator, Steve
Hansen, to track down a witness to Amanda Reese's fatal illness in hopes of speaking to her directly
about the events that day. And you want DL number? JAN GARAVAGLIA: I really needed to get
information on how she was before she made it to the hospital. I've got the hospital records, but I don't have the story
very well on what happened prior to her making it to the hospital. And so I really needed a firsthand witness.
NARRATOR: Several days later, investigator Steve Hansen locates one of Amanda's friends, an AmeriCorps
volunteer named Michele, who was with Amanda on the day she fell ill. And what she tells Dr. G redirects the course
of the investigation. According to Michele, Amanda's illness unfolded swiftly and without warning
on the way to a basketball game. MICHELE DZIEDZIC: We got in the van, and we noticed Amanda was lying down in the back seat.
And we asked her, we're like, Amanda, are you OK? And she's like, I'm just feeling really hot right now.
Then she sat up, and she was like, I think I'm having trouble breathing. And at that point, she started breaking out in hives.
It was all over her, her face, her arms, her chest, her back. And we were all like, oh, my God.
Because I've never seen bumps like that. NARRATOR: The testimony turns the investigation on its head.
Dr. G is now convinced that Amanda did die from anaphylactic shock, a fatal allergic reaction,
despite the fact that Amanda had no known allergies and the hospital's treatment for anaphylaxis was unsuccessful.
JAN GARAVAGLIA: The story she told me was not anything closely resembling an infection.
What she told me is that she was fine one minute. She started getting short of breath,
clearly had hives, and was getting more and more short of breath. Clearly, looked like an allergic reaction from that story.
NARRATOR: But her suspicion will not be easy to confirm. Anaphylaxis is difficult to diagnose post-mortem.
One of the only ways to diagnose anaphylaxis is to check a person's blood for a substance
called tryptase, an enzyme that is released into the bloodstream during an allergic crisis.
JAN GARAVAGLIA: Tryptase can only truly be measured for several hours after the initial event.
And then it really starts to go down, and it may go back to normal. NARRATOR: Dr. G requests blood samples
that were drawn when Amanda was first admitted to the hospital, because that is when the most accurate
readings of tryptase levels would be detectable. JAN GARAVAGLIA: I said, if you do have any original blood,
please send off a tryptase level, because a tryptase would indicate then an allergic reaction.
NARRATOR: Dr. G also orders tests on blood samples drawn at autopsy in case some of the tryptase enzyme
lingered in Amanda's system. Then, Amanda Reese's case becomes a waiting game. Amanda's body is released to her parents,
and one week after her death, she is buried in her hometown of Chicago, Illinois.
JIM REESE: There were a lot of people there, more than I even imagined. The waiting line outside the funeral home
was probably a block and a half long. We had people that came from Holland, people that came
from Washington, people that-- her pallbearers were her team from Charleston. AmeriCorps flew them all in.
It was very nice. CAROLE REESE: We spoke to Dr. G from November 20 when Amanda died till the middle of March.
They kept her autopsy open, searching so many months for an answer, trying to solve this mystery.
There were a lot of people working on this whole thing. She had two or three assistants working on it.
JAN GARAVAGLIA: I think at some point, they may have been just resigned to the fact they may never know
what killed their daughter. NARRATOR: But after a grueling four months, Dr. G finally receives the toxicology results on blood
and fluids drawn at autopsy. And it is not what she hoped for. Amanda's tryptase levels are normal.
JAN GARAVAGLIA: And I was very disappointed that the tryptase still wasn't-- it wasn't elevated.
So it looks like there was no way that I was going to be able to prove that this was anaphylaxis.
NARRATOR: But several days later, Dr. G receives the toxicology report on blood drawn when Amanda was
first admitted to the hospital. This time, the numbers are significant. JAN GARAVAGLIA: It was very high.
Normal could be in the 10 range. Hers was in the 100s range, like almost 400. So it was very high.
And that, with her history, was diagnostic for anaphylactic shock. So that was very satisfying to see that come in.
NARRATOR: Dr. G finally has a solid conclusion. Amanda died from a rare and fatal allergic reaction, which
can cause airways to swell and blood pressure to drop catastrophically, leading to death.
But unfortunately, there is one question that will never be answered. What triggered Amanda's deadly reaction?
JAN GARAVAGLIA: Ultimately, we don't know what the antigen is. Now, that sounds like that would be so rare.
But truly, with a large percentage of anaphylaxis, some people say up to 30% to 50%,
they never really know what it is that caused them to go into anaphylaxis. NARRATOR: Anaphylaxis typically occurs immediately
after exposure to an offending antigen, which is a substance foreign to the body.
But Dr. G cannot find any triggers in Amanda's death. JAN GARAVAGLIA: Sting in her arm.
That happened too far away from the event to have been the antigen that would have tipped her over.
There's too many hours. The same with her lunch. I was worried that maybe it was something she ate.
But that was at least a five-hour delay between when she ate and had the anaphylactic reaction.
And that's really out of the timeframe that we would expect with food to cause anaphylaxis.
You get the reaction much more immediate when you're exposed to that antigen. NARRATOR: Her conclusion?
Amanda suffered from an attack of what is known as idiopathic anaphylaxis, anaphylaxis
from an unknown cause. JAN GARAVAGLIA: When we don't know something, we'll call it idiopathic anaphylaxis.
And with this poor girl, we just cannot figure out why she went into anaphylaxis, what it was, what antigen it was that caused
her to go into this anaphylactic shock that was so refractory to their medication.
NARRATOR: By piecing together testimony from Amanda's friend, toxicology tests, and Amanda's autopsy results,
Dr. G can finally tell Amanda's parents why their daughter died and record her findings in the Report of Autopsy.
Although Dr. G cannot say for certain exactly when or what Amanda was exposed to, she knows some antigen caused a severe
and catastrophic reaction in Amanda on the way to a basketball game. JAN GARAVAGLIA: In most people, the main reasons
for anaphylaxis are insect bites, a drug, or food allergies. NARRATOR: For reasons unknown, Amanda's immune system
significantly overreacts to the antigen. In response, her body releases a flood of reactive chemicals, one of them
being tryptase, into her bloodstream, which triggers immediate physical manifestations.
Amanda's bronchial passages begin to swell shut, blood vessels throughout her body
begin to dilate, causing her blood pressure to drop precipitously. Hives erupt upon her skin.
At that point, Amanda was having trouble breathing. JAN GARAVAGLIA: They knew they had to get her help.
They called 9-1-1. At that point, she was so short of breath, she started getting combative and kind
of losing it mentally, because she wasn't getting enough blood to the brain. They tried to give her medication in the ambulance.
It doesn't seem to be affecting her. By the time she gets to the ER, her blood pressure is already low, and she's in refractory shock.
They just can't get her blood pressure back up enough to maintain enough oxygen to the rest of her body.
NARRATOR: At the hospital, Amanda is treated aggressively for anaphylaxis. But for unknown reasons, her condition
is so severe that medications are ineffective, leading doctors to believe that perhaps
Amanda is sickened with a life-threatening infection. But by this point, the damage caused
by the anaphylactic reaction is irreversible. JAN GARAVAGLIA: They gave her all the right medication,
but she was already too far gone for it to work. NARRATOR: Amanda's internal organs
begin to die, starved of oxygen from the effects of extremely low blood pressure.
After 29 hours, she dies in the ICU of massive organ failure. JIM REESE: Dr. G said I have to come to some conclusion here,
and that's all I can come up with. And she's very nice about it, and I said thank you.
And that was about it. I think she did the best she could. Well, I can't say I'm relieved, because we
still don't know why she died. JAN GARAVAGLIA: I think they were glad to put all that rest
of what she died from. I think they would be even like it better if they knew what it was that caused
her to go into anaphylaxis. But I just can't give them all the answers. You just never know what life's going to throw at you,
and it's just very scary. And I think what it tells me is life is precious, and you just never know when it's going to be taken away.
NARRATOR: Coming up next, a troubled man threatens to commit suicide and hours later is found dead.
Was his death intentional, as investigators believe? JAN GARAVAGLIA: Now, law enforcement and my investigator
really thought for sure this was going to be apparent suicide. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] 39% of the fatalities brought to the District 9 morgue each year
are categorized as natural. JAN GARAVAGLIA: 63-year-old white male left his residence
at 6:34 as usual, morning walk. NARRATOR: But 12 out of every 100 bodies that require an autopsy in Orlando and Osceola counties
are suicides. For Dr. G and her staff, these are some of the most wrenching cases to work on.
JAN GARAVAGLIA: Suicides are always the saddest cases, always the saddest cases, because there's
always that sense of anguish. You know they had to have that horrible anguish before they did it.
NARRATOR: But suicides are perhaps most heartbreaking for the victim's loved ones, who
are left to agonize about whether there was anything they could have done to prevent the death.
Such is the case in Dr. G's next autopsy, the suspected suicide of a troubled 35-year-old man with a history
of mental disease. The decedent's name is John Kent. JAN GARAVAGLIA: We have a 35-year-old black male
who my investigators think is an apparent intentional overdose. NARRATOR: Dr. G consults the investigator's report
to learn the details of the events leading up to John Kent's suspected suicide only hours earlier.
According to the report, the previous night John and his longtime companion Greg were on their way home
from a restaurant when the two men got into a heated and physical argument. JAN GARAVAGLIA: They're in the car,
and they're continuing their argument to the point where our victim here hits his friend
and hits the windshield. And he mentions maybe I should kill myself. NARRATOR: Shortly afterwards, Greg
drops John off at their home in Kissimmee to calm down. JAN GARAVAGLIA: The boyfriend doesn't want
to put up with this anymore. He leaves. He thought it would be best since they're arguing.
He'd get out of the picture for a while, maybe let the guy cool down. NARRATOR: But a few hours later, Greg returns home to find
his partner unconscious. JAN GARAVAGLIA: 9-1-1 comes, they attempt to do resuscitation.
But they realize that he's dead and don't transport him. NARRATOR: When the police arrive at the residence,
they discover copious amounts of medications belonging to the decedent. JAN GARAVAGLIA: There is a lot of medication in the house.
There's antidepressants, there's antipsychotics, tranquilizers. There is erectile dysfunction medication.
There is aspirin, there's acetaminophen. NARRATOR: The arsenal of medication is not shocking given the fact that John, who had worked
as a computer technician all his life, suffered from mental illness and depression for many years.
In recent months, he'd grown increasingly despondent and self-destructive. JAN GARAVAGLIA: He's had suicide attempts
before with an overdose, and just three months prior, he tried to stab himself with a knife.
A lot going on here. NARRATOR: Given the drugs found at the scene, John's history
of self-destructive behavior, and threats to take his life, Dr. G suspects that he killed himself
with a suicidal overdose. JAN GARAVAGLIA: Certainly, when we see a past history of suicide attempts like this fellow,
it makes us think that he does at least have suicidal ideations at times. NARRATOR: But her suspicions are devastating for John's
partner, Greg, who is overwhelmed with remorse over John's death. For many years, Greg had tried to help
John overcome his problems. His deepest fear now is that he failed John when he needed him most.
JAN GARAVAGLIA: I'm sure the fellow is feeling some guilt about that. I'm sure he is.
NARRATOR: Greg now is counting on Dr. G to tell him exactly how and why John died.
Though all signs point to an intentional overdose, Dr. G must approach each case with an open mind.
JAN GARAVAGLIA: We'll check his blood. We'll certainly look for natural disease.
We'll certainly look for trauma. There's a lot we're going to look for here. So we're going to have to keep our mind and eyes open
and just see what we'll find. NARRATOR: Dr. G begins the external exam. She notes John is a heavy man, weighing nearly 300 pounds.
This right away raises the suspicion that he could have suffered from a range of obesity-related diseases.
As she searches his body, she also discovers some recent trauma. His knuckles are bruised.
There was a contusion on his lip and a mark on his side. But these are likely all a result
of the fight he had with his boyfriend the night of his death. JAN GARAVAGLIA: That fits to what
the boyfriend had said, that he hit him and hit the windshield. So that fits. I really don't see any other trauma on him.
NARRATOR: There is nothing externally at least to indicate that John died from trauma
or some sort of foul play. What's more, Dr. G also finds no external evidence that John abused illicit drugs.
I see no needle puncture marks to suggest that he had recently shot up or that he'd use them.
So I doubt that he's an IV drug abuser. NARRATOR: But if John died from a fatal intentional overdose,
there may be no traces externally. Dr. G will have to look internally, beginning with the stomach.
Coming up next, Dr. G opens John Kent's body and doesn't like what she sees. Suicide is still a very real possibility with him.
NARRATOR: When "Dr. G, Medical Examiner" continues. [DRAMATIC MUSIC] At the District 9 morgue in Orlando,
Dr. G's staff prepares for the internal examination of John Kent. The victim, who struggled with emotional problems,
was found dead in his home by his companion after an argument. At this point, his death is considered a likely suicide.
And this fellow, we know, has had at least one previous suicide attempt, which makes you think that at least he's
got some suicidal ideations at times. NARRATOR: Now, his distraught boyfriend, Greg,
wants to know if he is responsible for John's death. He is counting on Dr. G to tell him if he could have
done anything to prevent it. Dr. G opens the body of John Kent with a Y incision,
and it isn't long before she encounters what may be the first forensic evidence of an overdose.
John's bladder is full, a common finding in drug deaths. JAN GARAVAGLIA: Oftentimes, that gives us a clue that he may
have laid there for a while before he died, because he doesn't feel that sense of needing to relieve his bladder,
because he's is possibly a coma. NARRATOR: And when she examines his stomach, she finds another clue that suggests
a possible drug-related death. JAN GARAVAGLIA: He's got a lot of fluid in his gastric contents, almost a liter of fluid.
And there appears to be some granular material in there. It makes me worry that maybe he's
got a lot of pill material. NARRATOR: The granular matter may be the remains of partially digested pills.
JAN GARAVAGLIA: A lot of times with the suicides, they'll take 50, 60 pills of something.
And then we'll see, it maybe doesn't all absorb from your stomach. NARRATOR: Dr. G preserves the gastric contents
for toxicology, along with samples of Johns blood, urine, and eye fluid to determine
what exactly was in his system at the time of death. JAN GARAVAGLIA: I'm obviously still worried about suicide.
NARRATOR: The findings so far support the suicide theory, but toxicology results won't be in for several weeks.
In the meantime, Dr. G continues to look for clues to John's death in the autopsy.
However, as she examines John's chest cavity, she is suddenly met with an unexpected abnormality,
one that threatens the very notion of an intentional death. JAN GARAVAGLIA: He's got a big heart, you know,
a big heavy heart that we would see with somebody with high blood pressure. NARRATOR: John's heart weighs over
500 grams, nearly double the weight of a normal adult male heart. It is likely a deadly consequence of his obesity.
JAN GARAVAGLIA: Those hearts are prone to have sudden arrhythmias, because they're thickened,
and the blood has a harder time getting into that thickened muscle. And they are prone to sudden arrhythmias and sudden death.
NARRATOR: With this one finding, Dr. G is met with a new possibility. What killed John Kent?
A fatal arrhythmia or an overdose? Answers will not be easy to come by. Fatal arrhythmias leave no traces in the heart tissue.
That is not something that we can say happened in this fellow until you rule out everything else.
NARRATOR: Which means Dr. G must first scrutinize the toxicology reports to rule
out a suicidal overdose. Coming up next, toxicology is in. So too are unexpected conclusions.
JAN GARAVAGLIA: The tox kind of surprised me. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] Several weeks after the death of 35-year-old John Kent, the toxicology results arrive at the District 9
morgue in Orlando. Initially, the case was a suspected suicidal drug overdose. But at autopsy, Dr. G discovered an enlarged heart,
opening the possibility that John Kent simply died of a fatal heart arrhythmia. Waiting for answers is John's longtime companion,
Greg, who still worries that John may have killed himself. Dr. G goes through the toxicology results
with a fine-tooth comb. JAN GARAVAGLIA: So when we look at the toxicology results,
it kind of gives us a window, again, more information on what's going on. I suspected one of his drugs is going to be super high.
That's not what I found. None of his medications suggested that it could have been an overdose.
If anything, they were therapeutic, which was at the level it should be, or low.
Very surprising. So when I first saw that tox, I went, how unusual. It was not what I expected.
But then, there was something else on the tox that I didn't expect-- cocaine. He had been using cocaine right before he died.
But the amount of cocaine he has in his system is just slightly above what we normally
see with people getting high. And I don't think you would suspect that that would've killed them.
NARRATOR: After reviewing the toxicology report and autopsy findings, Dr. G concludes that John Kent's
death was not intentional. He died from a fatal combination of cocaine and heart disease.
JAN GARAVAGLIA: Cocaine is a drug that can cause sudden cardiac arrhythmias, and he's already got a damaged heart.
That's a bad combination. It certainly suggests that that's why he died. He had recently used cocaine just before he died.
NARRATOR: With the unexpected findings in hand, Dr. G can now record the cause of John Kent's death
in the case file and describe in detail the events that led to his accidental fatality.
John is a 35-year-old man who suffers from mental illness and depression. He takes several prescription medications
that mediate his conditions, all in therapeutic and recommended dosages. Little does he know he also suffers from heart disease.
On the night of his death, John gets into an argument with his companion, Greg, while driving home from a bar.
JAN GARAVAGLIA: They continue their argument in the car. He hits the boyfriend. He hits the windshield.
The boyfriend's had enough. He leaves. And it looks like as he leaves, this gentleman then
decides to use some cocaine. NARRATOR: Though he uses only a recreational amount of cocaine,
its effects are deadly. The powerful stimulant causes his enlarged heart to beat erratically in an unstable arrhythmia.
As his heart begins to fail, his brain is deprived of oxygen, and he falls into a coma.
Within only a short time, the erratic heartbeat results in his death. His manner of death is not suicide but accidental.
JAN GARAVAGLIA: Although he says that he wants to kill himself, although he's tried to kill himself before,
I don't see that this is a suicide attempt. His cocaine use is what killed him. NARRATOR: When informed of the findings,
John's longtime companion, Greg, is both surprised and comforted. JAN GARAVAGLIA: He was relieved when he found out
that it wasn't a suicide, because that really is a lot of guilt for him. NARRATOR: But for Dr. G, John's death
typifies the ravages of drugs, something she sees all too often in the District 9 morgue.
JAN GARAVAGLIA: It's like Russian roulette. You don't know what dose of cocaine could kill you.
It can be the same dose you used last week, but you just gotta know you're taking a chance.
It's like spinning the cylinder on the gun. I certainly see the end result of it.
I see the family grieving over those who died from drugs, and I see the people dead from use of drugs.
Why people don't realize it's a dead-end road, literally, I don't know. [MUSIC PLAYING]

Amanda Reese breaks out in hives and begins to hyperventilate after returning from a Hurricane Katrina relief effort. Dr. G wonders if an infection caused this young woman’s untimely death.

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

Brief Summary

Amanda Reese died from anaphylactic shock; John Kent's death was an accidental overdose linked to cocaine use and heart disease.

Key points

A Mysterious Illness. A young woman falls ill after volunteering for Hurricane Katrina relief and dies unexpectedly.
The Investigation Begins. Dr. G is called to investigate the sudden death of Amanda Reese, raising public health concerns.
Anaphylactic Shock Confirmed. Toxicology results reveal Amanda's tryptase levels were diagnostic for anaphylactic shock.
Unexpected Toxicology Results. Dr. G discovers cocaine in John's system, changing the narrative of his death.
Accidental Death Revealed. Dr. G concludes John's death was accidental, not intentional, due to heart disease and cocaine.

Episode highlights

Episode quotes

She was just gone.

Jim Reese reflects on his daughter's sudden death.

0:32WatchJun 8, 2021

Tension

75/ 100High tension

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