Dr. G: Medical Examiner - Season 3, Episode 5 - Derailed - Full Episode | Forensic Files

[DRAMATIC MUSIC] NARRATOR: An elderly man dies after mysteriously falling from a high-speed train.
JAN GARAVAGLIA: He kind of disappeared off the train, and nobody saw him. At least, nobody's saying they saw it.
NARRATOR: Did he simply fall or is there a darker side to this story? JOYCE OLSEN: Right away, we were thinking
that someone did it someone. Someone pushed him off. NARRATOR: And then, a young woman
collapses during a romantic dinner with her husband. JAN GARAVAGLIA: Basically, she's brain dead by the time
she gets to the hospital. NARRATOR: Now, her distraught husband needs to know if a deadly habit finally took its toll.
She does like to use drugs, particularly cocaine. NARRATOR: Or is something else to blame?
We don't know. I mean, there are a lot of odd things that could occur. Altered lives, baffling medical mysteries,
shocking revelations. These are the everyday cases of "Dr. G, Medical Examiner."
You don't have to live inside Dr. G's jurisdiction to end up on her autopsy table.
You just need to die there. And all too often a traveler ends their journey prematurely
with a visit to the morgue. If you've died in the jurisdiction that I cover for,
we're going to need to find out why you died. We don't care where you came from.
If you've died in our jurisdiction, we're going to do that. NARRATOR: Such is the case of Victor Gust, who passed away
while traveling through San Antonio, Texas during Dr. G's tenure at the Bear County
Medical Examiner's Office. As Dr. G reads through the case file, she's surprised to learn that 76-year-old Victor
Gust was a resident of Wisconsin, over 1,300 miles away. Oh, boy. Well, we don't get too many people
from Milwaukee, Wisconsin. NARRATOR: To those who knew him, Victor was the life of every party.
JUDY YANTIS: He was a bit of a clown, and my mom always referred to him as the jokester of the family.
JOYCE OLSEN: Well, as far as I remember from back in the younger days that he had a good sense of humor.
I just remember that we had fun. We had a lot good times. NARRATOR: Afraid to fly, Victor was traveling through Texas
by train on his way to his sister's funeral in Phoenix, Arizona. But when the train arrived at the Phoenix station,
Victor didn't get off. JUDY YANTIS: My sister and I went down to the train station.
We waited and waited and waited. The train came in, people got off, and we'd be looking, going you know, is that him?
Is that him? We were telling ourselves that maybe he fell asleep. NARRATOR: Conductors searched through the cars for Victor,
but he's nowhere to be found. JOYCE OLSEN: We all were thinking that maybe he got off somewhere and didn't
get back on that train. We just had no idea what to think. NARRATOR: Two hours later, Joyce gets a call from police.
They found her uncle Victor, but he's 900 miles away just outside of San Antonio and lying
unconscious beside the train tracks. They find him alive but pretty much unconscious.
He can't really talk. They helicopter him to a hospital that is in my jurisdiction.
NARRATOR: Victor remains in critical condition in a San Antonio hospital for two weeks.
But he never regains consciousness. JAN GARAVAGLIA: He was very ill in the hospital,
on a ventilator. They eventually had to put a tracheostomy tube in. His respiratory state got worse and worse,
and he eventually died. NARRATOR: For Victor's family, the loss is bitter. His death was an especially sad time, because like I say,
we had just lost my mother. We were all just shook up by the whole thing. JUDY YANTIS: Then for this to happen, it just was--
just one thing after another was just compiled. NARRATOR: What happened to Victor Gust on that train,
traveling through San Antonio at 6 AM? There's no witnesses. They don't know how he got off that train.
So it's kind of a mystery. NARRATOR: The first scenario Dr. G considers is suicide.
His sister was the only immediate family Victor had left. And the long trip to her funeral may have
simply been too much to handle. JAN GARAVAGLIA: He's very upset, and maybe he feels what's the point?
He doesn't want to face that funeral, and he commits suicide. I've had more impulsive suicides that I've autopsied.
NARRATOR: Another possibility is that Victor could have simply suffered a fatal accident.
JAN GARAVAGLIA: He could have accidentally just tripped and fallen off the train.
NARRATOR: Finally, Dr. G considers the most disturbing scenario, that Victor was
pushed from the speeding train. Well, I'm always worried about foul play. NARRATOR: And in this case, there might be good reason.
According to several train passengers, Victor had been behaving oddly during the trip.
He was acting very bizarrely, supposedly making people irritated on this train. He stole a pair of shoes from a little girl.
He took somebody's pillow, and people were getting agitated at him. NARRATOR: Perhaps Victor did something that pushed
a fellow passenger too far. I would hope that this is not the scenario, but I don't know.
NARRATOR: It's this possibility that have police and Victor's family most concerned.
JUDY YANTIS: Right away, we thought that someone pushed him off or something. Why, you know, would someone fall off the train?
JAN GARAVAGLIA: He kind of disappeared off the train and nobody saw it, or at least
nobody's saying they saw it. NARRATOR: As a first step, Dr. G begins documenting Victor's
injuries from the fall, hoping they might reveal clues as to what happened. She finds abrasions on his hands and ears.
That is odd. Look at that. I have two of those on-- NARRATOR: And superficial puncture wounds
to his arms and elbows, all consistent with a fall from a moving train. Oh, this should be interesting.
NARRATOR: But it's Victor's head that seems to have sustained the most damage. JAN GARAVAGLIA: The lacerations extend through the scalp
and go down to the bone. So there are very significant lacerations. I'm going to get a chart for his head.
NARRATOR: Victor's head trauma might have been severe enough to kill him, but Dr. G won't know for sure until she
performs the internal exam. But we've got to see what's on inside the brain. NARRATOR: If that is the cause of death, however,
it may be impossible to say for sure what or who caused him to fall from the moving train.
Certainly, I would love it if somebody pushes him and I see handprints. But I'm sorry, it's not that easy.
It doesn't work like that in the real world. NARRATOR: Coming up next, Dr. G makes
a shocking discovery about what happened to Victor after his fall. There's a lot of pus in there.
It's clear. You can see it with your eye. NARRATOR: When "Dr. G Medical Examiner" continues.
[DRAMATIC MUSIC] Dr. G reflects the scalp of 76-year-old Victor Gust. While traveling by rail from Wisconsin to Arizona,
Victor somehow fell from the train and died two weeks later in the hospital. Dr. G is almost certain Victor died as a result of the fall.
But the question is, what caused that fall in the first place? JOYCE OLSEN: Someone must have done something bad,
you know, pushed him off or threw him off. I would hope that's not the case. But I have also had more senseless
murders that I've autopsied. So what is it? I don't know. NARRATOR: As Dr. G gets her first look
at the surface of Victor's skull, she is surprised by what she doesn't find. I don't see any skull fractures
at the top of his skull to the bottom of his skull. NARRATOR: Her assistant then uses the oscillating
saw to open his cranium. Here, Dr. G does find trauma, a subdural hematoma or bleed in the brain.
Oftentimes, with trauma, we see blood collecting between the dura and the brain.
And the dura is that tough covering over the brain. And the blood collects fast enough or enough,
it can press on the brain and really cause trouble. NARRATOR: But when Dr. G carefully
examines the collection of blood on Victor's brain, she determines that the hematoma is minor.
With his, he's got just a little bit-- just a little bit of blood there. It's layered out.
It's what we call non-space-occupying. I wouldn't think that that was enough to kill him.
NARRATOR: This is a surprising finding that could take the case in a completely different direction.
Dr. G's initial suspicion that Victor died from head trauma sustained in the fall is not the case.
In fact, the injury may not even have been severe enough to render him unconscious
or required a stay in the hospital. I don't know what his problem is yet. NARRATOR: But that fall might still
have caused other fatal internal injuries, and that's what she'll search for next.
Dr. G opens Victor's torso with the standard Y incision. JAN GARAVAGLIA: I look in the chest, I look in the abdomen,
but I don't see any trauma. I don't see any broken ribs. I don't see anything major as far as traumas concerned
in his chest or abdomen. NARRATOR: Incredible as it seems, 76-year-old Victor fell from a train going 80 miles per hour,
and he sustained no significant internal injuries. Whatever killed Victor Gust, it wasn't his fall from the train.
OK. But I gotta clean my hands. NARRATOR: With this shocking discovery, Dr. G is back to square one.
All she can do now is push on with the internal exam, removing and dissecting each vital organ in turn,
hoping for a clue. And it's not long before she finds one. Oh, my gosh. That left lung is just full of fluid.
His lungs look terrible. They were full of fluid. NARRATOR: But it's not just fluid buildup she sees.
There's a lot of pus in there. It's clear. You can see it with your eye. Yes. They're very congested.
They've got some edema too them. NARRATOR: This tells Dr. G that Victor has contracted pneumonia, a significant bacterial infection
in his lungs. It's very common to get pneumonias and infections in your long when you're on a respirator.
Patients on ventilators are at high risk for bronchial or lung infections, because the breathing tube bypasses
the normal defenses of the respiratory tract and can even harbor bacteria. Up to 25% of patients placed on a ventilator
for more than two days develop ventilator-associated pneumonia. Up to 50% of them die as a result. After his fall
from the train, Victor was on a ventilator for nearly two weeks. When you have a breathing tube down into your airway,
you can get colonized with a lot of different bacteria. NARRATOR: Dr. G believes this infection wasn't just severe,
she believes it's what ultimately killed Victor Gust. JAN GARAVAGLIA: I can clearly see that he died
from unable to be oxygenating. He just cannot exchange oxygen anymore from the air,
from the respirator. The lungs are too badly damaged. NARRATOR: In many autopsies, this discovery would be
the final piece to the puzzle. But not in the case of Victor Gust. It's clear he died from an infection
he contracted from a respirator in the hospital. But for Dr. G, what led him to be on that respirator
is the real culprit, the true cause of death. JAN GARAVAGLIA: I mean, that's clearly the end result.
But what is it that started this? He clearly didn't have lung damage when he was on the train.
I mean, this is just all a result of whatever happened to him. NARRATOR: Coming up next, Dr. G zeros in on a killer.
But will it be enough to close the case on Victor Gust? So how am I going to figure that out?
I don't know. NARRATOR: When "Dr. G, Medical Examiner" continues. [DRAMATIC MUSIC]
Dr. G is pulling out Victor's organs one by one and dissecting them. 76-year-old Victor Gust was hospitalized
two weeks ago after falling off a moving train. Dr. G has since discovered that Victor
died of pneumonia he contracted while on a ventilator. Although this is his cause of death,
Dr. G isn't satisfied, because to her, whatever caused Victor to be in the hospital
in the first place, an accident, an assault, or a natural disease, is what really killed him.
JAN GARAVAGLIA: The bottom line is, what happened to him? NARRATOR: Dr. G's next stop is the heart.
And here, she soon finds a clue in Victor's coronary artery. He's got bad coronary arteries.
NARRATOR: It contains a dangerous buildup of plaque, a condition known as coronary artery disease.
He has some coronary artery disease, but what's really troubling is that he's got a thrombus.
In one of the coronary arteries, in one of the vessels that supplies blood and oxygen to the heart,
he's got a thrombus. It looks like there was a little clot. NARRATOR: A thrombus or blood clot is clearly obstructing
Victor's coronary artery. JAN GARAVAGLIA: The blood flow then can't get through that thrombus.
It's blocking it. It's damming it so no blood can get in. NARRATOR: The blockage of the artery
deprives the heart of blood and oxygen, ultimately causing injury to the muscle itself.
JAN GARAVAGLIA: When I look at the muscle, it's yellow, it's soft, it's necrotic, because the muscle
fiber actually is dying. That's what the yellow is. It's just disintegrating and dying.
It's a huge heart attack. NARRATOR: Could this heart attack have set off the chain of events that led
to the death of Victor Gust? Or did Victor simply suffer the heart attack during his two
weeks in the hospital? To find out, Dr. G will have to try to determine exactly when the heart attack occurred.
To help establish a frame frame, she'll need to dissect the heart and examine it up close.
JAN GARAVAGLIA: When you have a heart attack, it changes from just pallor or paleness from lack of blood
to then some hemorrhage and then you can get some softening and get some yellow, because the muscle fiber actually is dying.
And so his is at the stage where it's really, really necrotic. The muscle is just as soft as can be.
NARRATOR: Based on her examination of the heart, she calculates that the heart attack struck about two weeks
earlier, around the time Victor was traveling on the train and before he was admitted to the hospital.
But she can't narrow the time frame any further. And that means that there is one question that she'll
never be able to answer. JAN GARAVAGLIA: Did he pass out from the heart attack and fall off the train or was it the whole stress
of either being pushed or accidentally falling off the train? Now, when you have stress, your blood pressure goes up,
and that certainly could have ruptured that plaque and caused the thrombus. Here's the problem with this--
I can't date it within seconds or even within hours at this point. Which came first?
The chicken or the egg? I cannot tell from just looking at that heart. NARRATOR: By the end of the autopsy,
Dr. G is certain that Victor Gust had a major heart attack, which then caused him to be on a respirator
and contract pneumonia. But she'll never know what triggered it. Unfortunately, it's one of those few cases
that you don't know. So we're never going to get an answer on this. NARRATOR: When she reports her findings,
Dr. G presents the scenario that seems most likely, even though she knows it's not the only possibility.
[TRAIN WHISTLE] 76-year-old Victor Gust is on a train bound for Phoenix, Arizona.
According to fellow passengers, Victor begins acting strangely during the second day of his journey.
JAN GARAVAGLIA: He's irritating people on that train, stealing shoes, stealing pillows.
People are starting to get irritated at him. NARRATOR: To Dr. G, this might be the first sign that he's
having a major heart attack. Lack of oxygen going to his brain because of the heart attack, it could
cause him to act funny from the heart just not pumping well. NARRATOR: Not completely in his right mind,
perhaps Victor opens a door or ventures between cars. He's had a heart attack. His heart isn't pumping very well.
He's acting somewhat bizarrely. He's probably getting some shortness of breath. He goes out to get some oxygen. He collapses
and tumbles off the train. NARRATOR: His head strikes the ground, and a small hematoma begins to form,
but it is not life-threatening. As the train clacks away down the tracks, Victor's heart attack puts him into a state of unconsciousness
that he will never return from. He's hospitalized, placed on a ventilator, and as a result,
contracts pneumonia. Slowly and slowly, his lungs get worse and worse and worse,
and he died. NARRATOR: For Dr. G, it's a poignant scenario, but it's not the only possibility.
The heart attack could have simply been the result of a fall from a fast-moving train.
JAN GARAVAGLIA: It could have happened after he'd fallen off the train and just the stress of falling off,
that heart attack could have occurred. NARRATOR: Victor's fate is something that forensic science
can never know. He either jumped off that train, he either fell off that train, or he
was pushed off that train. So it's one of those very unsatisfying movies where they do three different endings,
and you pick. I hate those. NARRATOR: The lack of certainty also troubles Victor's family.
JUDY YANTIS: The fact that we may never know what happened to him really bothers me.
It does. It still bothers me. And I'm sure it probably always will. JOYCE OLSEN: I would hate to think that another person
actually did this to him. I wish I could have given the exact answer to the family.
I feel bad about that. I always do. But I got as many answers as I could from that body.
I don't have a preponderance of evidence here. So I'm going to have to leave this one as undetermined.
NARRATOR: Coming up next, a young woman suddenly collapses and dies in the middle of a restaurant.
JAN GARAVAGLIA: People see her fall to the floor and have a seizure. NARRATOR: Did a dangerous habit ravage
this healthy woman's body? JAN GARAVAGLIA: She's known to use cocaine. She's known to use ecstasy.
She is known to drink on a daily basis. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] As chief medical examiner of the District 9 Morgue in Florida, Dr. Jan Garavaglia's job is to open and examine dead bodies
as soon as possible. Oh, my goodness, though. NARRATOR: Unless the decedent is an organ donor.
Somebody has already peeked in. But that's OK. We'll deal with that. NARRATOR: Today, an organ recovery agency
wants to remove the liver of a local 26-year-old woman, if Dr. G approves. They do have to get our OK.
It certainly makes things a little bit harder to find sometimes. NARRATOR: According to the agency representative,
the donor died in the hospital after a sudden collapse and three days in a coma.
JAN GARAVAGLIA: We can work around it. These are lifesaving measures, and I'm certainly not going
to refuse an organ just because it would make my job a little easier. NARRATOR: Ultimately, she allows the procedure to move forward.
So they went ahead and then procured the liver, transplanted that. And then we got the body.
NARRATOR: The next morning, Dr. G finds the donor, Jesse Davis, in the day's lineup.
Hi mom. Hi dad. NARRATOR: An aspiring cookbook writer, Jesse had a passion for playing with recipes.
But according to the investigator's report, her dreams were cut short three days earlier
while enjoying a meal at a favorite local diner. JAN GARAVAGLIA: She was having dinner
with her husband late at night, kind of early in the morning. And while she's eating, she falls
to the floor, starts seizing. NARRATOR: Her husband, Aaron, springs into action.
Starts CPR. They call 9-1-1. They're able to get her heart going, but basically she's brain dead by the time
she gets to the hospital. [SIREN] NARRATOR: Doctors immediately put Jesse on a respirator
and begin searching for a way to save her. Desperate, Aaron tells them everything he can.
JAN GARAVAGLIA: She doesn't have a history of seizures. She's got a family history of heart disease,
but it's a little bit vague. And the husband didn't really know that much about it.
NARRATOR: He also reveals that his wife has a history of drug abuse. JAN GARAVAGLIA: She does like to use
drugs, particularly cocaine. NARRATOR: But when the hospital runs a urine test, it comes up negative for all illegal substances.
A CAT scan of her brain and a chest X-ray also reveal nothing. And they never could figure out why, what happened to her.
NARRATOR: With nowhere else to turn, doctors must finally tell Aaron, there's no hope for recovery.
Three days later, he agrees to take Jesse off the respirator, and she dies. Now it's up to Dr. G to answer the question
ER doctors could not. What caused her to suddenly collapse and then start seizing?
NARRATOR: Based on the information thus far, she believes that whatever caused the seizure is likely
the killer. JAN GARAVAGLIA: When people present with a seizure, they don't usually die from it.
And it's usually from something else. NARRATOR: Unprecedented seizures are a symptom,
signaling that the brain has been suddenly deprived of blood and oxygen. But numerous ailments, including
strokes, heart attacks, and an overdose can trigger this condition. Dr. G can only speculate as to what
was behind Jesse's seizure. JAN GARAVAGLIA: Could be drugs, could be her heart, or it could be something we don't know.
I mean, there are a lot of odd things that could occur. Bottom line, is we don't know why she just all of a sudden
collapsed at the restaurant. So that's what we're going to have to figure out. OK.
We'll start. NARRATOR: As Dr. G begins Jesse's external exam, one glaring wound provides a glimpse of her journey
to the morgue. JAN GARAVAGLIA: She's got the large incision from the post-mortem organ retrieval.
NARRATOR: She also takes note of Jesse's white antiembolic stockings. JAN GARAVAGLIA: These are stockings
they put on to compress the legs so blood clots don't readily form. NARRATOR: Clots are the result of abnormally coagulating
blood in the veins. Blood clots can be life-threatening if they travel through the vascular system to the lungs.
She removes the stockings and sees no anomalies on the skin beneath. In fact, she finds nothing inexplicable
anywhere on the body until she inspects the arms. She has needle puncture marks.
She's got a lot of them. NARRATOR: These could be from the intravenous feeding she received while on the respirator.
Were these needle puncture marks from the hospital? NARRATOR: But Dr. G also considers
Jesse's history of drug abuse. Perhaps she'd injected a stimulant such as cocaine
and died of an overdose. Certainly, cocaine can precipitate a seizure. NARRATOR: The hospital drug screen did
test negative for narcotics. But Dr. G knows from experience that these tests are not always foolproof.
JAN GARAVAGLIA: With the urine drug screen, sometimes it won't pick up if you've
used the drug very quickly, before it gets a chance to build up in the urine. NARRATOR: The only way to prove whether she
seized from an overdose is a comprehensive blood screen. JAN GARAVAGLIA: What we'll do is we'll get the initial blood
from the ER-- they said they'd save some of that-- and go ahead and test it ourselves.
NARRATOR: But the lab work will take weeks. For now, Dr. G must proceed with the internal exam,
hunting for any evidence the ER staff might have missed. We're not going to know until we get inside.
NARRATOR: First, she looks for signs of a stroke. This ailment would have deprived a small part
of Jesse's brain of oxygen and could explain the seizure. So we're going to go ahead and start with the head,
and then I'll do the chest. NARRATOR: But even before she reflects the scalp, Dr. G knows a major challenge lies beneath.
A brain that grew soft while Jesse was kept alive on a respirator, long after the organ
itself was dead. JAN GARAVAGLIA: We call these respirator brains. If they're long enough on that respirator,
it'll be almost semi-liquid. NARRATOR: Coming up next, Dr. G struggles with a tricky maneuver.
It's difficult to get this brain out. I'm going to pulverize it. NARRATOR: When "Dr. G, Medical Examiner" continues.
[DRAMATIC MUSIC] Dr. G removes Jesse Davis's calvarium, or the top of her skull, looking for signs
of a stroke or other disease. Three days ago, while eating dinner, the 26-year-old suffered a seizure
and never regained consciousness. JAN GARAVAGLIA: Has a sudden arrest, unknown etiology,
unknown cause. NARRATOR: With no diagnosis, her death is shrouded in mystery. And Dr. G has little information with which to solve it.
We have no real history that she's got a family history. She'd been in foster care, and I'm not so sure how
much she knew about her family. NARRATOR: Jesse's husband fears that drug addiction, which she tried so hard to conquer, is to blame.
Now it's in Dr. G's hands to determine the true cause of death and bring a measure of peace
to her grieving husband. Dr. G attempts to extract the brain, but it's a risky operation.
Well, this is really difficult to get this brain out. She's been three days on a respirator brain dead,
and the brain has gotten very soft. It's starting to break down. I'm going to pulverize it.
NARRATOR: It takes a very steady hand. But after a few tense moments, she's able to pull it out intact.
I got it. NARRATOR: Now, she must dissect it as best she can, searching for any signs of a stroke.
This is interesting. NARRATOR: But after a thorough search, she finds no abnormalities whatsoever.
JAN GARAVAGLIA: And I didn't see anything in that brain that was unusual or that would have precipitated her death.
NARRATOR: So far, Jesse's killer is proving to be elusive. Now, she's hoping to track it down in the internal exam.
Dr. G performs the usual Y incision. Then she quickly homes in on a major organ,
whose failure could easily trigger a seizure, the heart. She's got a family history of heart disease.
Most likely, that has something to do with atherosclerosis. NARRATOR: Atherosclerosis, or the narrowing and hardening
of the arteries, is one of the leading causes of heart attacks. JAN GARAVAGLIA: 26 is pretty young,
but I've seen it before in young people of that age. So it is a possibility, particularly
if you use cocaine. NARRATOR: She methodically dissects the organ, searching for any visible abnormalities.
I'm looking at the thickness of the wall of the heart muscle. I certainly will look at the coronary arteries.
NARRATOR: But it doesn't take long to determine that Jesse's heart, like her brain,
was perfectly healthy. I don't really see anything that would indicate a chronic heart history from her family.
I don't see a lot of the chronic changes that I see with cocaine. That doesn't mean she would not have gotten it in the future.
But at 26, she did not have any heart disease. NARRATOR: With that possibility ruled out,
Dr. G seems further than ever from determining what cut down Jesse Davis in the prime of her life.
We've got the big two down, the brain and the heart, so we're running a little bit low on options.
NARRATOR: Now, she turns to the last major organ that could trigger a sudden lack of oxygen
and a seizure, the lungs. And as soon as she picks them up, she detects a problem.
They're kind of heavy and boggy, and I can see some hemorrhage on the surface. NARRATOR: Quickly, she digs deeper,
and it isn't long before her scalpel hits the jackpot. She's got these blood clots.
They look like little nubbins coming out of the blood vessels, kind of a dark purple, and you
can see kind of whitish strands through them. NARRATOR: These are multiple pulmonary thromboemboli,
blood clots in the lungs. It's an alarmingly common condition that strikes at least 650,000 Americans a year, most of whom
are elderly or immobilized after surgery. Typically, the clots originate in the legs
or pelvis, when the patient's blood starts coagulating too much. The cells that are in charge of clotting
in the blood, the platelets, start tacking onto each other and accumulating, and eventually they
form a large, soft, gooey mass. NARRATOR: Then, when it breaks loose, it travels through the cardiovascular system
until it gets stuck in the lungs. Well, what happens if you get a blood clot in the smaller
vessels of the lungs is the blood to get oxygen from the lungs can't get in. NARRATOR: The diminished access to oxygen
can cause shortness of breath, anxiety, and chest pain. That is, if the patient has any symptoms at all.
OMAR KAYALEH: Most of emboli can be asymptomatic. And not all of them are necessarily very evident,
even in the tests that we do. NARRATOR: This explains why doctors were unaware of Jesse's emboli.
JAN GARAVAGLIA: X-rays don't show blood clots very well. You're just not going to see them.
NARRATOR: But in autopsy, Dr. G is able to see dozens with her naked eye, peppered throughout the lungs.
JAN GARAVAGLIA: If you get enough of these or if you get big enough ones, it causes you to collapse from lack of oxygen.
So everything really fits with her. NARRATOR: The profuse clots trump all other possible causes of the seizure,
including a drug overdose. JAN GARAVAGLIA: Clearly, the sheer number of them is the reason why she collapsed and seized
and why her brain wasn't getting enough oxygen. And this is why she died. NARRATOR: Dr. G now has a definite cause of death.
But the discovery raises a new, baffling question. JAN GARAVAGLIA: A big piece of the puzzle that's missing
is why this young woman would have thromboemboli. NARRATOR: Unlike the classic victim,
Jesse was an active young woman. And from the way the clots have attached to the lungs,
Dr. G can tell they developed before her fatal collapse. This clearly predates her being just in the hospital.
So we really don't have anything that would put her at risk. NARRATOR: To fully explain her untimely death,
Dr. G must leave no stone unturned until she brings the true culprit to light. Coming up next, dead-ends and negative findings
plague the case. JAN GARAVAGLIA: She's not obese, doesn't have cancer that we know of.
NARRATOR: When "Dr. G, Medical Examiner" continues. [DRAMATIC MUSIC] Another physical autopsy comes to a close.
Three days ago, Jesse Davis seized and collapsed in front of her husband. Dr. G discovered deadly clots in her lungs.
But why this young woman fell victim remains inexplicable. Why would a 26-year-old have a risk factor for clotting?
NARRATOR: Now, she must look for the answers back at square one. As a next step, Dr. G reopens Jesse's original case file.
She pours through all the data, weighing each against every known cause of blood clots.
She's not obese, which is a risk factor. She doesn't have cancer, which is a risk factor.
She doesn't have a history of immobility prior to this hospitalization, like being
on a long airplane flight. That's a risk factor. NARRATOR: Dr. G also wonders if genetics played a role,
but as a foster child, Jesse's family history is tragically slim. Finally, she's left with only one option.
Go back to the man who knew Jesse better than anyone. JAN GARAVAGLIA: We may not have all of her history.
Maybe we'll come up once I talk to the husband why she would have these multiple
pulmonary thromboemboli. Hi, this is Dr. Garavaglia at the medical examiner's office.
NARRATOR: At first, it's appearing as if Aaron has no new information to offer. But then, he reveals two seemingly trivial facts,
with enormous implications. She's recently started birth control pill, and she smokes.
NARRATOR: For Dr. G, this new information breaks the case wide open. There is an association, although small,
between birth control pills and developing blood clots. NARRATOR: Normally, the human body
maintains a delicate balance between chemicals that promote clotting to heal wounds and chemicals that prevent
thrombosis or unwanted clots. JAN GARAVAGLIA: So the body has this beautiful balance,
and it has a way to regulate this internally. NARRATOR: But in less than 1% of women, for reasons yet unclear,
the hormones in oral contraceptives upset the chemical interaction. And smoking makes the problem worse
by constricting blood vessels and causing easy blockage. OMAR KAYALEH: If you're on oral contraceptives, and you smoke,
you are at increased risk of developing clots. NARRATOR: In Jesse's case, the odds
may have been stacked against her, if she was genetically prone to clots and never knew it.
JAN GARAVAGLIA: She developed them so quickly after taking the birth control pills.
So I really suspect that she has a hereditary predisposition for thrombosis. And, in fact, probably about 23% of women who get birth control
pills, who then develop these thrombi, have this predisposition. It's probably even much higher.
NARRATOR: Unfortunately, there's no way for Dr. G to prove that the pills directly caused the blood clots.
JAN GARAVAGLIA: We don't usually test for these hereditary thrombotic diseases, and there is nothing I can do to somehow correlate it
with the birth control pills. It's just that you put the pieces of the puzzle together.
NARRATOR: The pulmonary emboli, the oral contraceptives, the cigarettes, and the obscure family history.
Now, with accumulative evidence, Dr. G is confident she can say exactly what happened to Jesse Davis
on the night of her untimely death. At 26 years old, Jesse's life is in grave danger.
But it's not from her cocaine addiction or her family history of heart disease. It's from her new birth control pills.
JAN GARAVAGLIA: Probably when she starts taking these pills, the increased estrogen kind of throws off
that delicate balance your body has to dissolve the little blood clots that normally
form in our bloodstream. NARRATOR: Soon, clots begin to develop all over her pelvic vessels, and some begin a precarious journey
through her body. JAN GARAVAGLIA: Several of these are starting to break off and shower her lungs,
both sides, all lobes. NARRATOR: Unfortunately, like most who develop clots, she has no symptoms from these smaller ones,
until one night when a large one finally breaks loose. JAN GARAVAGLIA: Once that blood clot breaks off,
it travels very quickly, seconds, into your heart and then into your lung. NARRATOR: The embolus lodges firmly in one of her lungs,
completely blocking the blood flow. JAN GARAVAGLIA: And it just puts her over the edge.
She passes out and starts to seize. NARRATOR: No amount of CPR can fully resuscitate her.
JAN GARAVAGLIA: They're never really able to bring her brain back, which had already
died from lack of oxygen. NARRATOR: Three days later, without ever comprehending her fate, Jesse dies in her husband's arms.
While Dr. G can't say whether Jesse could have entirely prevented the clots, there's no question that quitting smoking
would have helped her odds. OMAR KAYALEH: Nobody really needs to be smoking, quite frankly.
But for those who do smoke, they need to realize that they are at risk for developing clots.
NARRATOR: And her genetic predisposition may have come to light with a blood test,
if only she'd known more about her family. JAN GARAVAGLIA: Unless she had the family history,
they probably wouldn't test you for it. It's a very small fraction of people that have it.
Otherwise, the pills should be very, very safe, and it shouldn't be a problem. She was just one of the unfortunate
ones that developed the clots. I guess you could say it's just the luck of the draw.
Some people are just unfortunate.

A train passenger behaves oddly en route to Arizona and then disappears. The next day his bloodied body is found in Texas. Dr. G attempts to piece together this bizarre tragedy.

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

Brief Summary

Dr. G investigates Victor Gust's train fall and Jesse Davis's sudden collapse, uncovering shocking medical truths about their deaths.

Key points

The Mysterious Fall of Victor Gust. An elderly man mysteriously falls from a train, leading to a baffling investigation.
A Shocking Discovery. Dr. G uncovers a significant infection that ultimately led to Victor's death.
The Heart Attack Mystery. Dr. G investigates whether a heart attack caused Victor's fall or was a result of it.
A Mysterious Collapse. Jesse Davis collapses while having dinner with her husband, leading to a desperate medical situation.
The Search for Answers. Dr. G investigates Jesse's death, uncovering a web of potential causes.
The Cause of Death Revealed. Dr. G discovers multiple blood clots in Jesse's lungs, explaining her sudden seizure and death.

Episode highlights

Episode quotes

What happened to Victor Gust on that train?

NARRATOR raises the mystery surrounding Victor's death.

4:46WatchJun 8, 2021

Tension

75/ 100High tension

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