Dr. G: Medical Examiner - Season 3, Episode 8 - Deadly Journey - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: A young woman is stricken with a sudden illness while on vacation in Orlando.
JAN GARAVAGLIA: Her chest hurt. She's actually coughing up some blood. NARRATOR: Within only hours, she dies in the hospital.
JAN GARAVAGLIA: She codes. And they don't have a cause of death. NARRATOR: But her killer shocks even Dr. G.
It is just something I probably will never see in the morgue again. NARRATOR: And then a hitchhiker turns up
dead in a deserted parking lot. And the only witness to her death could be the murderer.
Whenever I have a woman who is dead in the presence of a stranger, you know, I'm a little worried.
I don't know whether they need to arrest this guy or not. The sooner we figure out what happened to her,
the sooner the police can work on apprehending somebody. NARRATOR: Altered lives, baffling medical mysteries,
shocking revelations. These are the everyday cases of Dr. G, medical examiner. Orlando, Florida, is a popular vacation
destination for millions of Americans and many visitors from overseas. Unfortunately, not all of the trips to the Sunshine State
end happily. Each year in Orlando and Osceola counties alone, approximately 40 foreign tourists
die unexpectedly during their visit and will require an autopsy to determine the cause
and manner of their death. The final destination for these individuals is the District 9 morgue in downtown Orlando,
the Office of chief medical examiner Dr. Jan Garavaglia. Today, her first case is the death of a 32-year-old woman
named Maribel Simon, who had just arrived in Orlando from abroad when she died unexpectedly.
She's from Antigua. And she gets here and she's going to go out for breakfast with her family this morning.
But she starts getting really out of breath, sweating heavily, chest pain, and she's coughing up blood.
NARRATOR: According to the investigator's report, a seemingly healthy Maribel Simon arrived in the US
to visit her family in Orlando just two days ago. But shortly after her arrival, Maribel
begins feeling extremely sick. Alarmed, her family rushes her to the ER, where doctors fear
she may be suffering from a pulmonary embolism, a potentially fatal blood clot in the lungs' pulmonary artery.
They immediately take Maribel in for emergency diagnostic tests. Unfortunately, she doesn't even make it to the exam room.
JAN GARAVAGLIA: They were taking her in to do the test for a VQ scan. And that's one of the tests where they check to see
if she has pulmonary emboli. And as they were taking her into that test, they actually were taking off her oxygen mask,
and that's when she coded and died. NARRATOR: Maribel's death has left her family wheeling
with anguish and disbelief over the sudden loss of their loved one who was so far
away from home when she died. JAN GARAVAGLIA: That's scary. Because all of a sudden, you know,
their loved one, once they die, will be taken away from them. And they don't know where they're going.
They don't know what these people are like. NARRATOR: Hoping to find answers, Dr. G reviews the timeline and circumstances
of the young woman's death. She finds the onset of symptoms-- chest pain, coughing up blood, and difficulty
breathing-- consistent with a pulmonary embolism, making it a strong suspect in the case.
Moreover, as Dr. G reads through the case file, she discovers that Maribel also had
a key risk factor for developing a pulmonary embolism-- a protracted 12-hour airline flight
the day before her death. Some studies have linked air travel lasting over eight to 10 hours to an increased
risk of developing a pulmonary embolism. People who are immobile and aren't walking around,
they're not contracting their muscles, can develop thrombi in their vessels, the deep vessels of the leg, and they go into the thigh.
And these can break off then once to start getting mobile. And they can break off and then go to the lung.
And that's high on our list. So we'll have to see. I mean, her symptoms are good for a pulmonary embolism.
So I think, you know, maybe there's a good chance that's what it is. NARRATOR: Dr. G has not yet received
Maribel's medical records. But she has been in touch with Maribel's physician, who
is stunned by her sudden death. He reports that Maribel was a relatively healthy woman,
a non-smoker and non drinker. But he also discloses to Dr. G that, over the past few months,
Maribel had begun to take prescription steroids to treat lupus, a disease of the immune system,
which she had been diagnosed with several years ago. lupus is one of the classic autoimmune diseases.
Autoimmune is basically, your body starts forming antibodies against your own body.
NARRATOR: Maribel's lupus was apparently mild and managed effectively with medication.
JAN GARAVAGLIA: I talked to the doctor specifically, her rheumatologist. And she said her lupus seemed mild.
And we have to admit, I mean, lupus is something relatively uncommon we would see down here.
NARRATOR: Nevertheless, for Dr. G, the disclosure is vital. While lupus is rarely fatal, the drugs used to treat the disease
have significant and deadly risks, such as stomach ulcers and gastrointestinal bleeding.
Perhaps Maribel's symptoms were not from a pulmonary embolism after all, but fatal internal bleeding from steroids.
You know, it states that she's coughing up blood. There's blood in the mouth when she gets to the emergency room.
Occasionally, we see people who can't tell where that blood is coming from. And they're actually getting it from their GI tract.
So we'll have to see. What else did they say? NARRATOR: A pulmonary embolism, internal bleeding, steroids.
In this case, it will take a full autopsy to know for sure what cut Maribel Simon's life short, beginning with the external examination.
Dr. G examines Maribel's body. She notes right away that her lupus does seem mild,
as the doctor indicated. JAN GARAVAGLIA: I don't see any of the classic, you know,
findings of lupus. I don't see any-- you know, the discoid rash, the malar rash on the face.
NARRATOR: Approximately 30% to 50% of all patients with lupus develop a malar, or a butterfly rash across the face.
Oral ulcers are also a common complication of lupus. But Dr. G finds no sign of them either.
What she does discover, however, is that Maribel's lower extremities are swollen with edema, or fluid, which
can indicate a blood clot in the legs, the prelude to a pulmonary embolism. JAN GARAVAGLIA: We will often measure
the circumference of the leg. And classically, what we would see is, one leg maybe a little more edematous than the other,
because you tend to have it in maybe one than the other. When I do the external on her, we do see swelling.
It's bilateral. So maybe she does, maybe she doesn't. NARRATOR: Is the swelling a harbinger?
Did Maribel Simon die from a pulmonary embolism? The answer might lie in Dr. G's next stop,
Maribel's heart and lungs. That's what she was complaining of-- shortness of breath and chest pain.
NARRATOR: Dr. G and her staff are ready to begin the internal examination of 32-year-old Maribel Simon, who died
while on vacation in Orlando. JAN GARAVAGLIA: She came to visit family. She was going to hang out with some of her family members.
They were going to have fun down here. And she certainly didn't expect to die that morning.
NARRATOR: Dr. G opens Maribel's body with a Y incision. Her first step is to examine the organs
in situ, or in their natural position within the body. While it is suspected that Maribel died
from a pulmonary embolism, there is still a possibility that she succumbed to gastrointestinal bleeding
from therapeutic steroid use. Dr. G methodically searches for any signs of internal hemorrhage.
JAN GARAVAGLIA: Her GI track I look at. And her stomach's very dilated. But that's from the resuscitation.
It's mostly air. But I really don't see anything like an ulcer or anything along that line.
NARRATOR: Dr. G finds nothing suspicious in the abdomen. At this point, she does not believe that Maribel died
from gastrointestinal bleeding. Next, she needs to examine the respiratory organs.
One of the things I'm going to look at very, you know, closely is going to be her heart and lungs.
Because that's what she was complaining of-- shortness of breath and chest pain.
So is it the heart? Is it the lung? I'm not sure? NARRATOR: Dr. G opens the chest cavity
and gets her first look at the lungs. What she sees takes her aback. Maribel's lungs are very diseased.
What I see is some dilated large vessels and some little bit of hemorrhage. NARRATOR: The delicate pulmonary tissue is ravaged.
But why? JAN GARAVAGLIA: It's unclear what I'm seeing in the lung. The lungs don't look completely normal.
But they don't look infectious either. NARRATOR: A pulmonary embolism may explain part of the damage
to the lung tissue. But as Dr. G searches for a clot, she comes to a shocking realization.
I open the pulmonary artery and I don't see any pulmonary embolism. It's not a pulmonary embolism that killed her.
NARRATOR: The seemingly straightforward case of Maribel Simon has suddenly become a conundrum.
And when she examines Maribel's heart, the death investigation becomes even more mysterious.
JAN GARAVAGLIA: Something else is odd, in that her right side of her heart is very thickened and somewhat dilated.
So she's got right ventricular hypertrophy. That's odd. NARRATOR: Right ventricular hypertrophy
is a heart condition in which the right side of the heart is abnormally large and dilated.
Certain lung diseases can cause right ventricular hypertrophy, such as chronic obstructive pulmonary disease
and emphysema. But according to Maribel's physician, she did not have any of these lung disorders,
which leaves Dr. G perplexed. JAN GARAVAGLIA: Something's going on in her lungs.
And I'm not quite sure. I can't tell what it is until I look under the microscope.
So I take a lot of samples, biopsies of that lung, to see what's going on. NARRATOR: As Dr. G finishes examining Maribel's
internal organs and collecting tissue samples, findings continue to baffle. Some organs, such as Maribel's brain and pancreas,
appear normal. I certainly don't see meningitis. I don't see a stroke. I don't see bleed.
NARRATOR: Others, such as her spleen and kidneys in particular-- are quite diseased.
JAN GARAVAGLIA: I look at her kidneys. They were very scarred. And so I need to look at those under the microscope too.
NARRATOR: At the end of the autopsy, Dr. G is left with many findings, but few explanations.
Well, the end of the autopsy externally and internally, and reviewing her medical history with her doctor,
it's unclear why she died. I'm going to have to pend it until I look at the microscope at her tissues to be able to figure
out what's going on. NARRATOR: In this case, microscopic examination of tissue samples may be key.
But the slides will take several days to prepare. And when they do finally arrive, Dr. G is in for a shock.
It is just something I probably will never see in the morgue again. NARRATOR: Several days after the autopsy of 32-year-old Maribel
Simon, arrangements for the transport of her body to her family in the Caribbean are finalized,
and it is released from the morgue. JAN GARAVAGLIA: Most people who die here who are foreign nationals do not want to be buried here.
They want to go back to where they came from. Their loved ones want to take them
back to their home country. NARRATOR: Later that day, Dr. G receives the slide she has been waiting for,
the samples of Maribel's damaged internal organs. I think the microscopic examination is
going to be key in this case. NARRATOR: First, Dr. G examines the lung tissue samples under the microscope.
And what she sees astonishes her. There's something in her vessels there. NARRATOR: Maribel's lung tissue is hemorrhaged.
In addition, the blood vessels in her lungs are inflamed and narrowed, a condition known as vasculitis.
So when I look in the microscope, I look, and I do see signs that she has vasculitis, inflammation of the vessels,
narrowing of the vessels. NARRATOR: It is an indication of a very rare lung disorder
called pulmonary hypertension, a condition in which narrowed pulmonary blood vessels lead to dangerous increased
blood pressure in the lungs. This, over time, can severely damage the heart. The pressures are too great for the blood to get
through those little narrowing. And so the more peripheral, the bigger vessels dilate, and then
the heart has to start pumping harder, and that's why that thickens. So the reason her heart was thick
is because the vessels in her lung were narrowed, associated with pulmonary hypertension.
NARRATOR: But when Dr. G examines additional slides, she discovers that Maribel's lungs aren't the only organs
damaged by vasculitis. JAN GARAVAGLIA: She has it in her kidneys. She has it in her spleen.
When I looked through my microscope, it all made sense. All the pieces fit together-- her shortness of breath,
her coughing up blood. All of those things made sense. She's dying from the pulmonary complications of lupus.
NARRATOR: Maribel's lupus wasn't mild, as her doctor described. In her case, it was fatal.
She has the gamut of what you can have with pulmonary lupus, lupus in her lungs.
And that's why she died. She couldn't breathe. NARRATOR: Lupus is a complex and little
understood autoimmune disease that can cause the immune system to attack virtually
any organ in the body. ELLEN GINZLER: Lupus is a disease that primarily affects women of childbearing age.
We believe that lupus develops because of abnormalities of the immune system. JAN GARAVAGLIA: Basically, your body
is starting to see certain cells of your body as foreign. And then you get a whole myriad of problems.
NARRATOR: In Maribel's case, the disease attacked the blood vessels in her lungs
and other internal organs, leading to rare but deadly lung complications. JAN GARAVAGLIA: You know, it's rare to die acutely from lupus.
But if you do get the pulmonary hemorrhage and some of her manifestations, it is known you
can die rather quickly from it. It is just something I probably will never see in the morgue
again. NARRATOR: The findings are shocking. But Dr. G Finally knows what caused Maribel's
sudden and unusual death-- pulmonary complications from lupus. She records her conclusions in the case file
and describes the events that led to this young woman's rare death caused by a usually
manageable disease. Several years earlier, 32-year-old Maribel Simon is diagnosed with the autoimmune disease lupus.
Her symptoms-- skin rashes and joint discomfort-- seem to be mild and are managed effectively
with a prescription steroid. JAN GARAVAGLIA: She was on appropriate treatment. And she wasn't having any symptomatology that
would suggest otherwise that she had to have even more treatment, even more immunosuppressive.
NARRATOR: But Maribel's mild external symptoms are just the tip of an extremely dangerous iceberg.
As Dr. G discovered at autopsy, Maribel's lupus caused widespread vasculitis, narrowed
and inflamed blood vessels in her kidneys, spleen, and lungs. The symptoms that she had probably
developed very gradually. And probably, she did not realize how seriously involved her lupus was.
NARRATOR: Over time, the narrowed blood vessels in her lungs result in pulmonary hypertension,
or high blood pressure in the lungs, which, in turn, leads to damage to the right side of her heart.
It was kind of below the radar. Her disease in her lungs was kind of below the radar
until it just kind of went over the edge. NARRATOR: For Maribel, that critical point
occurs on the first day of her vacation in Orlando. That morning, as her strained heart pumps blood
into her lungs, the lung tissue begins to hemorrhage, and the blood seeps into the air passages of the lungs.
Why, all of a sudden, they get the hemorrhage into the lung is really unknown. But clearly, she wouldn't have these changes
if not for her lupus. NARRATOR: As her lungs hemorrhage, Maribel becomes short of breath.
She then begins to cough up the blood collecting in her airways. At the hospital, doctors recognize that the right side
of her heart is enlarged. But they misdiagnosed the cause. They could see she had right ventricular
hypertrophy on the EKG. They just didn't know the cause. They thought maybe you had to do with her thrombi in her lungs.
NARRATOR: But on the way to test for a potential pulmonary embolism, Maribel's heart suddenly gives out
and she dies. JAN GARAVAGLIA: She basically can't oxygenate. She can't breathe. And she never recovers.
NARRATOR: When they receive the explanation of her death, Maribel's family is bewildered, but grateful that the autopsy
yielded answers. Dr. G, too, is relieved to know that her conclusions provided a measure of help.
You know, the beauty of being in the morgue is, it's really interesting when we have,
you know, some of these interesting diseases come through, and you can use some of the skills you learned as a pathologist to diagnose things.
NARRATOR: Death from lupus is extremely rare and a surprise for any pathologist.
But the possibility of foul play is something Dr. G faces everyday in the morgue.
And this is the question she must grapple with in her very next case, the death of a 35-year-old woman
who was hitchhiking. JAN GARAVAGLIA: There's a lot of possibilities. And I am afraid that foul play is right up there.
NARRATOR: Dr. G opens the next file on her docket. It is the death of a 35-year-old woman named Carla Brooke.
She was last seen alive yesterday afternoon, hitchhiking. OK, well, we have a 35-year-old woman here.
And this should be interesting. Because it's kind of odd circumstances. NARRATOR: According to the investigators report,
Carla was in Auburndale, a city on the outskirts of Orlando, when she hitched a ride in the late afternoon.
JAN GARAVAGLIA: She gets a ride from a stranger, which you like to do when you hitchhike.
Things were going OK, but he takes her to an abandoned parking lot. NARRATOR: At 5:22 PM, paramedics receive a 911
dispatch to the secluded lot. There, on the ground, next to a van, they find Carla unconscious and unresponsive.
The van's owner identifies himself as Jack Brady. He tells paramedics he only just met Carla an hour ago.
She was perfectly fine when he picked her up. NARRATOR: But a few minutes after she gets in his car,
they pull off the road into a secluded parking lot. He claims that nothing really happened.
They just had a drink from the back of the van. NARRATOR: But then, according to Brady, Carla begins to shiver.
It's chilly out here. NARRATOR: And suddenly, to his horror, she vomits and collapses.
He calls the ambulance right away. And we know she's still alive somewhat. Because they had a pulse and blood pressure.
NARRATOR: The paramedics immediately head for the hospital. But while en route, Carla goes into cardiac arrest.
They try to keep resuscitating her. NARRATOR: Unfortunately, their efforts are in vain.
JAN GARAVAGLIA: She's pretty much dead by the time they get there. NARRATOR: When medical investigators finally
track down Carla's estranged family, they are shocked to hear of her sudden death.
According to them, Carla was always energetic and enjoyed good health. But she also had a rebellious nature.
Sadly, she had left home more than eight years earlier, sharing little about her life on the road.
But they suspect it wasn't easy. Now, we contacted her family, and they say she does have a possible promiscuous career
and that she may do drugs. NARRATOR: Now, given this background information, police must consider the worst case scenario.
Could Carla have been the victim of a homicide? Number one, as usual, I'm always worried about foul play.
I have to be suspicious of everyone. You know, let's call it what it is. She's probably a prostitute hitchhiking a ride
with somebody, and they stop at a deserted parking lot for, quote, a drink. You know, bad things can happen.
I mean, I don't know if we can buy this guy's story or not. NARRATOR: Dr. G also wonders if the alleged
drink could have included something more than just alcohol. Maybe they were doing drugs.
Maybe it's a drug overdose. NARRATOR: Stimulants such as cocaine and methamphetamine
can trigger high blood pressure, irregular heartbeats, and sudden death. JAN GARAVAGLIA: They could be doing
coke in the back of that van and she died from an overdose. You know, that could give the shaking
and the vomiting at the end. I don't know. NARRATOR: Perhaps Brady had only called
911 to throw off suspicion. She's not breathing. What should I do? NARRATOR: It's also possible that his claims are true,
and Carla's fate involved no foul play at all. Maybe it's a natural disease. I'm not really sure.
NARRATOR: But as far as Carla's family knows, she had a clean medical history. The family doesn't think that there's anything wrong with her
that they know of. NARRATOR: And the symptoms Brady describes are too vague to pinpoint an illness.
Vomiting internally, I mean, that could just be just nonspecific anything. Was it a seizure?
Was it chills? Was there pain? I don't know. NARRATOR: With no eyewitnesses, it's now up to Dr. G
to unravel the truth, holding Brady's story up against the forensic evidence. Do we take what he says at face value?
Of course not. That's why we do the autopsy. The sooner we figure out what happened to her,
the sooner the police can work on apprehending somebody, if need be. NARRATOR: Dr. G begins the external exam, searching
for signs of a fatal attack. So now we're going to look and make sure that nothing happened to her,
that he could have done something to her. But we'll also be looking for definitely natural disease.
NARRATOR: But as with many decedents, Carla's body initially reveals less about her death
and more about how she lived. Probably looks a little older than her stated age of 35.
Kind of looks like a hard life. NARRATOR: She gets another glimpse of that hard life
on Carla's arms. She's certainly got needle puncture marks in her arms. She's got vascular scars where she's
shot up, obviously, before, and a fresh needle puncture mark. NARRATOR: The scars confirm her illicit drug use.
She could have been shooting up drugs before she met him. Or they could have done this together.
NARRATOR: But whether or not narcotics played a part in her death will have to wait
until the toxicology report. For now, Dr. G must set aside this possibility and return to her foremost concern.
Was this a homicide? What were they doing in an abandoned parking lot? Why did she want to stop there?
She's in this a promiscuous career. You know, did he strangle her and kill her? Did he-- you know, did he get mad at her for some reason?
Did he try to rob her? Did he hit her over the head? NARRATOR: Now, Dr. G intensifies her search
for wounds on Carla's body. I'm looking at any evidence of trauma to the hands, like she'd maybe been fighting somebody off.
NARRATOR: With no obvious ones in sight, she methodically looks for subtle clues,
starting at the head. She's got a nice full, thick head of hair. So it's very difficult.
NARRATOR: She palpates the skull for bumps, cuts, underlying fractures, and finds no external indications
of trauma. But it's far too early to rule it out. We're going to have to wait until we open her up
to see if there's any internal trauma to her head. NARRATOR: As a next step, Dr. G turns to Carla's neck,
looking for any evidence of strangulation. If I find a woman dead, and there's no evidence externally,
like a beating or a stab wound, we would be worried about strangulation. NARRATOR: Dr. G carefully begins to inspect
the neck of 35-year-old Carla Brooke, searching for any signs of strangulation. JAN GARAVAGLIA: Very congested neck.
There's a lot of possibilities. And I am afraid that foul play is right up there.
And that certainly has to be ruled out. NARRATOR: And sure enough, as Dr. G examines Carla's neck,
she notices an abnormality. I saw distended neck vasculature. You can see the external jugulars
very prominently on her. NARRATOR: But the distended vessels are not a typical sign
of strangulation. They're a symptom often associated with heart failure. You know, a lot of times, you'll see distended neck
veins with heart failure. Because your heart's not pumping. The blood's returning.
And it kind of starts building up pressure, because it's not all pumping out of that heart.
Most heart attack victims are 50 years or older. But a history of drug use can greatly alter this age.
Yeah, I've certainly had 35-year-olds-- particularly 35-year-olds that use crack cocaine--
you can accelerate atherosclerosis in even young women. NARRATOR: Atherosclerosis, or the hardening of arteries,
is an underlying factor in nearly 3/4 of all heart-related deaths in the US, killing more than 66,000 Americans each year.
Now, Dr. G wonders if Carla's long-term drug abuse might have caused her to develop atherosclerosis,
which often paves the way for a deadly heart attack. Her neck certainly looked like a typical heart attack.
NARRATOR: A heart attack can also trigger nausea and vomiting, which would corroborate Brady's story.
But to completely rule out foul play or a lethal overdose, she must find more hard evidence in the internal exam.
Once I start hitting bone or hit anything metal, it ruins the scalpel, and I've got to get a new one.
NARRATOR: Dr. G makes the standard Y incision. While removing the skin and subcutaneous fat,
she keeps an eye out for any hint of violence. I'm looking for hemorrhage underneath the skin,
subtle signs of pressure or trauma. I don't see any. NARRATOR: Next, she turns to the internal organs,
looking for clues. I don't see any trauma inside the chest cavity or the abdominal cavity.
Everything looks fine. OK, Arden, just get in-- NARRATOR: With her technician's help,
she begins to remove the organs one by one for closer inspection. And almost immediately, she discovers
a striking abnormality in a pair of organs. JAN GARAVAGLIA: Black lung. These are going to be heavy.
675. She has very heavy lungs-- very heavy, wet lungs. NARRATOR: Wet lungs or pulmonary edema
can have several different causes, including prolonged resuscitation, a coma, and problems
with the nervous system and brain. But given Carla's autopsy findings so far, Dr. G suspects two other reasons.
Pulmonary edema can be a subtle sign of drug overdose. We can see it also in congestive heart failure.
NARRATOR: At this point, both are strong possibilities. Since we have extra, here's how we'll do it.
Put some in there. Fill that up. And give me another one. NARRATOR: First, to test for an overdose,
she takes samples of Carla's blood for a full toxicology screen. She will get the results in a few weeks.
Certainly, one of the things I am going to be very interested in is the stimulants-- the cocaine, methamphetamine,
things along that line. Because those can kill you rather suddenly. NARRATOR: Next, she turns her attention to the heart.
If Carla had premature atherosclerosis that triggered a heart attack, Dr. G should be able to find
the blocked arteries. Right off the bat, she notes a slight abnormality in its size.
375 for the heart. So it is a little bit large, as if she had high blood pressure.
NARRATOR: But it does not appear enlarged enough to have caused her death. She proceeds with the full dissection,
slicing the heart to inspect the cross-section of each main artery. And before long, she finds her answer.
JAN GARAVAGLIA: I don't see any natural disease that certainly would kill her. Her heart looked fine.
NARRATOR: It's clear. Carla did not die of heart disease. Now, Dr. G wonders if narcotics could be behind her death
after all. I'm thinking it's probably not foul play at this point. I'm not seeing any trauma.
I see these heavy lung. It's looking like maybe this is going to be a drug overdose.
NARRATOR: But the autopsy is not over. Before she can make the final call, Dr. G must completely eliminate foul play
as the cause of death. That means searching one last place for trauma-- inside Carla's head.
She's got a big head of hair. So what we're going to do is, we do an incision from basically
the back of your ear to the back of your ear and reflect off your scalp from your calvaria, your skull.
NARRATOR: Dr. G reflects the scalp, looking for injuries on the skin and bone beneath.
On the calvarium, the top of the skull, I don't see any fractures. We don't see any bruising on the inside
of the scalp, which is, you know, making trauma a little less likely. NARRATOR: But then she digs deeper,
lifting off the calvarium to expose the brain. And there, she makes a shocking discovery.
She's got blood. NARRATOR: Captured in the membrane around the organ is a pool of excess blood.
And I see blood coming up at the base of the brain up to the sides, along the sides of the brain.
So she's definitely bleeding inside her cranial cavity. NARRATOR: The question is, what is causing the bleeding?
She's got trauma to the head. Where did this trauma come from? NARRATOR: Dr. G carefully removes Carla's brain
to find out what caused the heavy bleeding inside the cranial cavity. I'm a little worried that she might have some head
trauma, maybe a blow far down. NARRATOR: First, the collected blood is carefully washed away.
So I take very gently a stream of water and try to take out all the loose blood.
Because I need to get down to where those vessels are. Let's clear some of this blood off.
NARRATOR: Slowly, the area clears up. And there at last, Dr. G finds what caused the bleeding.
And it's not trauma. Instead, on a vessel near the main circular artery in the brainstem, she discovers an aneurysm,
or abnormal outpocketing. JAN GARAVAGLIA: It's like a little tiny berry sitting atop the vessel.
They call them berry aneurysms because they look like a little berry sitting there.
NARRATOR: Berry aneurysms often occur when high blood pressure pushes against a weak spot
in a blood vessel. The force creates a kind of balloon, ranging in size from a few millimeters
to over two centimeters in diameter. Carla's is small, only about three millimeters wide.
It's probably a congenital weakness that, over time, with the high blood pressure, causes
that little outpocketing. NARRATOR: This type of brain aneurysm often stays dormant, growing throughout a person's lifetime,
but never bursting. A lot of people have them and don't know it. NARRATOR: But it's clear to Dr. G that Carla's has ruptured.
It doesn't have a lid anymore. You could see the top had blown off of it. NARRATOR: Unfortunately, aneurysms
typically rupture quickly, the warning signs coming too late. They'll just leak a little bit and you'll get a really bad
headache, like the worst headache of your life, or a headache like somebody just hit
you on the back of the head. NARRATOR: This headache is caused by the leaking blood,
which irritates the brain. When the aneurysm ruptures, the blood suddenly rushes out, putting pressure on the brainstem.
And the brainstem, of course, is where the cardiac and respiratory functions are.
And you can cause that to stop. And that's what caused her to die rather quickly.
The mortality rate's very high. A good 10% to 15% don't even make it to the hospital.
NARRATOR: But one question remains. What, if anything, could have caused this often dormant
aneurysm to suddenly explode? When the toxicology report comes back, Dr. G notices something that could have contributed
to Carla's tragic death. We found the byproduct of cocaine. Probably, she used that cocaine within that day
or maybe the day before. I mean, she's certainly got needle puncture marks in her arms.
And so maybe she's shooting up cocaine. NARRATOR: The trace amounts prove Carla did not die from an overdose.
Instead, Dr. G suspects that chronic cocaine use had given Carla high blood pressure, as seen
in the condition of her heart. And the resulting high blood pressure had put her at risk
for the aneurysm to burst. Any kind of stress-- sometimes, people-- we see people die suddenly with berry aneurysms that are
in fights, because the stress of the fight causes their blood pressure to go up.
NARRATOR: In Carla's case, Dr. G believes that a natural defect in the vessel combined with her hypertension
created the perfect setup. Maybe part of that vessel that just form quite right.
And that's prone to the effects of your blood pressure on it to cause it to eventually weaken.
NARRATOR: Now, with all the pieces of the puzzle in place, Dr. G can finally explain what happened to Carla Brooke
on the day of her untimely death. Carla left home eight years ago. According to her family, soon after,
she developed a drug habit and a promiscuous lifestyle. Then, one day, she hitches a ride with a total stranger.
JAN GARAVAGLIA: They go to an abandoned parking lot. He offers her a drink from the back of the van.
Thank you, baby. You're welcome. NARRATOR: But this stranger does not attack her.
Instead, another fatal blow is about to strike. She had a little ticking time bomb in the space of her brain
that she didn't know about, which was a little outpocketing in the blood vessel at the base of the brain that was stretching.
NARRATOR: The wall of this aneurysm, or outpocketing, has been expanding for months, perhaps even
years, made worse by her high blood pressure, brought on by cocaine use. A lot of times, when we see ruptured berry aneurysms,
they might be doing something to cause their blood pressure go up. And cocaine is certainly one that causes
your blood pressure go up. NARRATOR: Now, as Carla sips on a beer in an abandoned parking
lot, the wall of that vessel comes closer and closer to giving way, until finally, it explodes.
JAN GARAVAGLIA: It couldn't hold the blood in anymore. It bleeds very fast. NARRATOR: Pressure quickly builds on her brainstem,
interrupting signals between the brain and vital organs. As a result, her heart and lungs begin to fail.
JAN GARAVAGLIA: She gets very sick. She probably started seizing a little bit. And then the terminal vomiting.
So it really does all fit to what he said. NARRATOR: Then suddenly, Carla collapses.
Uh, a friend of mine just collapsed. We were just having some fun. NARRATOR: Shocked, the driver calls 911.
But it's too late. By the time paramedics arrive, she's unconscious and soon goes
into cardiac arrest. JAN GARAVAGLIA: They try to resuscitate her, but she dies. NARRATOR: Despite the traces of cocaine in Carla's system,
Dr. G files the case as a natural death. We're going to go ahead and call this a natural.
Because you don't need cocaine to get these. You can-- anybody can have these, little outpocketings.
And they felt-- like, you know, the actual defect is probably congenital. She certainly didn't choose to die this way.
But unfortunately, it was very bad luck. Well, I think that helps the family, that they don't--
they're not worried that something happened to her, some foul play. It was just an unfortunate incident.
Sometimes, you know, your number's up, your number's up. And I-- there's-- I don't know what you can say about that.
ANNOUNCER: Atlas.

Dr. G reviews a woman's medical records and learns that that she suffered from an auto-immune disease called lupus, which might have something to do with her death.

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

Brief Summary

Dr. G investigates the sudden deaths of Maribel Simon and Carla Brooke, revealing lupus complications and a ruptured aneurysm as causes.

Key points

A Mysterious Death in Orlando. A young woman dies unexpectedly while on vacation, leaving her family in shock.
The Shocking Cause of Death. Dr. G uncovers a rare lung disorder linked to Maribel's lupus, revealing the true cause of her death.
The Mystery of Carla's Death. Dr. G investigates the circumstances surrounding Carla's death, uncovering a tragic combination of factors.

Episode highlights

Episode quotes

It is just something I probably will never see in the morgue again.

Dr. G reacts to the unique nature of Maribel's case.

0:32WatchJun 8, 2021

Tension

75/ 100High tension

More from True Crime Files

Solve the Crime

Read a real case one clue at a time, then see how your call held up against the investigators.